B l a d d e r & B o w e l C a r e. For Patients with Spinal Cord Injuries

Transcription

1 B l a d d e r & B o w e l C a r e For Patients with Spinal Cord Injuries 1

2 Bladder Specific Care Intermittent Catheterization (IC) is used to empty the bladder with a catheter. A catheter is a tube that is inserted into the urethra (where urine exits) that leads into the bladder to empty it. IC should be completed approximately 5 times a day or more and should occur every 4 to 6 hours. Starting a routined schedule of when to perform the IC may be useful, and how many times you need to cath may change depending on how much fluid you drink. Why is IC so important? It prevents infections of the kidneys and bladder. If you do not have sensation (feeling) in your bladder, you may not know when you need to empty it. Therefore, IC is a way to monitor the frequency of emptying your bladder and can help to prevent leaks and infections that may occur if the bladder is not properly emptied throughout the day. What position should I be in for IC? Comfort is the most important factor when performing cathing. Therefore, choose the best option for you based on the pictures below. What supplies do I need? Soap, water, and towel for cleanup and infection precautions Catheter Urine collection container 2

3 How do I know which catheter to use? Talk to your doctor about the best catheter option for you. There are different sizes, types, and prices available, and sometimes a lubrication may be needed. How do I manage my catheter? Do not remove unless directed by health care Wash hands with soap and water before handling the catheter If the foley accidently disconnected- clean both ends with alcohol pad Empty catheter every 4-8 hours or more frequently if needed What are some problems that I may run into with IC? Infections Poor bladder management is a leading cause of hospitalization in people with spinal cord injuries. Urinary tract infections (UTI) are common in individuals with SCI, especially in those who are developing a new bathroom or catheterization schedule. A UTI are caused by bacteria, which often grow in urine if it is not fully released from the bladder. Symptoms of infection may include: Fever greater than 101 degrees Chills Autonomic dysreflexia Nausea Headache Burning with urination Confusion Leaking between IC Blood in the urine Increased spasticity Image: 3

4 How can I prevent a UTI? Empty your bladder on schedule each day Always wash your hands before catheterization Always make sure your private areas are thoroughly cleaned Wash skin around catheter daily with soap and water after each bowel Drink plenty of fluids, especially water (6-8 glasses), each day Cranberry juice can be helpful in preventing a UTI Limit soda, coffee, and other caffeinated drinks What should I do if I think I have a UTI? UTI is a very serious condition and should treated by your doctor as soon as possible. The most common treatment is antibiotics. Bladder management video from Christopher and Dana Reeve Foundation: Patient learning module: Autonomic Dysreflexia (AD) is a bodily response caused by something causing the body pain. There are many symptoms that can present if AD is occurring: Rise in blood pressure Sudden and pounding headache Sweating Goose bumps Nausea Blurred vision What are some common causes for AD? Bladder fullness (#1 cause) Infections Tight fitting clothing Full bowel Pressure sores Ingrown toenails What steps can you take if you experience AD? Call for help Sit up if you aren t already Check your catheter or empty your bladder Do your bowel program Skin check for sores or pressure, along with checking of nails 4

5 Unable to insert catheter This problem may be resolved with the use of lubricant. If not, it may be more of an internal issue and this can be discussed with your doctor. Catheters What are catheters made of? Silicone Latex Rubber Plastic What are the different types of catheters? Indwelling : This type of catheter is located inside of the bladder and are also referred to as Foley catheters 5

6 Suprapubic : This is a catheter that is inserted into the bladder through a hole in the abdomen External (Condom Catheters) : These catheters are placed on the outside of the body. These are for the use of men only. Intermittent : This type of catheter is inserted for a brief period of time for the emptying of the bladder. Once this task is complete, the catheter is then removed. 6

7 Bowel Specific Care Importance of Bowel Management Setting up certain time each day to perform a bowel movement will allow you perform daily life activities without worrying about accidents, embarrassment, uncleanliness and the negative impacts of constipation. Know your Bowel Type Reflexive Bowel refers to when your bowel empties on its own. This may require the use of fecal incontinence pads (diapers) to manage unexpected bowel movements. Areflexive Bowel refers to when your bowel does not empty on its own. This can cause stool to get stuck in the colon. Someone with an areflexive bowel will require digital stimulation (described below) or other methods to have a bowel movement. Bowel Retraining In the initial time after your injury, your bowel will most likely be areflexic, which will require you to use a manual technique to make yourself have a bowel movement. Talk to your doctor if you experience any vomiting or difficulty breathing as this might be a sign of a serious problem. With clearance from your doctor, a bowel training program can be initiated. This process teaches the bowel to empty at the same time each day or every other day. Choose a time of day that will allow you time to complete the bowel program. For those with a reflexive bowel, the bowel movement should be started with the use digital stimulation of the rectum, use of a suppository, or both techniques. For those with an areflexic bowel, you must manually remove fecal from the rectum. To aid in this, you can contract any available abdominal muscles, insert a suppository several minutes before the manual evacuation of the stool, or use both techniques. How to Perform Digital Stimulation What is digital stimulation? It is a technique that is used to start the flow of urine or a bowel movement. How do I perform digital stimulation? This is performed by using one of your fingers and inserting it into the rectum. Once the finger has been put in, it can be moved in a circular motion, which will hopefully stimulate the rectum wall to cause a bowel movement to occur. 7

8 Do I have to be in a certain position to perform digital stimulation? Typically, it is performed on the toilet, a wheelchair, or lying on the left side. Do I need any supplies? Gloves Plastic bag or pads for waste, if not sitting on toilet Lubricant as needed Other tips to helping bowel movements occur: Plenty of fluid intake Eat enough fiber Exercise regularly Keep track of when you go to the bathroom, and how much you go Tips for Naturally Promoting Bowel Movements Stay active Abdominal massage in a clockwise direction along the direction of the large intestine (See picture below) Perform bowel program seated in an upright or forward lean to assist the movement of the feces Drink adequate amounts of water and eat food that will promote the consistency of feces that is best for the type of bowel that you have For those with areflexive bowels, it is best for feces to be firm but not hard. For those with reflexive bowels, it is best for feces to be formed and soft. 8

9 Diet for a Healthy Bowel Insoluble fiber can help add bulk to your stool and help it move through your body. Soluble fiber can help with constipation. This type of fiber can be found in: Image adopted from: 9

10 Bowel Stimulating Medication Is there something that can help me go when I can t go on my own? Yes! Things that can help you go would be known as bowel stimulants. There are many different brands and types. The most common types that you will likely encounter are stool softeners, laxatives and suppositories. What is a stool softener? It is a pill or a powder that you can take by mouth that will soften your stool so that when you attempt to use the bathroom, everything comes out a bit easier. If your stool becomes too soft, dosage changes may be necessary. What is a laxative? This is a pill or a powder that helps to get everything moving in preparation for a bowel movement. What is a suppository? This is a small pill that is inserted into the rectum. It is more frequently used by spinal cord injuries T12 and above. Another option to help with performing a bowel movement is an anesthetic ointment It is a jelly like substance that is used to help prevent symptoms of autonomic dysreflexia that may occur while having a bowel movement. Only about a size of a quarter is necessary. The jelly should be applied inside of the rectum. Once the jelly is applied, the suppository and bowel treatment can then begin. Additional Options to Bowel Management Functional Electrical Stimulation Bowel movement can also be stimulated by the use of a low-wattage electrical impulse to either the sacral nerves or the abdominal muscles Colostomy or Ileostomy If standard bowel management is not an option, a surgical procedure may be performed which connects the colon to an external, removable bag for the collection of feces. 10

11 Overflow vs. spasticity What is overflow/flaccid bladder? Bladder: when reflexes of the bladder are absent or delayed in those with injury below T12. When the bladder is too full damage can happen to the bladder wall, increasing the risk for infection. Bowel : For spinal cord injuries below T12, the muscle is relaxed making it hard to have a bowel movement What is spasticity? Bladder : This usually occurs with cord injuries above T12 level in which you have no control over when the bladder empties, the bladder fills and is emptied uncontrollably. Bowel : For spinal cord injuries above T12, the ability to sense bowel movement and stop it from occurring is lost and frequent leakage is likely to occur. Planning and Practicality Helpful tips for those on a bladder and/or bowel programs in the real world Look up destinations online or call to see if the restrooms are ADA compliant Bring extra clothing to outings in case of accidents Monitor your fluid and food intake while in situations that may not allow you to perform your bladder and bowel programs Install adaptive equipment to help make the bowel program effortless and safe (toilet cushion, grab bars) 11

12 Real World Examples/Cases Bowel Stimulant after SCI: Bowel Digital Stimulation: Bladder management from Christopher and Dana Reeve Foundation: Patient learning module: Resources: agement patient-carer-section 12