Bladder Management in Spinal Cord Injury

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Introduction[edit | edit source]

Neurogenic urinary tract dysfunction is common among individuals with spinal cord injuries(SCIs) and may lead to common complications such as; renal insufficiency, incontinence, and urinary tract infections[1]. Research indicates that urinary tract infections(UTIs) are the most common secondary complication (62%) reported among individuals with SCIs in the first year after discharge from in-hospital treatment. It was also found that UTI's were more prevalent among individuals with higher SCI-levels and complete SCI[2]

Bladder dysfunction also decreases psychological and social well-being in individuals with SCIs[3].

Pathophysiology[edit | edit source]

SCI often affects the urinary system and leads to bladder dysfunction or neurogenic bladder. Neurogenic bladder is when bladder control is affected due to brain-, spinal cord- or nerve complications[4].

The 3 areas of the CNS that control bladder function is;

  1. The cerebral cortex,
  2. The pontine micturition centre, and
  3. The sacral micturition centre.[3]

In SCI, lesions can interrupt 3 pathways that will lead to bladder dysfunction;

  1. Interruption of the pontine and sacral micturition centres (central lesions) or
  2. The detrusor muscle innervation ( sacral cord lesions) or
  3. The bladder neck innervation (sympathetic) and the external urethral sphincter's innervation[3]

Neurogenic bladder can be classified according to different types of conditions involving the detrusor and sphincter activity.

  1. Hypereflexia with an involuntary contraction: This leads to sphincter dyssynergia, reflex incontinence and residual urine.
  2. Arefelxia of detrusor - and sphincter muscles: This is due to sacral injury and leads to stress incontinence and residual urine.
  3. Areflexia of the detrusor muscle and hyperreflexia of the sphincter: This leads to urinary retention and overflow incontinence.
  4. Areflexia of the sphincter and hyperreflexia of the detrusor muscle: This leads to reflex incontinence.[3]

Other classifications include injury to levels in the suprasacral, sacral, or infrasacral segments. Suprasacral neurogenic bladder occurs due to SCI between the brainstem and sacral centre. This leads to disinhibited sacral reflexes, overactivity of the detrusor, overactivity of the external and/or internal sphincters, and impaired coordination between these two muscles. Possible complications are voiding, urgency, frequency, incontinence, and high pressures in the bladder, leading to reflux, hydronephrosis, and kidney failure. Sacral neurogenic bladder occurs due to SCI to the sacral spinal cord, while infrasacral neurogenic bladder occurs due to SCI to the cauda equina. Both these are classified as lower motion neuron lesions (LMNL) and often result in difficulty bladder emptying and lack of sensation, which leads to overflow and stress incontinence, urinary tract infection, bladder distension, and possible renal failure[5].

References[edit | edit source]

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