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Paralysis at any level almost always affects the function of the bladder and intestines. This happens because the nerves that control these internal organs are attached to the very base of the spinal cord (levels S2–4) and are therefore isolated from the information sent by the brain.
Although it is not always possible to regain the same control that one had before paralysis, there is a wide range of techniques and tools available to control bladder function.
Functioning of the bladder
Urine is the excess water and salts that the kidneys remove from the bloodstream. From the kidneys, urine is pumped through thin tubes called ureters, which normally allow urine to flow only one way. The ureters connect to the bladder, which is basically a storage bag. When the bladder is full, the nerves send a message through the spinal cord to the brain.
When you're ready to go to the bathroom, the brain sends a message back through the spinal cord to the bladder, telling the detrusor muscle (the wall of the bladder) to contract and the sphincter muscles, a valve that surrounds the part upper part of the urethra, to relax and open. The urine then passes through the urethra to leave the body. The simple act of urination consists of a fairly sophisticated muscle coordination process.
After paralysis, however, the body's normal bladder control system goes haywire; It can no longer exchange messages between the muscles of the bladder and the brain.
It is quite common for people with multiple sclerosis to have some problems with bladder control. This can involve small urine leaks when sneezing or laughing, or even total loss of control. Proper clothing, absorbent pads, and incontinence devices are helpful in managing a lack of control.
After a spinal cord injury, the neurogenic bladder is affected in one of two ways: the spastic bladder (reflex) and the flaccid bladder (non-reflex).
Spastic bladder (reflex)
The spastic (reflex) bladder condition occurs when the bladder fills with urine and a reflex automatically triggers the emptying of the bladder. Spastic bladder generally occurs when the injury is above the T12 level. With a spastic bladder, the patient does not know when or if the bladder will empty.
Flaccid bladder (does not reflect)
Flaccid (non-reflex) bladder condition occurs when the reflexes of the bladder muscles are slow or absent. If the patient does not feel when the bladder is full, the bladder may become overstretched or overstretched. Urine can flow back through the ureters to the kidneys (this is called reflux). Stretching also affects the muscle tone of the bladder.
Dysynergia occurs when the sphincter muscles do not relax as the bladder contracts. Urine cannot flow through the urethra, and this can force it back into the kidneys. Also, the bladder may not empty completely. Treatments include medicine or surgery to open the sphincter.
Treatments
The most common methods of emptying the bladder are the intermittent catheterization program (ICP); the drainage (Foley) catheter and a condom-type external catheter for men.
There are several surgical alternatives for bladder dysfunction. The Mitrofanoff procedure builds a new pathway for urine using the appendix. This allows catheterization to be done through the abdomen into the bladder, a great advantage for women and for people with limited hand functions.
Bladder augmentation is a procedure that surgically enlarges the bladder (using a portion of the intestines) to reduce the need for frequent catheterizations.
Sphincterotomy reduces pressure on the valve, thus allowing urine to flow more easily out of the bladder. There is a possibility that the operation will affect a man's ability to get a reflex erection. This operation is not normally done in women.
Urinary tract infection
People with paralysis are at high risk of getting urinary tract infections (UTIs). The source of infection is bacteria (a group or colony of small, microscopic, single-celled organisms that live in the body and can cause disease).
Bacteria from the skin and urethra easily enter the bladder with PCI, Foley, and suprapubic bladder control methods. Also, many people cannot completely empty their bladder; bacteria are likely to grow in the urine left in the bladder.
Some of the symptoms of UTI are fever, chills, nausea, headache, increased spasms, and autonomic dysreflexia (AD). There may also be burning when urinating and / or discomfort in the area p
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thank you
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que 1+1 es 3 XD
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