BOWEL / BLADDER

DYSFUNCTION
Urinary and bowel dysfunction are frequent problems experienced by the neuro client.
Goals of Management: Control of incontinence
Establishment of regular elimination patterns
Etiology:
• Actual impairment of the neurological system
o Spinal cord injuries; Multiple Sclerosis; Parkinson’s
• Cognitive Impairment
o CVA; Head Injury: Brain Tumor
• Inability to reach the toilet in time due to mobility problems resulting from neuro deficits
o CVA; etc.

BLADDER DYSFUNCTION
• Neurogenic Bladder: Bladder disturbance that results from a lesion of the nervous system
• Bladder function is controlled by spinal segments S2, S3, and S4 and is also under the control
of the higher centers in the cerebral hemispheres.

ASSESSMENT
• I&O
• Voiding Pattern – Current and previous
• Urinalysis including culture
• Level of Consciousness; Cognitive function
• Palpation of the bladder for distention
• Presence of risk factors – NPO status; Fluid restriction

NURSING DIAGNOSES
Based on assessment data
• Urinary Retention
• Incontinence:
o Reflex (Neurogenic)
 Associated with spinal cord lesions which interrupts cerebral control of voiding
o Functional
 Individuals with intact excretory physiology who experience mobility impairment,
environmental barriers, or cognitive problems (unable to reach toilet or call for
assistance)
o Total
 Individuals who are unable to control excreta due to physiologic or psychological
impairment
• Self Care Deficit: Toileting

NURSING MANAGEMENT
• Bladder retraining programs
• Indwelling catheter insertion and care
• Intermittent catheterization
• Condom catheters
 • Increase fluids unless contraindicated
• Leaning forward: Crede maneuver
• Provide privacy
• Barrier free access to toilet or provide means to call for assistance
BOWEL DYSFUNCTION
Defecation is a coordinated reflex of spinal segments S3, S4, and S5

ASSESSMENT
• Bowel elimination patterns – Current and previous
• Check bowel sounds
• Assess for bowel distention
• Presence of risk factors
o Fluid restriction; prolonged immobility; NPO status; decreased bulk in diet; spinal
nerve compression; lack of sensation; altered LOC; cognitive deficits

NURSING DIAGNOSES
• Constipation
• Diarrhea
• Incontinence, Bowel
• Self Care Deficit: Toileting

NURSING MANAGEMENT
• Bowel programs
• Barrier free access to toilet
• Digital stimulation
• Positioning
o Initiation of Valsava maneuver; Push-up on toilet; Leaning forward
• Dietary Considerations
o Increase In fluid and bulk
• Increasing activity and exercise
• Provide Privacy
• Administer medications as ordered
o Bulk Formers: Metamucil
o Stool Softeners: Colace
o Mild Laxatives: MOM, Exlax
o Suppositories: Glycerine, Dulcolax
• Enemas may be ordered and necessary