Anda di halaman 1dari 6

MARIANO MARCOS STATE UNIVERSITY

COLLEGE OF HEALTH SCIENCES


Department of Nursing
Batac, Ilocos Norte

NEUROGENIC BLADDER
DYSFUNCTION

SUBMITTED BY:
Valencia, Lemer Jhon E.
BSN 3-A

SUBMITTED TO:
Ma'am Jessahlyn Ragonjan
CLINICAL INSTRUCTOR

NOVEMBER 27, 2017


I.BRIEF DESCRIPTION
 Neurogenic bladder is a problem in which a person lacks bladder control due to a brain,
spinal cord, or nerve condition.
 Simply referred to as neurogenic bladder, is a dysfunction of the urinary bladder due to
disease of the central nervous system or peripheral nerves involved in the control of
micturition (urination). Neurogenic bladder usually causes difficulty or full inability to pass
urine without use of a catheter or other method due to neurologic dysfunction emanating
from internal or external trauma, disease, or injury.
 TYPES:
1. flaccid (hypotonic) neurogenic bladder-volume is large, pressure is low, and
contractions are absent. It may result from peripheral nerve damage or spinal cord
damage at the S2 to S4 level.
2. Spastic bladder- volume is typically normal or small, and involuntary contractions
occur. It usually results from brain damage or spinal cord damage above T12. Precise
symptoms vary by site and severity of the lesion. Bladder contraction and external
urinary sphincter relaxation are typically uncoordinated (detrusor-sphincter
dyssynergia).
3. Mixed patterns (flaccid and spastic bladder)-may be caused by many disorders,
including syphilis, diabetes mellitus, brain or spinal cord tumors, stroke, ruptured
intervertebral disk, and demyelinating or degenerative disorders
(Major types:)
4. Uninhibited neurogenic bladder-Caused primarily by lesions in the corticoregulatory
tracts.
5. Sensory paralytic bladder-Results from an interruption in the lateral spinal tracts
6. Motor paralytic bladder-Caused by lesions in the motor outflow from sacral vertebrae
2-4.
7. Autonomous neurogenic bladder-Occurs following destruction of all nerve
connections between the bladder and the CNS at S2, S3, or S4.
8. Reflex neurogenic bladder-Caused by transaction of the spinal cord above the sacral
segments.
II. PATHOPHYSIOLOGY
If a problem occurs within the nervous system, the entire voiding cycle is affected. Any part of the
nervous system may be affected, including the brain, pons, spinal cord, sacral cord, and peripheral
nerves. A dysfunctional voiding condition results in different symptoms, ranging from acute
urinary retention to an overactive bladder or to a combination of both.
Urinary incontinence results from a dysfunction of the bladder, the sphincter, or both. Overactive
bladder is associated with the symptoms of urge incontinence, while sphincter underactivity
(decreased resistance) results in symptomatic stress incontinence. A combination of detrusor
overactivity and sphincter underactivity may result in mixed symptoms.
III.RISK FACTORS
Nerve messages go back and forth between the brain and the muscles that control bladder
emptying. If these nerves are damaged by illness or injury, the muscles may not be able to tighten
or relax at the right time.
Disorders of the central nervous system commonly cause neurogenic bladder. These can include:
 Alzheimer disease
 Birth defects of the spinal cord, such as spina bifida
 Brain or spinal cord tumors
 Cerebral palsy
 Encephalitis
 Learning disabilities such as attention deficit hyperactivity disorder (ADHD)
 Multiple sclerosis (MS)
 Parkinson disease
 Spinal cord injury
 Stroke
Damage or disorders of the nerves that supply the bladder can also cause this condition. These can
include:
 Nerve damage (neuropathy)
 Nerve damage due to long-term, heavy alcohol use
 Nerve damage due to long-term diabetes
 Vitamin B12 deficiency
 Nerve damage from syphilis
 Nerve damage due to pelvic surgery
 Nerve damage from a herniated disk or spinal canal stenosis
IV. MANIFESTATIONS
-The symptoms depend on the cause. They often include symptoms of urinary
incontinence.
*Symptoms of overactive bladder may include:
 Having to urinate too often in small amounts
 Problems emptying all the urine from the bladder
 Loss of bladder control
*Symptoms of underactive bladder may include:
 Full bladder and possibly urine leakage
 Inability to tell when the bladder is full
 Problems starting to urinate or emptying all the urine from the bladder (urinary retention)
V. MEDICAL MANAGEMENT
A. DIAGNOSTIC PROCEDURES
 Postvoid residual volume
 Renal ultrasonography- done to detect hydronephrosis
 Serum creatinine- measured to assess renal function.
 Cystography-is used to evaluate bladder capacity and detect ureteral reflux.
 Cystoscopy-is used to evaluate duration and severity of retention (by detecting bladder
trabeculations) and to check for bladder outlet obstruction.
 Cystometrography-can determine whether bladder volume and pressure are high or low;
if done during the recovery phase of flaccid bladder after spinal cord injury, it can help
evaluate detrusor functional capacity and predict rehabilitation prospects (see Testing).
 Urodynamic testing-of voiding flow rates with sphincter electromyography can show
whether bladder contraction and sphincter relaxation are coordinated.
VI. TREATMENT
 Exercises to strengthen your pelvic floor muscles (Kegel exercises)
 Keeping a diary of the time of urination, the amount urinated, and if there is leaked urine.
This may help learn when one should empty the bladder and when it may be best to be near
a bathroom.
 Bladder training program
-With or withut intermittent catheterization.
- For flaccid bladder, especially if the cause is an acute spinal cord injury, immediate
continuous or intermittent catheterization is needed. Intermittent self-catheterization is
preferable to indwelling urethral catheterization, which has a high risk of recurrent UTIs
and, in men, a high risk of urethritis, periurethritis, prostatic abscesses, and urethral fistulas.
Suprapubic catheterization may be used if patients cannot self-catheterize.
 Pharmacologic Management
 Antipasmodic and Anticholinergics
-Given to relieve uninhibited or reflex bladder contractions
 Bethanecol Chloride
-Helps stimulate an atonic bladder.
 Surgical management
a) External Sphincterotomy-The excision/ resection of a sphincter.
b) Rhizotomy-Surgical division of a root, especially that of nerve.
c) Urinary Diversion-May be perfprmed if external sphincterotomy and rhizotomy fails.
o Ureterosigmoidostomy-The surgical implantation of a ureter into the sigmoid
colon
o Ileal conduit-A surgically constructed passageway for urine in which a section of
the Ileum is separated from the rest of the bowel and one end is closed, the 2 ureters
are attache to this segment which serves as a bladder; The unclosed end is brought
to the surface of the abdominal wall in a stoma where the urine is collected in a
special bag.
o Cutaneous ureterostomy- Transplantation of the ureter to the skin in the iliac
region.
o Nephrostomy-A surgically established fistula from the pelvis of the kidney to the
body surface.
VII. NURSING CARE PLAN

 Nursing diagnosis: Impaired Urinary Elimination related to decreased bladder capacity as


manifested by loss of bladder control.

INTERVENTION RATIONALE
Encourage adequate fluid intake (2–4 L per Sufficient hydration promotes urinary output
day), avoiding caffeine and use of aspartame, and aids in preventing infection. Note: When
and limiting intake during late evening and at patient is taking sulfa drugs, sufficient fluids
bedtime. Recommend use of cranberry are necessary to ensure adequate excretion of
juice/vitamin C. drug, reducing risk of cumulative effects.
Note: Aspartame, a sugar substitute (e.g.,
Nutrasweet), may cause bladder irritation
leading to bladder dysfunction.
Promote continued mobility. This decreases risk of developing UTI.
Cleanse perineal area and keep dry. Provide Proper perineal hygiene decreases risk of skin
catheter care as appropriate. irritation or breakdown and development of
ascending infection.
Teach Kegel exercises. These exercises improve pelvic floor muscle
tone and urethrovesical junction sphincter
tone.
Educate patient about the importance of These chemicals are known to be bladder
limiting intake of alcohol and caffeine. irritants. They can increase detrusor
overactivity.