Neurogenic Bladder Management and Nursing Care
Published: 07 December 2020
Published: 07 December 2020
Neurogenic bladder is the overlying term for a variety of urinary dysfunctions caused by a disease or an injury that has disrupted normal neurological functioning (Shenot 2020).
Depending on the nerve damage experienced by the individual, their bladder may become overactive (spastic) or underactive (flaccid) (Cleveland Clinic 2016).
Normal bladder function relies on information travelling through neural pathways from the cerebral cortex, through the spinal cord, and on to the bladder to coordinate normal micturition and urinary continence. When this pathway is damaged, it can result in loss of bladder sensation and also the loss of the coordination between the urethral sphincter and its muscles. This means that these muscles may not contract even when the bladder fills or the person has the urge to void, leading to bladder dysfunctions such as urinary incontinence and retention (Mauk 2012).
Depending on the aetiology and classification of the neurogenic bladder, the individual may experience a variety of symptoms, including:
Neurogenic bladder can be caused by any condition that affects the bladder or bladder outlet nerves, including:
(Shenot 2020; Johns Hopkins Medicine 2015)
A neurogenic bladder can be classified in many ways, typically depending on the location of the neurologic lesion:
(Dorsher & McIntosh 2012; Mauk 2012)
Diagnosis of neurogenic bladder is essential to ensure effective management strategies are implemented. There are a variety of investigations and assessments that need to be completed in order to diagnose a neurogenic bladder and exclude other possible causes. Some of these investigations include:
(Greenwood et al. 2013)
In addition to physical complications caused by neurogenic bladder, there may also be negative psychosocial effects including decreased quality of life and feelings of embarrassment and depression, which can lead to further social isolation. This may be devastating in the case of someone with a progressive neurological condition (Ginsberg 2013a).
Potential physical complications of neurogenic bladder include:
(Shenot 2020; Mauk 2012)
Management of neurogenic bladder needs to be individualised according to the patient, the classification of their bladder dysfunction, the cause of their dysfunction and their symptoms. Nurses will often be involved in supporting the patient to learn techniques and strategies for managing the condition.
The main focus of management is patient education. The goal of all bladder management programs is to develop predictable and effective patterns of elimination by emptying the bladder and preventing potential complications. The patient needs to be involved in their own bladder management program to ensure it works for them and fits in with their lifestyle. This may mean a combination of bladder training, behaviour modification and medications, and as a last resort, surgery may be required (Dorsher & McIntosh 2012; Mauk 2012).
Bladder training is an essential component of neurogenic bladder management. It ensures regular and adequate emptying of the bladder and may be through the means of a voiding schedule or self-catheterisation (Ginsberg 2013).
Intermittent catheterisation can be used for patients who have complete or partial urinary retention. Self-administered intermittent catheterisation has many benefits over indwelling catheters, including enhanced independence and confidence, and a reduction of potential barriers to sexual function. If the patient has some ability to void, intermittent catheterisation can be used as part of their bladder retraining program. Patient education is critical for patients who are self-administering intermittent catheterisation, with one of the most frequent complications being urinary tract infections (Ginsberg 2013b).
An indwelling catheter or suprapubic catheter can also be used, but once again, patient education is essential for catheter care on discharge. While this is not the preferred method of long-term bladder management, it may be the most effective and practical solution for people with poor hand function, high fluid intake, lack of support or lack of success with other management strategies (Mauk 2012).
Pharmacological therapies can also be used for bladder management; antimuscarinics are commonly used and not only result in an increased bladder capacity, but also delay the urge to void (Ginsberg 2013b).
Surgical interventions are generally implemented as a last resort and include procedures such as transurethral sphincterotomy and enterocystoplasty (Ginsberg 2013b).