Neurogenic bladder dysfunction can be common in patients suffering from a variety of medical conditions; most commonly, neurological conditions. A person with multiple sclerosis (MS) will have a 40 to 90% chance of developing neurogenic bladder dysfunction, and instances are just as high in people with Parkinson’s disease, spinal cord injuries and strokes (Dorsher & McIntosh 2012).
The term neurogenic bladder dysfunction is the overlying term for a variety of lower urinary tract disorders that are caused by a disease or an injury that has disrupted normal neurological function (Mauk 2012).
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 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 dysfunction such as urinary incontinence and retention (Mauk 2012).
Dependent on the aetiology and classification of the neurogenic bladder dysfunction, the individual may experience a variety of symptoms, which commonly include:
(Greenwood et al. 2013)
A neurogenic bladder can be classified in many ways, however, generally classification is based 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)
Not only are there physical complications related to neurogenic bladder dysfunction, there can also be negative psychosocial effects present in the individual. These can include a decrease in the individual’s quality of life, and feelings of embarrassment and depression that can further lead to social isolation – devastating in the case of someone with a progressive neurological condition (Ginsberg 2013).
Some potential complications of neurogenic bladder dysfunction include:
Management of neurogenic bladder dysfunction 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 the management of neurogenic bladder dysfunction through patient education and support as they learn techniques and strategies for their management of this condition.
The main focus of management is on 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 dysfunction 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. The use of self-administered intermittent catheterisation has many benefits over an indwelling catheter, including enhancing the patient’s independence and confidence with self care, and reducing 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 occurring being urinary tract infections (Ginsberg 2013).
An indwelling catheter or suprapubic catheter can also be used, and once again, patient education is essential for catheter care on discharge. This is not the preferred method of bladder management in the long-term for a patient, however, it may be the most effective and practical solution for people with poor hand function, high fluid intake, lack of support and 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 2013).
Surgical interventions are generally implemented as a last resort and include procedures such as transurethral sphincterotomies and enterocystoplasties (Ginsberg 2013).