A client is experiencing spinal shock. Nurse Myrna should expect the function of the bladder to be which of the following?
A. Normal
B. Atonic
C. Spastic
D. Uncontrolled
Correct Answer: B. Atonic
In spinal shock, the bladder becomes completely atonic and will continue to fill unless the client is catheterized. The full spinal examination should include motor, sensory reflexes including bulbocavernosus reflex and anal wink reflex. Motor activity and strength decrease not only in the skeletal muscles but the motor activity of internal organs like bowel and bladder. This decrease leads to constipation and urinary retention.
Option A: The bladder would not be on its normal function during spinal shock. Often it is observed that the patient starts losing neurologic function above the level of injury, which brings anxiety to an inexperienced provider prompting more imaging of the patient’s spinal cord. Loss of function that happens several days post-injury above the level of the injury is mostly due to spinal cord pathways rearrangement.
Option C: Spastic or neurogenic bladder is caused by neurologic damage, and not by spinal shock. In clinical practice, patients usually have a mixture of symptoms that involve both pathways. Patients with sacral or intracranial lesions often complain of alterations in erectile function. Reflexogenic erections, like bladder and external sphincter contractility, rely on the somatic function of the pudendal nerve and the autonomic function of the pelvic nerve. These pathways may become disrupted in patients with intracranial or CONUS lesions, but 95% of patients with suprasacral lesions have reflexogenic erections.
Option D: An uncontrolled bladder can be caused by pregnancy, changes in age, menopause, enlarged prostate, prostate cancer, or an obstruction. Stress urinary incontinence is the involuntary leakage of urine that occurs with increases in intra abdominal pressure (e.g., with exertion, effort, sneezing, or coughing) due to urethral sphincter and/or pelvic floor weakness. Young women active in sports may experience this type of incontinence. In addition, pregnant women and women who have experienced childbirth may be prone to stress urinary incontinence.