neurogenic bladder definition, pathophysiology, causes, clinical manifestation, diagnosis, treatment and nursing interventions

1. Neurogenic Bladder
Gufu Abdikadir
Sultana Nasrudin

2. Definition
• Neurogenic bladder is bladder dysfunction
(flaccid or spastic) caused by neurologic damage
• In 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.
After acute cord damage.
• In spastic bladder, volume is typically
normal/small, and involuntary contractions occur.
Results from brain damage or spinal cord damage.

3. Pathophysiology
• Control of bladder function involves the
somatic efferent as well as autonomic
sympathetic and parasympathetic systems
• The sympathetic NS reg.> urine storage in
the bladder.parasympathetic NS controls
bladder contractions and the passage of
urine. The somatic efferent system permits
voluntary control over the external
periurethral sphincter.

4. Ct.
• The external sphincter is under voluntary control and
normally contracts in response to cough
• when the bladder retains urine,alpha1 receptors
on the bladder and urethra activate contraction,
while beta2 receptors in the bladder body relax the
detrusor muscle to permit filling. Somatic efferent
fibers from the cerebral cortex permit voluntary
contraction of the external sphincter to provide
extra support. Muscarinic receptors in the trigone,
bladder neck, and urethra stimulate relaxation,
while the beta2 receptors in the detrusor body
stimulate contraction to facilitate bladder emptying.

5. Ct.
• Central control of micturition is performed
by 3 areas: the sacral micturition center,
the pontine micturition center, and the
cerebral cortex. The sacral micturition
center is located at the S2-S4 levels and is
responsible for bladder contraction. The
pontine micturition center acts as a central
relay and may play a role in the
coordination of external sphincter
relaxation with bladder contraction.

6. Causes
Causes may involve the CNS (eg, stroke, spinal
injury,
peripheral nerves (eg, diabetic, alcoholic, or
vitamin B12 deficiency neuropathies; herniated
disks; damage due to pelvic surgery),
Parkinson disease, multiple sclerosis, syphilis). (eg,
due to benign prostatic hyperplasia,
prostate cancer
fecal impaction

7. Clinical presentation
• overflow incontinence is symptom in patients
with a flaccid bladder. Patients retain urine
and have constant overflow dribbling. Men
have Erectile Dysfuncton.
• spastic bladder may have frequency, nocturia
• urine leakage<bladder contractions

8. Dx
 Postvoid residual volume is measured
 Renal ultrasonography
 Serum creatinine
 Usually cystography

9. Medical mgt
 Catheterization-indwelling urethral catheterization,
which has a high risk of recurrent UTIs and risk of
urethritis
 Increased fluid intake prevent DeH2O esp. in flaccid
neurogenic bladder.
 Drugs’- anticholinergics e.g atropine>block the action
of acetylcholine on the parasympathetic nervous
system (PNS)
 Surgery if conservative measures fail- artificial urinary
sphincter placed surgically.

10. Nursing mgt
• General aim includes renal function
monitoring, control UTI
• high fluid intake to decrease risk UTI
• early ambulation
• frequent changes of position
• dietary calcium restriction
• Care of catheter

11. Nursing Dx
• Altered urinary elimination related to
incontinence or retention secondary to
trauma or CNS dysfunction
• Self care deficit
• Risk of infection