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Bladder, Bowel and Sexual Function with SCI - Coggle Diagram
Bladder, Bowel and Sexual Function with SCI
Bladder Function
Micturition control: S2, 3 and 4
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Goal of Bladder Management: prevent or minimize urinary tract complications including-
- UTI - 60% or more pple will get UTIs in first year post-injury
- Hydronephrosis
- Renal Calculi
- Bladder Calculi
- Vesicouretheral reflux
Bladder Management
Indwelling Catheter:
- changed every 3-4 weeks
- maintained until urine output is consistently 1500-2000 mL/day (acute SCI)
- stop intake late in day
- Bladder volume < 500-600 mL
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Influence of level of Injury:
- C6 or higher will need assistance with ICP and may choose indwelling or Suprapubic
- C7 or lower may become independent in ICP
ICP:
- Strict Fluid Schedule
- 2000mL from 7am to 7pm
- Avoid diuretics
- Straight cath every 4 hours
- Adjust per MD
- Cath volume 500-600cc per cath (if have more do in baby steps of 500cc at a time or can throw into A.D.
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Complications of Bladder Dysfunction
- UTI (super infections by not finishing antibiotics)
- Renal Calculi
- Urethral Strictures
- Enlarged Prostate
- Latex Allergies
- Penile and scrotal fisulas
- Urethral divertiuculum
- Reflux
- Hydronephrosis
- Autonomic Dysreflexia
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Sexual Function
Sexual Capabilities:
- UMN (damage above S2-4: have reflexive erection with physical stimulation unless S2-4 pathway was damaged
- LMN (damage involving T12/L1) more psychogentic erection
Types of Erections (male)
- Greater in UMN than LMN
- Greater in ISCI than CSCI
- Reflexive: in response to external physical stimulation (intact reflex are required (S2-4)
- Psychogenic: thru cognitive activity such as erotic fantasy, mediated from cerebral cortex thru thoracolumbar or sacral cord centers
Ejaculation (male)
- LMN>UMN at achieving
- ISCI> CSCI
- Low fertility with impaired spermatogenesis and inability to ejaculate
- Vibratory Stimulation and electroejaculation have higher semen quality for fertility purposes
Orgasm
- Orgasm= a cognitive, psychogenic event
- Ejaculation= physical occurrence
- 45% males with SCI report achieving orgasm
- Limited data on female orgasm due to less pt with SCI are female
Female Sexual Dysfunction
- UMN: components of sexual arousal (vaginal lubrication, engorgement of labia, clitoral erection) will occur reflexogenic stimulation but not psychogenic response is lost
- LMN: psychogenic response be preserved and all reflex responses lost (need to use lubrication to protect pt perianal tissues during vaginal penetration)
- 4-5 mos post-injury pt will be in period of amenorrhea but after fertility is unaltered
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Sperm Retrieval
- Penile Vibratory Stimulation (PVS)
- Electroejaculation (EEJ)
- Surgical Sperm Retrieval
- Prostate Massage
Birth Control
- Oral contraception (high thromboembolism risk): Progesterone only is safer than estrogen w/ progesterone
- Condoms (safest option for pt with SCI as long as they can trust their partner to use them)
- Diaphragm (difficult for higher tetras with minimal hand function)
- IUD: high migration risk and risk of Pelvic Inflammatory Disease so not the best option of SCI pt
Bowel Function
Goal: Safe and predictable emptying at a socially acceptable time and place - avoid constipation, unplanned evacuations and autonomic dysreflexia
- Complete under 1 hour
- Healthy skin
Bowel function controlled by: S2,3,4
Bowel Management
UMN Bowel
- reflexive/spastic bowel
- spinal cord lesion above S2
- PSNS from S2-4 are intact and reflex defecation occurs when rectum fills with stool
- Use of suppositories, mini enema and dig stim (manual stretch of anal sphincter
- Valsalva and massage
- May empty daily or every other day
LMN Bowel
- flaccid/areflexive bowel (Cauda equina)
- PSNS of S2-4 are NOT intact so no reflexive emptying
- Feces can impact and incontinence can occur if flaccid external sphincter)
- Relies on manual evacuation and gentle Valsalva
- 2x/day (after meals)
- use the gastrocolic reflex, dig stim, manual evacuation, bending side to side, massage, pressure relief, Valsalva
Managing Bowel Care
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If suppositories, mini-enema or rectal solution then wait 30 minutes
Use Abdominal Massage - Do siting up or lying on left
- Up on the Right
- Across
- Down on the Left
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