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Neurogenic Bladder.pdf

  1. Click to edit Master title style 1 Neurogenic Bladder
  2. Click to edit Master title style 2 2 Micturition, also known as urination, is the process of expelling urine from the bladder. The purpose of urination is to eliminate metabolic products and toxic wastes from the body that have been filtered from the blood by the kidneys. INTRODUCTION
  3. Click to edit Master title style 3 3 The urinary tract comprises of two mutually dependent components: the upper tract, which contains the kidneys and ureters, and the lower tract consisting of the bladder and urethra. The lower tract is involved in the micturition reflex. Relevant Anatomy & Physiology The bladder is a hollow organ that functions as reservoir for the storage and periodic elimination of urine. The bladder’s walls are made up of three layers of smooth muscle, known as the detrusor. At the bottom of the bladder is an outlet into the urethra known as the bladder neck, which is surrounded by a ring of smooth muscle known as the internal urethral sphincter and is involuntarily controlled. The urethra, the passage in which urine is excreted out of the body.
  4. Click to edit Master title style 4 4 The pelvic floor musculature encircles the urethra creating the external urethral sphincter, which operates under conscious control. During storage, both the internal and external sphincters are contracted to prevent leakage. Normally, the detrusor muscle is relaxed, which allows the bladder to expand as it fills with urine. When the bladder is full, the detrusor contracts to expel urine out of the body through the urethra. A normal healthy adult bladder can hold anywhere from 300-500mL of urine for 2-5 hours.
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  6. Click to edit Master title style 6 6 Mechanism Micturition is a complex and highly distributed process, involving pathways at multiple levels of the brain, spinal cord and PNS, in addition to being mediated by multiple neurotransmitters. o At the most basic level, the micturition reflex is triggered when the bladder fills with urine. o The detrusor muscle remains relaxed until the bladder fills to about 250 mL with urine. o As the bladder fills, the detrusor muscle contracts, which increases the pressure within the bladder. o Stimulates the stretch receptors within the detrusor and exciting parasympathetic fibres to relay this information to the sacral nerves of the spine.
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  8. Click to edit Master title style 8 Neurogenic Bladder, also known as Neurogenic Lower Urinary Tract Dysfunction, is when a person lacks bladder control due to brain, spinal cord or nerve problems What is Neurogenic Bladder?
  9. Click to edit Master title style 9 underactive (flaccid or hypotonic) bladder Types of neurogenic bladder overactive (spastic or hyper-reflexive) bladder
  10. Click to edit Master title style 10 10 ➢ A spastic or hyperreflexic bladder (UMN lesion) contracts and reflexively empties in response to a certain level of filling pressure. The reflex arc is intact with this type of injury. The detrusor muscle is generally hyperreflexive. There can be increased tone of the sphincter, contraction of the detrusor with small urine volumes, and lack of coordination between detrusor and sphincters (dyssynergia). ➢ A flaccid or areflexive bladder (LMN lesion) is essentially flaccid because there is no reflex action of the detrusor muscle.
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  12. Click to edit Master title style 12 12 Symptoms of Neurogenic bladder The symptoms of neurogenic bladder vary depending on whether someone has an overactive or underactive bladder. The symptoms of an overactive bladder can include: o frequently urinating in very small amounts o feeling the urge to urinate a lot o lack of bladder control o urinary incontinence The symptoms of an underactive bladder may include: o having a bladder that is frequently full o not being able to tell when the bladder is full o difficulty urinating o overflow leakage
  13. Click to edit Master title style 13 13 Causes of neurogenic bladder Nerve dysfunction is what causes neurogenic bladder. This means that any condition or trauma that affects the nervous system may cause problems with bladder control. o diabetes o genetic conditions that affect the nerves o trauma to the brain and spinal cord o brain and spinal cord tumors o Parkinson’s disease o multiple sclerosis
  14. Click to edit Master title style 14 14 Neurogenic bladder treatment Treatment can improve the symptoms and have a significant impact on a person’s quality of life. It can also prevent certain complications, such as UTIs or kidney damage. Treatment will differ depending on whether the person has an overactive or underactive bladder. Depending on the severity of a person’s symptoms, treating an underactive or overactive bladder usually begins with making lifestyle changes.
  15. Click to edit Master title style 15 15 Lifestyle changes: o Quick flicks: When a person gets the urge to urinate, they can try squeezing and relaxing their pelvic floor muscles as quickly as they can. They should do this until they no longer want to urinate. o Dietary changes: Soda, caffeine, spicy foods, and alcohol can irritate the bladder, so a person may want to reduce their consumption of these items to ease the symptoms. o Delayed voiding: This involves a person delaying urination for a few minutes to begin with, then slowly building up the delay. Eventually, they may be able to go a few hours without urination. o Scheduled voiding: This involves a person using the bathroom according to a daily schedule, such as every 2–4 hours, depending on how often they need to urinate.
  16. Click to edit Master title style 16 16 Additional overactive bladder treatment 1. Drug treatment: botulinum toxin (Botox) injection into the bladder muscle to stop it from contracting as much. Botox can wear off after a period of time, so a person may need to have injections every 6–12 months. 2. Sacral neuromodulation: This treatment stimulates the nerves with electricity, especially the sacral nerve, which relays signals from the spinal cord to the bladder. 3. Percutaneous tibial nerve stimulation: During this treatment, a doctor inserts a needle into the tibial nerve, which is in the leg. They then stimulate this nerve with electrical impulses. These impulses travel to the sacral nerve. A person usually needs to receive 12 sessions of this treatment.
  17. Click to edit Master title style 17 17 Additional underactive bladder treatment If a person does not notice any improvements in their underactive bladder symptoms after making the above lifestyle changes, a doctor may recommend medication or a catheter. There are two different types of catheterization that a person can try: 1. Clean intermittent catheterization (CIC) 2. Continuous catheterization. CIC involves inserting a sterile catheter into the bladder through the urethra and leaving the catheter in for only as long as it takes to drain the bladder. A person can then remove the catheter and wait another 6–8 hours to do this again. Continuous catheterization continuously drains urine. That said, these catheters do need replacing every so often to prevent infection.
  18. Click to edit Master title style 18 18 THANKYOU Presented by: Dinu Dixon MPT (Neurology)