Neurogenic Bladder and Bowel Management

Introduction

Signals between the brain and the rest of the body are transmitted via the spinal cord. The spinal cord comprises 31 nerve bundles rather than a single literal ‘cord.’ However, a partial or total spinal cord injury can impair an individual's capacity to manage multiple systems and muscle activities, which include bladder and bowel control. Many people who have survived spinal cord injuries deal with these conditions but often feel embarrassed to discuss them with their doctors or family.

What Is Neurogenic Bladder or Bowel?

A spinal cord injury can occasionally disrupt communication between the brain and the spinal cord's nerves, controlling bowel and bladder function. This may result in neurogenic bladder or neurogenic bowel dysfunction, which affects both the bladder and the gut. In a neurogenic bowel, normal bowel function is lost, which affects the upper or lower gastrointestinal tract rather than the bladder (as in neurogenic bladder). People with conditions like spina bifida (a condition usually seen at birth that affects the baby’s spine) or multiple sclerosis (a condition that affects the protective covering of the nerves) may also have a neurogenic bladder or bowel.

What Are the Symptoms of a Neurogenic Bladder?

The signs and symptoms of a neurogenic bladder may include:

• Bladder control is affected.

• Not able to empty the bladder.

• The frequency of urination may increase.

• Higher risk of urinary tract infections.

• Pressure on the bladder increased.

• Hampered quality of life.

• Kidney issues.

What Are the Symptoms of a Neurogenic Bowel?

• Loss of bowel control.

• Abdominal pain.

• Constipation.

• Diarrhea.

• Irregular bowel.

• Infrequent bowel.

• Autonomic dysreflexia (a condition that occurs due to the injury to the sixth thoracic vertebra).

• Lack of bowel movements.

How Are These Conditions Treated?

Certain factors determine the course of treatment for neurogenic bladder and bowel. But there is not a ‘cure’ for the illness. Individuals who have neurogenic bladder and bowel disorders usually learn to adjust their daily routines to accommodate bladder and bowel management procedures. The Urology Care Foundation states that the doctor's choice of treatment for neurogenic bladder will be based on several criteria, which include:

• The cause of the nerve damage.

• Age of the patient.

• The overall health of the patient.

• The symptoms of the condition.

• The severity of the conditions.

• Therapies were done for the condition.

• The tolerance of the patient.

• The patient’s expectations of the treatment.

The treatment options for neurogenic bladder conditions include:

• Changes In Lifestyle: Bladder control can be improved by planning regular toilet breaks, avoiding foods and beverages that can irritate the bladder, and engaging in activities that strengthen the bladder muscle.

• Medicines: The healthcare provider might recommend medication to help with bladder function. These drugs may lessen the frequency of urination, improve bladder control loss, enhance bladder storage, lessen the urge to urinate or assist in emptying the bladder.

• Botox Injections: The frequency of bladder contractions may be decreased by injecting this medication (Botulinum) into the bladder muscle. Repeat these injections around every six months as they wear off over time.

• Clean Intermittent Catheterization (CIC): In this procedure, a thin tube is inserted into the bladder multiple times a day to empty the bladder. The patient or a medical practitioner can do this. This tube passes through the urethra.

• Continuous Catheterization: To consistently empty the bladder, a medical practitioner may place a catheter through the patient's urethra or abdominal wall.

• Stimulation Therapy: It consists of Percutaneous Tibial Nerve Stimulation (PTNS) and Sacral Neuromodulation (SNS) therapy. They frequently treat neurogenic bladder symptoms when lifestyle modifications and medicines are ineffective. These two methods require attaching gadgets to the nerves that regulate the regulation of the bladder. The bladder is controlled by electrical impulses sent by these devices.

• Surgery: Surgery to reconstruct the bladder can be performed by medical professionals skilled in bladder care, which may alleviate or improve bladder problems. Creating an artificial sphincter, bypassing the bladder, enlarging the bladder, and excising the weaker portion of the sphincter are among the various surgical procedures that could be carried out.

Treatment options for a neurogenic bowel include:

• Lifestyle Changes: Improving bowel control can be achieved through dietary modifications and journaling the foods and beverages that aggravate the symptoms. Having daily bowel movements on a regular schedule can also be beneficial.

• Oral Medication: To control the frequency and regularity of bowel motions, a healthcare provider can recommend taking medication. Oral laxatives are commonly utilized, although they have yet to be thoroughly investigated in the neurogenic population. Prokinetic drugs facilitate High-Amplitude Propagating Contractions (HAPCs), which speed up colonic evacuation.

• Anal Irrigation: The more recent conservative approach to managing the bowel is anal irrigation. A catheter that contains an inflatable balloon is used to provide fluid, which helps with efficient bowel movement and management and also reduces constipation.

• Abdominal Massage: In patients with spinal cord injury, abdominal massage was observed to improve several elements of neurogenic bladder dysfunctions (abdominal distention, fecal incontinence, and colonic transit time) in an uncontrolled clinical investigation. A more recent trial utilizing an electromechanical device for abdominal massage revealed mixed results in terms of overall satisfaction and device confidence.

• Biofeedback Therapy: Exercises designed to strengthen pelvic floor muscles and enhance bowel control are performed on a machine as part of this treatment. Anorectal biofeedback provides motor and sensory retraining through exercises guided by manometry, utilizing operant conditioning.

• Nerve Stimulation: In this mode of treatment, the sacral nerves that regulate the bowels are stimulated electrically by a tiny battery-powered gadget.

• Suppositories: Glycerin suppositories and Bisacodyl are frequently used in the conservative treatment of neurogenic bladder. Three trials comparing hydrogenated vegetable oil and Polyethylene Glycol (PGB) based bisacodyl suppositories have shown shorter times for bowel care, flatus, and feces. While suppositories can stimulate the rectal area, people with weak anal tones may find them difficult to maintain.

• Surgery: To address issues with intestinal management, surgeons with experience in bowel surgery may undertake reconstructive surgery.

Conclusion

Patients with neurologic disorders frequently have problems with their bowel and urine systems, which lowers their quality of life. Bowel dysfunction treatment is highly variable and has received little research. Treatment goals are to minimize time spent using toilets, prevent complications (such as urinary tract infections), prevent fecal incontinence, and improve quality of life. The initial lines of treatment are laxative manipulation, bowel regimen customization, and lifestyle interventions.