Neuro Bowel/Bladder, Sexuality and W/c

The bladder can store _____mL of urine before stretch receptors on the wall signal fullness.

200-300

True or False. Spastic bowel/bladder is the same as saying reflexive bladder/bowel.

TRUE

The S2-S4 nerve root controls ______ and _______muscles. This is known as the level of _________activity.

external sphincter, pelvic floor; reflexive activity

After a complete SCI, what two bladder functions do we tend to "lose" (have problems with)?

voluntary control/sensory awareness of bladder being full, loss of coordinated system

During spinal shock, the bladder can be flaccid for ____weeks.

6-8

During spinal shock, the sphincter is _____(open, closed) leading to urinary retention. How can this be fixed?

closed; cath

What is affected in the bowel/bladder after an incomplete SCI?

depends on extent and level of lesion; sacral reflex arc and connection to brain impaired

What level SCI's are typically resulting in a spastic bladder/bowel? what about flaccid/areflexive?

spastic=cervical/thoracic

flaccid=at or below T12

What bladder dysfunction involves being able to signal when the bladder is full but struggles filling/emptying?

reflexive/spastic bladder

The S2-S4 reflexive arc is ____(in tact, absent/disrupted) with reflexive bladders, but the ability to connect to the brain is ____(in tact, disrupted)

in tact; disrupted

What is one thing you may want to be aware of when a patient has a cervical SCI with a spastic bladder?

may be triggered to go to the bathroom before filling at 200-300mL so may need more bathroom breaks

What are different ways a patient can trigger urine output when they suffer from a spastic bladder?

Additionally, what specific maneuver did we learn that could help?

tap abdomen, stroke inner thigh

crede maneuver (pressure to abdomen starting at belly button and pressing down)

What catheter is most common for long term bladder management? How long should you empty?

intermittent; every 4-6hrs

True or False. You canNOT use an intermittent catheter when in spinal shock.

FALSE You can

With areflexive bladder movements, the S2-S4 reflex is _______ and they ___(can, cannot) feel or signal when the bladder is full.

absent/diminished; canNOT

Stretching ____(increases, decreases) tone in the bladder.

decreases

True or False. With areflexive bladder movements, the bladder tends to fill less than the normal 200-300mL.

FALSE (can fill that or more cuz not enough tone to help signal reflex)

After a complete SCI, are bowel reflexes in tact? what about control and sensory awareness of fullness?

reflexes in tact! control/sensory awareness lost

When a patient is in spinal shock, their peristalsis with regards to bowel control ___(increases decreases) and defecation reflexes are ________

decreases; absent/diminished

With reflexive bowel movement, S2-S4 is ____(absent, in tact) and the anal sphincter is ___(open, closed) because of tone.

in tact; closed

True or False. reflexive bowel movement occurs at a specific time with a warning from when the rectum fills.

FALSE; occurs at any time without warning (may retain stool cuz no ability to release)

What nerve damage can we see with areflexive bowel movement? What type of tone do they have?

SC or peripheral nerve damage; low tone

Can the bowels empty on their own with areflexive bowel movement?

nah

How often should someone manage reflexive bowel movements? What about areflexive?

reflexive: daily or every other or 2x/week

areflexive: 1x/day

What is the best position for a patient to be in when managing reflexive bowel movements?

sitting or sidelying

What are the two components for a male to have and maintain a proper erection?

psychogenic, reflexive

the ________ component of erection helps maintain the erection whereas ________ is needed to initiate the erection.

psychogenic; reflexive

What is the inability to maintain erection sufficient for a partners sexual needs?

erectil dysfunction

What is the most common treatment for erectile dysfunction?

oral meds

What are the side effects for penile injection therapy when trying to treat ED?

there aren't any!

What erectile dysfunction treatment is more direct and a suppository?

MUSE (medical urethral systemic erection)

What treatment for ED is known as the "last resort"

surgical implant

If a male wants to freeze his sperm how quickly does he need to do this after a SCI? What is the other option if he doesn't wanna freeze?

6-12 days; PVS (penile vibratory system), or probe

Is fertility an issue for women post SCI?

nah not once their period resumes

The psychogenic portion of arousal focuses on the brain signaling to levels ______ whereas reflexive focuses on nerve roots _____

T10-L2; S2-S4

True or False, a female with a SCI will have to deliver a baby via cesarean section

FALSE gotta do natural

What is the key to an effective/efficient propulsion (in w/c)?

POSTURE!

What muscle length can tell us how far a patient can lean forward?

hamstring

IF hamstrings are tight in a SCI patient, what may they be at increased risk for?

sacral wound and poor posture

Can you have a patient trial a wheelchair?

YES

When looking at the seat of a wheelchair why do we want a stable base?

in order to support pelvis

The back rest of a wheelchair can help promote what two things?

stability and mobility

Why may a patient have a curved back on their wheelchair?

to clear the scaps and they have good balance

If a patient seems to be slouching in their wheelchair, is there a way to alter the chair to help their posture?

sometimes have straps on back to alter seat

Why are cushions important on a wheelchair?

pressure relief

What are the 2 key things we want to look at when assessing proper leg positioning in a wheelchair?

feet flat on foot rest; femurs supported

how can we tell the femurs are supported by the wheelchair?

2 fingers can fit b/t seat and popliteal fossa (2in off femur length)

Where should a patient's shoulders be aligned with regards to the axle when sitting in a wheelchair?

either vertical or just in front of axle

bob has been coming to your clinic in outpatient and is 7 months post injury. when assessing his fit in his wheelchair, you notice his shoulder alignment is slightly behind the axl of the wheel. Should you fix it?

not necessarily because it can help with wheelies

Overall what should the placement of the wrist and shoulder look at right before a person pushes their wheel chair? what about when they release?

wrist neutral, shoulder extension 10-20 (2:00)

release at 11:00

Is a rigid manual wheelchair or folding chair better for patients?

rigid cuz lets you use all push power

What term describes how far apart the wheels are on a wheel chair (aka the angle)? What are the pros and cons to having a large angle?

camber

pro: more stability, easy push

con: may not fit through door

what wheel camber angle will allow for a patient to most likely fit through the door ?

3-5 degrees

What are the front wheels on the wheel chair called? what is the happy medium size of them?

caster; 3-4in

What are the 2 power assist options a patient can add to their manual chair? Which does not change the weight of the chair?

smart drive, e motion; smart drive does not change weight of chair

What category of wheel chair is used for a C4-5 patient who can't push? What are the 3 specific types?

power wheelchair; rear wheel, mid wheel*, front wheel (=most common)

Why are midwheel and front wheel power chairs better than rear?

smaller turn radius so good inside and out