Bladder Managment for Adults with Spinal Cord Injury - 16

BLADDER MANAGEMENT FOR ADULTS WITH SPINAL CORD INJURY

uate for vesicoureteral reflux, and cystoscopy to evaluate bladder anatomy. It should be noted that urodynamics is an important evaluation for determining bladder function. Unfortunately, history, level of injury, and signs and symptoms alone are not enough to determine if a person is experiencing high intravesical pressures, which may cause renal complications over time.

cytes (increased white blood cells, or WBCs) in the urine generated by the mucosal lining (on rare occasions gram positive bacteria do not provoke a WBC response); (2) discomfort or pain over the kidney or bladder, or during urination; (3) onset of urinary incontinence; (4) increased spasticity; (5) autonomic dysreflexia; (6) cloudy urine with increased odor; (7) malaise, lethargy, or sense of unease (NIDRR Consensus Statement, 1992).
AUTONOMIC DYSREFLEXIA

U ro l o g y F o l l o w - u p
No studies have been done on the optimum frequency of follow-up evaluations. Many medical centers evaluate upper and lower tract functioning on an annual basis. Urological evaluations are done more frequently if an individual is having problems, changing medications, or altering bladder management in some way.
D E F I N I T I O N O F U R I N A RY T R A C T INFECTION

Urinary tract infections (UTIs) are mentioned throughout the guideline. Because of the number of definitions of urinary tract infections that exist, the guideline development panel decided to use the definition for symptomatic UTIs agreed upon by the National Institute on Disability and Rehabilitation Research (NIDRR) Consensus Statement, “Prevention and Management of Urinary Tract Infection among People with SCI” (1992). This definition states that three criteria must be met for an individual to be considered as having a UTI: (1) significant bacteriuria, (2) pyuria (increased white blood cells in the urine), and (3) signs and symptoms. Criteria for significant bacteriuria (the number of bacteria that signify that the bacteria are truly from the bladder and not just a contaminant) depend on the method of bladder management being used: For those on intermittent catheterization = 102 colony forming units (cfu). For those using clean-void specimens from catheter-free males who use external condom collecting devices = 104 cfu. For those with specimens from indwelling catheters, any detectable concentration (Gribble, 1994). Because a UTI implies bacteriuria with tissue invasion, leukocytes in the urine (pyuria) are generated by the mucosal lining. This tissue invasion also results in signs and symptoms, which may include one or more of the following: (1) leuko-

Autonomic dysreflexia is another term mentioned throughout this guideline. Autonomic dysreflexia can occur in individuals who have a spinal cord injury at thoracic level 6 (T6) or above. It occurs as a result of any noxious stimuli. The most common causes are bladder distention (which provokes uninhibited bladder contractions and sphincter dyssynergia) and bowel problems such as constipation and impaction. The most dramatic problem associated with autonomic dysreflexia is a sudden severe elevation in blood pressure. Those with an SCI at or above T6 frequently have a normal systolic blood pressure in the 90–110 mm Hg range. Autonomic dysreflexia is frequently defined in adults as a systolic blood pressure greater than 140 mm Hg. Another definition is a systolic blood pressure 20 to 40 mm Hg above baseline. Systolic blood pressures elevations more than 15–20 mm Hg above baseline in adolescents with SCI or more than 15 mm Hg above baseline in children may be a sign of autonomic dysreflexia. Other common problems that can occur in autonomic dysreflexia include severe headache, sweating, flushing, goose bumps, chills, feelings of anxiety, and a slower pulse rate. However, about 30 percent to 40 percent of people with autonomic dysreflexia have elevated blood pressures with few if any other symptoms (silent dysreflexia). If autonomic dysreflexia occurs, immediately sit the person up (if the person is supine), loosen any clothing or constrictive devices, monitor the blood pressure and pulse frequently, and quickly survey the individual for possible causes, beginning with the urinary system. If the cause is not obvious, seek immediate emergency treatment. For more information on autonomic dysreflexia see: www.guideline.gov/search. A written copy of the guideline may be downloaded for free at www.pva.org.

http://www.guideline.gov/search http://www.pva.org

Bladder Managment for Adults with Spinal Cord Injury

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