DEFINITION•refers to dysfunction of the urinary bladderdue to disease of the central nervoussystem or peripheral nerves involved in thecontrol of micturition (urination).
FLACCID BLADDER•A flaccid, or hypotonic, bladder ceases to contractfully, causing urine to dribble out of the body. Besidesthe complications that stem from urine dripping,rashes can occur in the area where urine pools. Thistype of bladder disorder occurs when the volume ofurine is large but the pressure is low.
Spastic Bladder:•A spastic, or reflex, bladder occurs whenthe volume of urine is normal or small, butthere are involuntary contractions, causinga person to feel the need to urinate evenwhen he doesnt need to release urine
Causes of NeurogenicBladder•Stroke•Parkinson’s disease•Multiple sclerosis•Alzheimer’s disease•Spina bifida and neuraldisorders resulting from diabetesor alcoholism
Nerve damage mayresult from:•Child birth•Pelvic injury•Brain or spinal cord injury•Herniated disc•Heavy metal poisoning, or tumors of thebrain, spinal cord or pelvis
Symptoms of Neurogenic Bladder•Overactive bladder .•Frequent urination, in the daytime and at night(nocturia)•Stress incontinence•Urge incontinence•Inability to urinate (urinary retention)•Underactive bladder – bladder is unable to signalwhen full
Etiology And Risk Factors•Tumors•Neurologic disorders•Trauma to the nervous systemClinical Manifestation•Retention with or without incontinence•The client may or may not feel a need tovoid or feel a sense of bladder distension.
NURSING DIAGNOSIS•Overflow Incontinence related to chronically overfilled bladder withloss of sensation of bladder distention.•Overflow Incontinence related to detrusor-sphincter dyssynergy(DSD)•Reflex Incontinence related to absence of sensation to void and lossof ability to inhibit bladder contraction.•High Risk for Infection related to retention of urine or introduction ofurinary catheter.•Urge Incontinence related to inability to inhibit urination after urge isperceived.•High risk for Loneliness related to embarrassment from incontinencein front of others and fear of odor from urine
Treatment•Medicines that relax the bladder (oxybutynin,tolterodine, or propantheline)•Medicines that make certain nerves more active(bethanechol)•Botulinum toxin (Botox)•GABA supplements•Antiepileptic durgs
Your doctor may refer you someone who has been trained tohelp people manage bladder problems. Skills or techniques youmay learn include:•Exercises to strengthen your pelvic floor muscles (Kegelexercises)•Keeping a diary of when you urinate, the amount you urinated,and if you leaked urine. This may help you learn when youshould empty your bladder and when it may be best to be neara bathroom.
Sometimes surgery is needed. Surgeries for neurogenicbladder include:•Artificial sphincter•Electrical device implanted near the bladder nerves, tostimulate the bladder muscles•Sling surgery•Creation of an opening (stoma) in which urine flows into aspecial pouch (this is called urinary diversion