2. DEFINITION
•refers to dysfunction of the urinary bladder
due to disease of the central nervous
system or peripheral nerves involved in the
control of micturition (urination).

4. FLACCID BLADDER
•A flaccid, or hypotonic, bladder ceases to contract
fully, causing urine to dribble out of the body. Besides
the complications that stem from urine dripping,
rashes can occur in the area where urine pools. This
type of bladder disorder occurs when the volume of
urine is large but the pressure is low.

5. Spastic Bladder:
•A spastic, or reflex, bladder occurs when
the volume of urine is normal or small, but
there are involuntary contractions, causing
a person to feel the need to urinate even
when he doesn't need to release urine

6. Causes of Neurogenic
Bladder
•Stroke
•Parkinson’s disease
•Multiple sclerosis
•Alzheimer’s disease
•Spina bifida and neural
disorders resulting from diabetes
or alcoholism

7. Nerve damage may
result from:
•Child birth
•Pelvic injury
•Brain or spinal cord injury
•Herniated disc
•Heavy metal poisoning, or tumors of the
brain, spinal cord or pelvis

8. 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 signal
when full

9. Etiology And Risk Factors
•Tumors
•Neurologic disorders
•Trauma to the nervous system
Clinical Manifestation
•Retention with or without incontinence
•The client may or may not feel a need to
void or feel a sense of bladder distension.

10. NURSING DIAGNOSIS
•Overflow Incontinence related to chronically overfilled bladder with
loss of sensation of bladder distention.
•Overflow Incontinence related to detrusor-sphincter dyssynergy
(DSD)
•Reflex Incontinence related to absence of sensation to void and loss
of ability to inhibit bladder contraction.
•High Risk for Infection related to retention of urine or introduction of
urinary catheter.
•Urge Incontinence related to inability to inhibit urination after urge is
perceived.
•High risk for Loneliness related to embarrassment from incontinence
in front of others and fear of odor from urine

11. 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

12. Your doctor may refer you someone who has been trained to
help people manage bladder problems. Skills or techniques you
may learn include:
•Exercises to strengthen your pelvic floor muscles (Kegel
exercises)
•Keeping a diary of when you urinate, the amount you urinated,
and if you leaked urine. This may help you learn when you
should empty your bladder and when it may be best to be near
a bathroom.

13. Sometimes surgery is needed. Surgeries for neurogenic
bladder include:
•Artificial sphincter
•Electrical device implanted near the bladder nerves, to
stimulate the bladder muscles
•Sling surgery
•Creation of an opening (stoma) in which urine flows into a
special pouch (this is called urinary diversion

15. SPASTIC NEUROGENIC
BLADDER

16. LESIONS AT ABOVE T12
INTERRUPTED AFFERENT SIGNALS
EXCITATION OF NEURONS BELOW T12
SPONTANEOUS CONTRACTION
OF DM
URINARY SPHINCTER SPASMS
INTRAVESICAL VOIDING
PRESSURE
BLADDER WALL HYPERTROPHY
WITH TRABECULATION
REDUCED URINE-VOLUME
CAPACITY
UNCONTROLLED URINATION
FREQUENT URINATION

17. FLACCID NEUROGENIC
BLADDER

18. LESIONS AT OR BELOW S2/S4
INTERRUPTED AFFERENT SIGNALS BELOW S2/S4
LOW OF SENSATION OF BLADDER FILLING
RELAXATION OF
DETRUSOR MUSCLE
POOR CONTRACTION OF
DETRUSOR MUSCLE
INTRAVESICULAR PRESSURE
BLADDER CAPACITY (2000ML)
OVERDISTENDED BLADDER
BLADDER PRESSURE REACHES A
BREAK THROUGH POINT
SMALL AMOUNTS OF URINE DRIBBLE
RESIDUAL
URINE
RETENTION