Bladder

Question 1

what is the process of bladder fx?

Answer 1

micturition

Question 2

what muscle controls micturition?

Answer 2

detrusor muscle

Question 3

what are structure of micturition?

Answer 3

Kidneys
Ureters
Bladder
Urethra

Question 4

what does normal bladder fx depend on?

Answer 4

neurological control of the detrusor (smooth), External sphincter (striated), and Periurethral (striated) pelvic floor muscles

Question 5

what types of innervation does the bladder have?

Answer 5

autonomic and somatic innervation

Question 6

where are motor neurons for detrusor muscle located?

Answer 6

sacral spine- S2- S4 segments

Question 7

what happens once the bladder is full?

Answer 7

sensation of fullness is transmitted to the spinal cord and then to the cerebral cortex- conscious inhibition of the micturition reflex

Question 8

what does overfilling of the bladder cause?

Answer 8

urine reflux (back up into kidneys)

Question 9

what occurs during urination?

Answer 9

detrusor muscle contracts and the internal and external sphincter muscles open to allow urine to pass

Question 10

how does bladder control work for children?

Answer 10

micturition is reflexive and as children learn bladder control, it becomes a voluntary function

Question 11

what occurs during urine retention?

Answer 11

kidneys function normally, but bladder retains
Potential for bladder infection
can be dangerous

Question 12

what is Urethral Obstruction?

Answer 12

stricture or closing/blocking of urethra can lead to bladder retention

Question 13

who is urethral obstruction common for?

Answer 13

elderly people

Question 14

what can cause urethral obstruction?

Answer 14

prostate enlargement, tumor, congenital narrowing, scar tissue from injury or infection, also constipation and fecal impaction

Question 15

what is stress incontinence?

Answer 15

involuntary loss of urine with local stress/pressure

Question 16

what can cause stress incontinence?

Answer 16

hyper mobility and displacement of urethra during exertion

Weakness pelvic floor mm

During laughing or sneezing changing internal pressure within body

Question 17

what is urge incontinence?

Answer 17

involuntary loss of urine associated with strong desire to void
Often involuntary and hyper reflexive detrusor

Question 18

who does urge incontinence happen to?

Answer 18

people with neurological bladder dysfx, can also occur in ppl with no neurological dysfx

Question 19

how do you tx urge incontinence?

Answer 19

bedside commode

Question 20

what is overflow incontinence?

Answer 20

involuntary loss of urine when intra vesicular pressure exceeds maximal urethral pressure, absence of detrusor activity

can occur with retention- small amounts or urine are passed

Question 21

wha does overflow incontinence cause?

Answer 21

bladder distension with absence of detrusor mm activity

Question 22

what does overflow incontinence often occur with?

Answer 22

obstruction of bladder neck

Question 23

what causes Neurogenic Bladder Disorder?

Answer 23

if innervation of the bladder is interrupted
can occur from interruption at any level of lesion
i.e. Brain injury, stroke, spinal cord injury, PNI

Question 24

what does neurogenic bladder disorder result in?

Answer 24

Problem with brain telling sphincter what to do and sphincter not being able to follow

resulting in flaccid bladder
or spastic bladder

Question 25

what causes Flaccid Bladder aka areflexia?

Answer 25

lesion at level of sacral micturition reflexes or peripheral innervation of the bladder accompany detrusor muscle dysfx external sphincter tone and perineal mm tone diminished

Question 26

what does flaccid bladder result in?

Answer 26

voluntary urination doesn't occur but achieved through supra pubic pressure Urine leaks b/c sphincter isnt squeezing tight enough

Question 27

how does spastic bladder occur?

Answer 27

occurs with lesion above the level of sacral control of micturition (S2-4)

Question 28

what does Detrusor Sphincter Dyssynergy affect?

Answer 28

Coordinated activity between the detrusor mm. and the external sphincter

Question 29

what causes Detrusor Sphincter Dyssynergy?

Answer 29

Lesions that affect the micturition center in the brain stem or impair communication

Question 30

what does Detrusor Sphincter Dyssynergy result in?

Answer 30

Instead of relaxing during micturition, the external sphincter becomes more constricted. can lead to increasing pressure and back up into kidney

Question 31

how does bladder dysfx occur?

Answer 31

During the period of spinal shock, all reflexes are depressed, including micturition. Bladder is atonic and cannot contract

Question 32

how long does bladder dysfx last?

Answer 32

1-2 months and then spinal reflexes return and become hyperactive

Question 33

what is still intact during bladder dysfx?

Answer 33

Sacral reflex arc

Question 34

what does bladder dysfx result in?

Answer 34

Stimuli generated by bladder stretch receptors produce freq contractions of detrusor mm. Sacral Sparing retains bladder/bowel fx

Question 35

what are Peripheral NN disorders that can lead to bladder dysfx?

Answer 35

Neuropathies that involve pelvic, pudendal and hypogastric nerves Diabetes mellitus = most common cause: urination becomes less freq

Question 36

what are TXs for Bladder Dysfunction?

Answer 36

Catheterization Bladder Training Pharmacology Surgery

Question 37

what is a Texas Catheter?

Answer 37

external condom catheter

Question 38

what is an indwelling catheter?

Answer 38

cant pass own urine. Stays in place and gets changed every few days. Threaded through urethra to base of bladder to sphincter. Pressure from catheter relaxes sphincter. Work out slowly to get urine from base of bladder

Question 39

what is an intermittent catheter?

Answer 39

not there all the time. Only put in when need to be relieved

Question 40

what are methods for bladder training?

Answer 40

body positions that facilitate micturition monitoring fluid intake Trigger voiding methods biofeedback

Question 41

what are trigger voiding methods?

Answer 41

Tapping over the suprapubic area, pulling of pubic hairs, rubbing the thigh Crede’s method- person sitting, apply pressure to supra pubic area to increase intra vesicular pressure Valsalva’s maneuver- bearing down by exhaling against a closed glottis. increases intra abdominal pressure

Question 42

what are pharmacology methods of bladder control?

Answer 42

anticholinergics to decrease detrusor mm tone and increase bladder capacity with spastic bladder dysfx parasympathometic drugs to inc bladder tone in mild flaccid Neurogenic bladder mm. relaxants to decrease tone of ext sphincter

Question 43

what are surgery options for bladder control?

Answer 43

Sphincterectomy TURP- trans urethral resection prostrate Suprapubic Catheter Placement

Question 44

what is an implication for suprapubic catheter?

Answer 44

Catheter placed in bladder | Must be cleaned more often

Question 45

what occurs for Bowel Function Following Spinal Cord Injury?

Answer 45

S2-S4 controls the reflex to relax the external anal sphincter. Spastic control similar to bladder sphincter may lead to flaccid control

Question 46

How does the bowel empty?

Answer 46

Reflex control with cortical input (brain allows expelling) when rectum is full: fullness sensation is transmitted to spinal cord via sacral nerves and then to cerebral cortex

Question 47

what is examined in a bladder assessment?

Answer 47

``` bowel routine prior to injury routine since injury dietary habits GI problems or abnormalities current medications rectal sensation rectal tone ```

Question 48

what are Goals of bowel management following SCI?

Answer 48

est. complete bowel evacuation minimize incontinence minimize complications afford dignity and independence

Question 49

what are methods for a pt's bladder to expel normally?

Answer 49

``` dietary management- high fiber, high fluid Medication consistent timing of evacuation privacy and positioning techniques to relax sphincter ```

Question 50

how does Sex after SCI happen?

Answer 50

complex reflexes combine during sexual expression stimuli can be mental- erotic material, situations, and thoughts touch- applied to genitalia or other parts of the body

Question 51

what part of the spinal cord controls genitals?

Answer 51

penile erection and vaginal lubrication S2-4 and T11-12- L1 Reflexive erection can occur

Question 52

how does Erection before spinal cord injury occur?

Answer 52

Stimuli from the genitalia are carried to the sacral center by the pudendal nerve reflex activity is controlled higher centers in the brains (inhibition)

Question 53

how does Erection after spinal cord injury occur?

Answer 53

brain is disconnected and no longer has the inhibitory fx, erection becomes reflexive

Question 54

what to know when addressing sex with SCI pts?

Answer 54

Sexual behaviors can still occur Women can still become pregnant Couple/individual will need to explore techniques and details of the act

Question 55

what are problems to address with SCI pts?

Answer 55

``` accidental bowel/bladder during sex logistics of clothing management positioning alternative techniques worries about victimization ```