Bladder management after spinal cord injury



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Frazier Rehab Institute Bladder Management After
Spinal Cord Injury
Belinda N. Coyle, RN, BSN, CRRN Spinal Cord Medicine Program Frazier Rehab & Neuroscience Center The Urinary System
ŽConsists of the kidneys, ureters, bladder, sphincters, & urethra ŽMajor functions: 1. Regulates electrolytes to keep balance of chemicals needed for body function 2. Removes waste products and excess H2O (urine) from the blood via the kidneys Frazier Rehab Institute Process of Urination
ŽKidneys filter blood to remove waste products & create urine ŽUrine travels thru the ureters to the bladderŽSensory nerves send messages up the spinal cord to the brain when bladder is full Frazier Rehab Institute Process of Urination cont…
ŽThe brain then sends message down the spinal cord to the bladder telling it to empty ŽThe sphincter muscles relax, the bladder muscles tighten to push urine from the bladder, & the urine leaves the body thru the urethra Frazier Rehab Institute

The Urinary System Frazier Rehab Institute Urination After SCI
ŽMessages/signals from the bladder to the brain and vice versa become disrupted or lost completely due to the SCI ŽNeurogenic BladderŽThe level of injury of the spinal cord will determine how urination will occur Frazier Rehab Institute Spastic Bladder (above T12- L1)
ŽAlso called reflex or ŽReflexes are hyperactive bladder triggered to let urine ŽOccurs with upper flow but it may occur when you are motor neuron injuries ŽThe bladder fills, ŽThe brain does not stretches, pushes out get the messages to on nearby nerves that tell you the "right" send signals to the Frazier Rehab Institute Flaccid Bladder (below L1-L2)
ŽAlso called areflexic ŽSignals are not able or "floppy" bladder to reach the spinal ŽOccurs with lower cord; bladder does motor neuron injuries not get the message ŽThe bladder fills, ŽBladder will become stretches, & pushes too full & urine will out on nearby nerves that send signals to leak out (may back up into kidneys and can cause problems) Frazier Rehab Institute A Bladder Management
Programs May Include:

ŽIndwelling catheter (Crede' maneuver, ŽSuprapubic catheter Valsalva, suprapubic ŽExternal catheter ŽBehavioral strategies ŽIncontinence devicesŽManual techniques to Frazier Rehab Institute ŽFoley—catheter that remains in the bladder & continuously empties urine into a drainage bag/device.
ŽSmall balloon at the end of the catheter is filled with normal saline to keep it in the bladder.
ŽArea around catheter should be cleaned at least 1-2 times daily & catheter changed at least once per month ŽIncreases risk of infection Frazier Rehab Institute ŽCatheter surgically inserted into bladder through the abdomen (stomach) that continuously empties urine into drainage bag/device.
ŽCan be sutured (stitched) to skin &/or balloon filled with normal saline used to hold in place in the bladder ŽInsertion site should be cleaned a couple times daily & catheter changed every 1-2 months.
ŽIncreases risk of infection Frazier Rehab Institute ŽAlso known as "in & out" catheterizationŽCatheter inserted into bladder which drains urine into collection device and then the catheter is removed ŽTypically performed about every 4-6 hours around the clock (varies person to person) ŽPreferred over Foley because there is less risk of infection Frazier Rehab Institute ŽAlso known as Texas or condom cathetersŽBeneficial for males who experience spontaneous voiding ŽFits over penis (much like a condom) & hooks to drainage bag to keep you dry ŽAdhesive on the condom catheters holds the catheters in place Frazier Rehab Institute ŽBecause of their anatomy, the only available external option for a female would be in the form of an incontinence pad or brief.
Frazier Rehab Institute Choosing Incontinence
ŽMany different kinds of catheters available
ŽInsurance benefits vary person to person
ŽCan be purchased off Internet or at a local
drug store/pharmacy ŽYour rehab team can help you choose which device(s) would work best for you Frazier Rehab Institute ŽTimed toileting/voidsŽPelvic muscle exercises (Kegel)ŽElectrical stimulation (stress or urge incontinence problems only) Frazier Rehab Institute Medications for Bladder
Ž Anticholinergics—help
Ž Cholenergics—help prevent bladder spasms; bladder contract; promotes emptying (ex. (examples Ditropan, Oxytrol, Detrol, Bentyl) Ž Alpha blockers—relax Ž Alpha adrenergics— muscles at base of increase pressure on bladder; promotes bladder neck; promote emptying (ex. Flomax, Uroxatral, Minipress, Hytrin, Cardura) Frazier Rehab Institute ŽMitrofanoff procedure: requires surgery to construct a new passageway for urine using the appendix tissue; passageway allows catheter to pass through the abdomen and directly into bladder. It is good for women & those w/decreased hand function.
ŽBladder augmentation: surgical enlargement of bladder; reduces need for frequent caths Frazier Rehab Institute Surgical Procedures cont…
ŽSphincerotomy: allows easier urine flow by reducing pressure on sphincter; may affect ability to have reflex erection; usually not done on women.
Frazier Rehab Institute Clean Intermittent
ŽTechnique used in home setting; a sterile
technique is used in the healthcare setting ŽEquipment needed: clean catheter, water- based lubricant, washcloths or baby wipes, clean tray, and antiseptic soap ŽCan be performed lying down (in bed) or in a seated position (on toilet/BSC or in wheelchair) Frazier Rehab Institute Clean IC cont…
ŽWash hands with soap & waterŽClean genital area with baby wipe or damp washcloth and soap *Males clean from tip to base of penis *Females clean front to back ŽLubricate catheter & position tray between legs (point end of catheter toward toilet/BSC if seated) Frazier Rehab Institute Clean IC cont…
ŽInsert catheter into meatus until urine flows & allow urine to drain ŽWhen urine stream starts to trickle, massage abdomen (Crede' maneuver) ŽSlowly remove catheter when urine is no longer flowing out ŽPlace used catheter in a storage container to be cleaned later or discard if one-time use ŽInspect urine for color, amount, odor, or sediment (should generally be clear to light yellow) Frazier Rehab Institute Clean IC cont…
ŽRinse genital area with baby wipe or damp ŽAlways wash your hands when finished! Frazier Rehab Institute Cleaning Catheters at Home
ŽAfter using the catheter, wash & rinse inside and out with soap and water ŽDry on clean towel, making sure to drain inside of catheter ŽInspect catheters after each use and after ŽDiscard those that are damaged & store the Frazier Rehab Institute Cleaning Catheters at Home
ŽThose with frequent Urinary Tract Infections
(UTIs) or if you have a current UTI, you may want to alter the cleaning technique a little ŽAfter cleaning and rinsing with soap & water, you will boil the catheters on the stovetop for 15-20 minutes ŽDrain, dry, and store as described before Frazier Rehab Institute Urinary Tract Infection (UTI)
ŽBacteria that multiply in the urinary tract can cause an infection ŽPossible signs & symptoms include: cloudy &/or foul smelling urine, increase in mucous or sediment, blood in urine, pain or burning with urination, increase in bladder spasms, increase in frequency of urination or incontinence, low back or flank pain, elevated temp/fever, chills, nausea/vomiting Frazier Rehab Institute Prevention of UTI: Things to Do
ŽProper fluid intake (8-10 glasses of liquid per day, preferably water) ŽRoutine bladder emptying (keep on bladder management schedule; volumes should not to exceed 400-500ml at once) ŽGood hygiene (wash hands & keep skin around genitals clean) Frazier Rehab Institute Prevention of UTI: Things to Do
ŽProper positioning & draining of collection device (leg bag/bedside drainage bag) ŽDaily cleaning of drainage devices & proper cleaning of catheters (after each use) ŽRegular check-ups with your healthcare provider (at least yearly) Frazier Rehab Institute Detection & Treatment of UTI
ŽCall MD if you suspect UTIŽMay need urine specimen (UA C&S) to determine if true infection ŽTreatment may include use of antibioticsŽContinue to always use preventative Frazier Rehab Institute ŽIt may take time & effort, but proper bladder management can be achieved in those with spinal cord injuries.
ŽTry to keep a healthy urinary system by staying educated, sticking to a regimen, and using preventative measures. ŽFollow the recommendations of your healthcare providers! Frazier Rehab Institute Questions or Concerns?
Frazier Rehab Institute Spinal Cord Medicine Clinic Belinda Coyle, SCMP Nurse Coordinator Bladder care. (n.d.). Retrieved July 25, 2006, from Bladder care. (n.d.). Retrieved July 25, 2006, from Bladder care. Chapter in Patient and Family Handbook for Spinal Cord Injury. Frazier Rehab Institute, 2009. Available under Education section at Fine, C.K., & Nelson, A. (Eds.). (2001). Nursing practice related to spinal cord injury and disorders: A core curriculum. New York:Eastern Paralyzed Veterans Association.
Haeman, S.P. (2002). Rehabilitation nursing: Process application and outcomes, 3rd edition. Mosby.
Maddox, Sam. (2003). Paralysis Resource Guide. New Jersey: Christopher Reeve Paralysis Foundation.
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