Which focus is the nurse most likely to teach for a client with a flaccid bladder?

Neurogenic bladder is bladder dysfunction (flaccid or spastic) caused by neurologic damage. Symptoms can include overflow incontinence, frequency, urgency, urge incontinence, and retention. Risk of serious complications (eg, recurrent infection, vesicoureteral reflux, autonomic dysreflexia) is high. Diagnosis involves imaging and cystoscopy or urodynamic testing. Treatment involves catheterization or measures to trigger urination.

Any condition that impairs bladder and bladder outlet afferent and efferent signaling can cause neurogenic bladder. Causes may involve the central nervous system (eg, stroke Overview of Stroke Strokes are a heterogeneous group of disorders involving sudden, focal interruption of cerebral blood flow that causes neurologic deficit. Strokes can be Ischemic (80%), typically resulting... read more

In flaccid (hypotonic) neurogenic bladder, volume is large, pressure is low, and contractions are absent. It may result from peripheral nerve damage or spinal cord damage at the S2 to S4 level. After acute cord damage, initial flaccidity may be followed by long-term flaccidity or spasticity, or bladder function may improve after days, weeks, or months.

In spastic bladder, volume is typically normal or small, and involuntary contractions occur. It usually results from brain damage or spinal cord damage above T12. Precise symptoms vary by site and severity of the lesion. Bladder contraction and external urinary sphincter relaxation are typically uncoordinated (detrusor-sphincter dyssynergia).

Mixed patterns (flaccid and spastic bladder) may be caused by many disorders, including syphilis Syphilis Syphilis is caused by the spirochete Treponema pallidum and is characterized by 3 sequential clinical, symptomatic stages separated by periods of asymptomatic latent infection. Common... read more

• Postvoid residual volume

• Renal ultrasonography

• Serum creatinine

• Usually cystography, cystoscopy, and cystometrography with urodynamic testing

Diagnosis is suspected clinically. Usually, postvoid residual volume is measured, renal ultrasonography is done to detect hydronephrosis, and serum creatinine is measured to assess renal function.

Further studies are often not done in patients who are not able to self-catheterize or ask to go to the bathroom (eg, severely debilitated older or post-stroke patients).

In patients with hydronephrosis or nephropathy who are not severely debilitated, cystography, cystoscopy, and cystometrography with urodynamic testing are usually recommended and may guide further therapy.

• Cystography is used to evaluate bladder capacity and detect ureteral reflux.

• Cystoscopy is used to evaluate duration and severity of retention (by detecting the degree of bladder trabeculations) and to check for bladder outlet obstruction.

• Cystometrography can determine whether bladder volume and pressure are high or low; if done during the recovery phase of flaccid bladder after spinal cord injury, it can help evaluate detrusor functional capacity and predict rehabilitation prospects (see Testing: "In cystometrography..." Testing ).

Urodynamic testing Testing of voiding flow rates with sphincter electromyography can show whether bladder contraction and sphincter relaxation are coordinated.

• Catheterization

• Increased fluid intake

• Drugs

• Surgery if conservative measures fail

Prognosis is good if the disorder is diagnosed and treated before kidneys are damaged.

Specific treatment involves catheterization Bladder Catheterization Bladder catheterization is used to do the following: Obtain urine for examination Measure residual urine volume Relieve urinary retention or incontinence Deliver radiopaque contrast agents or... read more or measures to trigger urination. Intermittent catheterization is preferred to continuous catheterization whenever possible. General treatment includes renal function monitoring, control of urinary tract infections Introduction to Urinary Tract Infections (UTIs) Urinary tract infections (UTIs) can be divided into upper tract infections, which involve the kidneys ( pyelonephritis), and lower tract infections, which involve the bladder ( cystitis), urethra... read more (UTIs), high fluid intake to decrease risk of UTIs and urinary calculi Urinary Calculi Urinary calculi are solid particles in the urinary system. They may cause pain, nausea, vomiting, hematuria, and, possibly, chills and fever due to secondary infection. Diagnosis is based on... read more (although this measure may exacerbate incontinence), early ambulation, frequent changes of position, and dietary calcium restriction to inhibit calculus formation.

• Damage to the neural pathways that control voiding can render the bladder too flaccid or spastic.

• Flaccid bladder tends to cause overflow incompetence.

• Spastic bladder tends to cause frequency, urge incontinence and, particularly with detrusor-sphincter dyssynergia, retention.

• Measure postvoid residual volume, do renal ultrasonography and serum creatinine measurement, and in many patients, do cystography, cystoscopy, and cystometrography with urodynamic testing.

• Treatment for flaccid bladder includes increased fluid intake and intermittent self-catheterization.

• Treatment for spastic bladder may include measures to trigger urination and/or measures used to treat urge incontinence (including drugs).