​Rethinking Your Bladder Program

Posted by Nurse Linda in Daily Dose on October 05, 2022 # Health

CatheterSome of you may be thinking, this does not apply to me, but other neurology issues come together with issues that need to be addressed. What one area of healthcare discovers is often applicable to other disciplines.

From a healthcare point of view, any issues with neurogenic bowel care depend on the entirety of the gut, but the bladder function is very different. Some thoughts and tips may make things run a bit more smoothly.

The urinary system consists of two parts. The upper urinary tract consists of the kidneys and ureters. Two kidneys are companions on each side of the body about mid-torso. They work as your blood pumps to remove waste from your system constantly. The kidneys do not stop and are constantly filtering your blood. Kidneys do not store urine; they make it. As urine is made, it flows down the ureters, one ureter for each kidney. Ureters are tubes that flow from each kidney to your bladder. It is a one-way flow. Backflow in the ureters can damage the kidneys.

The lower urinary tract is your bladder and urethra. The bladder is a storage organ. It holds urine until an appropriate time to release it. The bladder is a muscle that expands as urine collects and contracts as urine is emptied from it. The urethra is a sphincter that opens to drain urine and closes to let more urine collect.

A neurogenic bladder occurs when there is a neurological issue that affects how the nerves that control the function of the bladder. This chart contains an overview of neurogenic bladder issues and how they affect bladder function. This is a brief overview. Your individual neurogenic bladder issue may not match the chart exactly.

Neuro Diagnosis

Area Affected

Bladder Issue

Stroke

Brain sensory cortex

Brain motor cortex

Corticospinal Tract

Or any combination of above

-Difficulty in perceiving bladder filling

-Frequency with low volume output

-Urgency

-Short wait time for toileting

-Incontinence

Parkinson’s Disease

Basal ganglia

Extrapyramidal tract

-Sudden urge to toilet

-Difficult to control urine output

-Incomplete emptying

-Dribbling

Spinal Cord Injury from disease or trauma

Upper Motor Neuron Injury

Cervical or Thoracic level of injury

Pontine center of the brain is unable to send or receive messages

-Unable to tell when the bladder needs to be emptied

-Hyperactive bladder with frequent contractions

-Incomplete emptying with urinary incontinence

-Overactive external sphincter tone with sphincter incoordination (detrusor overactivity with detrusor sphincter dyssynergia, DSD)

-High voiding pressure, high residual urine volumes

-Higher incidence of autonomic dysreflexia

Spinal Cord Injury from disease or trauma

Lower Motor Neuron Injury

Lumbar or Sacral level of injury

Sacral nerve root injury

-Unable to tell when the bladder needs to be emptied or sensation of a full bladder is altered

-Bladder is without tone, fills but does not empty

-Occasionally has overflow leakage

-Sphincter retains some tone

Diabetes

Multiple Sclerosis

Peripheral nerve sensory pathways

-Loss of sensation that bladder is full

-Overfilling bladder

-Dribbling, incontinence

Each of these bladder concerns will have treatments, medications, and therapies that will improve your bladder situation. Neurogenic bladder programs are devised to maintain the health of your urinary system. This can include timed toileting to reduce urinary incontinence for individuals with urgency, urine collection systems for incontinence, specialized voiding techniques such as Valsalva or rectal stretching for individuals with lower motor neuron bladders, and intermittent catheterization for individuals to control and contain urinary output. Some individuals with high bladder pressures will have a sphincterotomy where a small incision is made in the sphincter to allow urine to flow out continuously. Others may have a suprapubic catheter placed through a surgical opening in the abdomen above the bladder to keep the pressure low. There are options to increase your bladder size (bladder augmentation). Some individuals who have difficulty reaching the urethra for intermittent catheterization will have a Mitrofanoff surgical procedure which uses the appendix or a part of the bowel to make a tract from the belly button to the bladder. Catheterization then occurs through the belly button.

Medications may be used to contract the bladder, relax the bladder, contract the sphincter, relax the sphincter, or coordinate the contraction of the bladder with the opening of the sphincters to reduce pressure in the bladder. Botox injections into the bladder are helpful in controlling the hyperactivity of the bladder or sphincters.

There are some global actions you can take to make sure your neurogenic bladder program is working well:

  1. Maintain excellent hygiene. This includes washing your hands with soap and water prior to and after catheterization to minimize the risk of bacteria entering your urinary system.
  2. Wash the area of your urethra with mild soap and rinse well before and after catheterization. This reduces the risk of infection. Using a mild soap and rinsing well reduces the drying of the urethra and surrounding skin which can produce cracks in this delicate, moist tissue.
  3. Follow the timing of your bladder catheterization program carefully to ensure you are not catheterizing too soon, which is an infection risk, or catheterizing too late, which overfills your bladder.
  4. Drink fluids as your bladder program management allows you to keep your volumes within your target range. This avoids overfilling your bladder and backing up urine into the nonstorage kidneys.
  5. Drink water as a mainstay of fluids. Drinks that contain alcohol, sugar, artificial sweeteners, and caffeine will dehydrate your body and fill your bladder more quickly. Unfortunately, they can also serve as a breeding ground for bacteria.
  6. Move your body, especially your legs, either on your own or have someone move your body for you. This shakes the urine in the bladder, helping to keep bacteria from clumping together. Rolling a few times in bed will also help.
  7. If you do develop a urinary tract infection, get treatment quickly. Urinary tract infections are easier to treat in the earlier stages. Treating a urinary tract infection early will lead to fewer issues with antibiotics later.
  8. Take the full course of prescribed antibiotics to kill the bacteria in your body. Even if you feel better, antibiotics are developed to only rid bacteria when the full prescription is taken.
  9. Dispose of urinary equipment appropriately. Leaving dirty equipment is a risk for whoever has to pick it up.

Have a urodynamic test to assess your bladder. Your healthcare professional will guide you as to improvements or treatments to keep your urinary system healthy. It is essential to lifelong care to maintain your urinary system.

Pediatric Consideration:

With children, it is important that you use catheterization equipment that is appropriate for your child’s size. It will need to be adjusted as they grow.

The developmental needs of children should be considered with their neurogenic bladder program. Even though babies wear diapers, they still need catheterization with neurogenic bladder diagnoses. As you catheterize, tell your child what you are doing so they learn the steps. Eventually, as they develop, you can have them gather supplies, wash their hands (even if you are performing the catheterization to start a good habit), learn about fluid intake, and eventually complete the entire catheterization process.

As parents want to do the most for their child, it can be easy to just do the catheterization for them but remember, when your child goes to school, they should be able to catheterize on their own if they have the developmental skills to do so. This is their normal. Make it yours as well. Independence is what all parents are trying to achieve for their children.

Linda Schultz is a leader, teacher, and provider of rehabilitation nursing for over 30 years. In fact, Nurse Linda worked closely with Christopher Reeve on his recovery and has been advocating for the Reeve Foundation ever since.

The National Paralysis Resource Center website is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $8,700,000 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government.