Understanding Neurogenic Bladder Supported by an unrestricted educational grant from Hollister Incorporated. Hollister Incorporated is not responsible for the content of this booklet. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific medical advice or highly technical questions should consult his or her own physician. Table of Contents The Healthy Urinary System ..................................5 Bladder Problems ..........................................9 • Neurogenic Bladder Disorder ............................9 • Urinary Tract Infections ...............................10 • Urinary Incontinence .................................11 Diagnosing Bladder Disorders ................................12 Management and Treatment .................................13 • Medications ........................................13 • Fluids .............................................13 • Catheters ..........................................14 Intermittent Catheterization ..................................14 Choosing Your Intermittent Catheter ...........................17 Frequently Asked Questions .................................20 Glossary of Terms .........................................24 Support Networks ................................... Back Cover If you have just been diagnosed with a neurogenic bladder or are taking care of someone with a bladder disorder, you may find yourself learning new skills and making many decisions. You may feel overwhelmed by the information and the product choices at first. This book has been created to provide information to newly injured or diagnosed people, their caregivers, and their families. This guide provides a framework for discussions with your healthcare professional about the best ways for you to manage your bladder. In addition, Hollister professionals are available to provide information on their full range of Continence Care products, to answer your questions, and to provide you with educational information. 4 The Healthy Urinary System Kidneys The kidneys filter certain waste products from the Your urinary system blood to make urine. The kidneys typically produce is made up of the 1-3 ounces of urine each hour. Urine is carried kidneys, ureters, from the kidneys through tubes called ureters to bladder, urethra, the bladder, where it is temporarily stored until and the internal and urination occurs. external sphincters. Ureters The ureters are narrow, hollow tubes that lead from the kidneys to the bladder. Each adult ureter is about 11-14 inches long. The ureters end in the lower portion of the bladder and are attached to the bladder in such a way that it helps prevent urine from flowing back up into the kidneys. Muscular contractions in the ureters push urine down from the kidneys to the bladder almost constantly. Bladder The bladder is a hollow organ with a muscular wall and two primary functions – the storage and emptying of urine. In a relaxed state, the adult bladder can hold about 16 ounces of urine before you feel a strong urge to urinate. The size and shape of the bladder and the amount of urine stored varies from person to person. Emptying the bladder (also called voiding or urination) involves the coordination of both voluntary and involuntary muscles. When the bladder is emptied, urine leaves the body through a tube called the urethra. Voiding occurs when the bladder muscle (also called the detrusor) contracts and the sphincters open. Urine then passes through the urethra and leaves the body. 5 The Healthy Urinary System (Cont’d) Females In females, the urethra is about 1 inch long and Urethra runs in a slight curve behind the pubic bone. The opening of the urethra is just in front of the vaginal The urethra carries opening. The female urethra is highly susceptible to urine from the infection since it is close to the vagina and the anus bladder out of where bacteria are present. the body. It is a muscular tube lined with a mucous membrane. The kidneys opening of the urethra is called the ureters meatus. The primary difference in female detrusor muscle and male urinary bladder tracts is the length trigone area internal sphincter of the urethra. urethra external sphincter kidneys ureters large intestine uterus bladder vagina rectum pelvic floor muscle urethra 6 Males In males, the urethra is 8-10 inches long. It runs in an S-curve from the bladder through the prostate and the pelvic floor, and it ends at the tip of the penis. kidneys ureters detrusor muscle bladder trigone area internal sphincter prostate gland external sphincter urethra penis kidneys ureters large intestine bladder prostate gland rectum urethra scrotum 7 The Healthy Urinary System (Cont’d) Sphincters The urethra is surrounded by two ring-like muscles called the internal and external sphincters. The external sphincter is the one that is voluntarily contracted to control when you urinate. The sphincters work best when the pelvic floor muscles are healthy and strong. The pelvic floor muscles consist of several small muscle groups that surround the urethra, vagina (in women), and rectum. They provide support to the organs of the pelvis, and they help to hold the urethra in place. Nervous System The process of urination involves coordination between the bladder, the sphincter muscles, and an intact nervous system. When the bladder is full, nerve impulses are sent to the lower portion of the spinal cord, and then to the brain to communicate that the bladder is full. At that time, the brain sends a message to the bladder telling it to contract in order to release the urine. A healthy functioning nervous system and brain are very important for proper coordination of this complex process. bladder urethra pelvic floor muscle 8 Bladder Problems Men and women may experience problems with normal urination for a variety of reasons. Anyone who has problems with urine leakage or is not able to Common Issues empty their bladder completely should consult their healthcare professional for diagnosis and treatment. Men may experience problems with urination as they Neurogenic Bladder Disorder age. In males, the prostate gland sits A neurogenic bladder means that you have some type of underneath the bladder control problem caused by an injury or an illness bladder and wraps of the nerves, spinal cord, or brain. The bladder, brain, completely around and sphincter are not communicating well. Your bladder the urethra. The may empty too frequently, not frequently enough, or in prostate can become an uncoordinated way. Your urinary sphincters may also larger, and this work incorrectly. The way your bladder and sphincters may block the flow behave depends on the location of the neurologic of urine from the disorder in your brain, spinal cord, or peripheral nerves, bladder. and the extent of your disease or injury. For women, multiple If your bladder empties too frequently, it may be pregnancies and described as overactive. Your body is unable to store as vaginal deliveries much urine as it should, and the bladder empties more can weaken the frequently than a normal bladder. Symptoms may be pelvic floor muscles urinating more than once at night, strong urgent desire that support the to urinate, and increased frequency (voiding more than bladder and uterus 8 times in 24 hours). causing problems Some neurologic disorders prevent the bladder from such as urine emptying properly. Your bladder fills with urine yet you leakage. do not have the feeling to urinate or your bladder does not squeeze to make the urine come out. This type of bladder disorder can also be described as underactive, flaccid or atonic bladder and it can result in urinary retention, or the inability of the bladder to empty. Neurologic disorders or injuries can also cause the urinary sphincters to function improperly. They may not close or open at the right times; or may not close at all. In a condition called detrusor sphincter dyssynergia, the pelvic floor muscles contract and close the urethra when the bladder contracts, preventing the bladder from emptying. This can cause urine to flow up the ureters toward the kidneys, which can possibly damage the kidneys. 9 Bladder Problems (Cont’d) Urinary Tract Infections You may experience If you have a neurogenic bladder disorder you may these signs if you have occasional or frequent urinary tract infections have a urinary tract (UTIs). Urinary tract infections occur when there infection: is an increased amount of bacteria (or other microorganisms) inside the bladder lining, urethra, More frequent and kidneys. This may be the result of not emptying urination than normal the bladder completely. In men, urinary tract infections can also include the genitals, particularly Leakage of the prostate, seminal vesicles, epididymis, or urine between testicles. normal voiding or Timely Recognition catheterization It is important to contact your healthcare provider at Increased muscle the first sign of a urinary tract infection. spasms (if you are Not everyone develops these symptoms. If you spinal cord injured) are not feeling well or you suspect you have an infection, contact your healthcare provider. Fever Your urine will be tested and medications will be Back pain used if an infection is present. Be sure to take all of the antibiotic prescribed, and to contact your Milky, cloudy, or healthcare provider if your symptoms return. If you darkly colored urine experience frequent urinary tract infections, your healthcare provider may recommend additional tests or treatments.