Parkinson’s disease, multiple sclerosis, and spinal cord injury all involve types of neurological damage that often cause bladder, bowel, and sexual problems. For example, among people with multiple sclerosis, bladder and sexual problems are common (occurring in more than 70% of cases according to some studies).
Bowel problems are not reported as often (for example 35-54% from some studies) but underreporting is frequently suspected. In a recent sample from the US, involving more than 9300 individuals with multiple sclerosis, a much higher number was seen. 91% were bothered by either bladder, bowel, or sexual symptoms, or a combination of these. Many of these patients were not satisfied with their treatment and healthcare providers frequently did not ask about their problems.
Bladder, bowel, and sexual problems also affect people with spinal cord injury and preventive actions need to be considered. One initiative in this area is the Canadian best evidence guideline 'Actionable Nuggets' for primary care for people with spinal cord injury. See www.actionnuggets.ca
A recent update of this guideline recognizes new methods for bowel management (e.g. transanal irrigation) and the need to monitor bladder function annually. Another important and relevant reality for people with spinal cord injury is the risk of autonomic dysreflexia. This is a serious condition that has recently been associated with bowel care and quality of life.
Intermittent catheterization is a general gold standard treatment for neurogenic bladder, caused by for example stroke, Parkinson's disease, multiple sclerosis, and spinal cord injury. Together with drug treatments, intermittent catheterization is the foundation for bladder management in these individuals. Intermittent catheterization is in fact the treatment of choice for anyone with difficulties emptying their bladder, and it is widely available and minimally invasive.
Last but not least, people with Parkinson’s disease, multiple sclerosis, and spinal cord injury often share a need for good follow-up and continuous monitoring of their condition. Nursing skills are central to this and highlighted as an important factor in the research. For example, nursing is important in treating patients with spinal cord injury who have neurogenic bowel disorder. Also, increased knowledge among nursing staff could help to reduce complications such as urinary tract infections for patients needing intermittent catheterization. It may be difficult to address this significant requirement, but new technologies may be useful in developing solutions. A new study evaluating telenursing identified it as a tool with potential in the care of people who need intermittent catheterization.
Summary of Publications
Treatment satisfaction and bothersome bladder, bowel, sexual symptoms in multiple
sclerosis.
https://www.ncbi.nlm.nih.gov/pubmed/29275057
Author and Origin
Wang G, Marrie RA, Fox RJ, Tyry T, Cofield SS, Cutter GR, Salter A.
US
Summary
Observational survey of bladder, bowel, and sexual symptoms in 9341 multiple sclerosis (MS) patients.
Conclusions
MS health providers asked about bladder problems (in 62% of cases), bowel problems
(51%), and sexual problems (21%) but many more patients were experiencing troubles. Only one-third of participants were completely satisfied with treatment for any of the symptoms.
Comments
Study showing extent and low treatment satisfaction of bladder, bowel, and sexual symptoms in
MS patients.
See more details in the Publication Highlight.
Promoting long-term health among people with spinal cord injury: What’s new?
http://www.mdpi.com/1660-4601/14/12/1520
Author and Origin
McColl MA, Gupta S, Smith K, McColl A.
Canada
Summary
Update of the best evidence guideline ’Actionable Nuggets’ for primary care for people with spinal cord injury.
Conclusions
The 2016 update of the Nuggets includes new methods for bowel management (e.g. transanal irrigation) and clarifies the importance of annual bladder monitoring.
Comments
Summary update of www.actionnuggets.ca (3rd ed) giving best practice guidelines to physicians about health promotions and primary care for people with spinal cord injury.
Open access.
This is a highlight from the January 2018 Science Alert:
A community perspective on bowel management and quality of life after spinal cord injury: the influence of autonomic dysreflexia.
https://www.ncbi.nlm.nih.gov/pubmed/29239268
Author and Origin
Inskip JA, Lucci VM, McGrath MS, Willms R, Claydon VE.
Canada
Summary
An observational survey study describing the relationship between bowel care, autonomic dysreflexia (AD) and quality of life (QoL) in 211 individuals with spinal cord injury (SCI).
Conclusions
Bowel management was considered a problem by 78% of the respondents. Longer duration of bowel care and more severe AD symptoms were associated with lower QoL.
Comments
An observational study investigating the association between bowel management, AD and QoL.
Conservative management of adult neurogenic lower urinary tract dysfunction.
https://www.ncbi.nlm.nih.gov/pubmed/29260540
Author and Origin
DI Benedetto P, Finazzi-Agrò E.
Italy
Summary
Review and clinical guidelines for early and correct management of patients with neurogenic lower urinary tract dysfunction (NLUTD).
Conclusions
Treatment goals include avoiding renal failure, improving urinary continence, voiding dysfunction, and the quality of life of patients. Conservative, noninvasive or minimally invasive techniques are cornerstones of treatment.
Comments
Review recognizing intermittent catheterization and pharmacotherapy for treatment of NLUTD (due to e.g. stroke, Parkinson’s disease, multiple sclerosis, spinal cord injury).
Real world treatment patterns in the neurogenic bladder population: A systematic literature review.
https://doi.org/10.21037/tau.2017.09.17
Author and Origin
Jaggi A, Fatoye F.
UK
Summary
Review of neurogenic bladder treatment alternatives based on eight published studies.
Conclusions
A great variation of treatment modalities was seen and included; antimuscarinics (13-87%), catheterization (0-100%), reflex voiding (3-53%), and surgery (0-55%). Results indicated that it was common to switch between treatments.
Comments
Epidemiological data on treatment alternatives used for neurogenic bladder management.
Open access.
Self-intermittentcatheterization and urinary retentions in Parkinsonian
syndromes.
https://www.ncbi.nlm.nih.gov/pubmed/29273299
Author and Origin
Savard E, Declemy A, Coindreau V, Babany F, Chesnel C, Charlanes A, Le Breton F, Amarenco G.
France
Summary
Observational retrospective study of intermittent catheter use in 42 patients with Parkinson’s disease.
Conclusions
Reported bladder dysfunctions were: voiding dysfunction (71%), overactive bladder syndrome (48%), and stress urinary incontinence (14%). About one-third of the patients stopped intermittent
catheterization prematurely due to worsening condition.
Comments
Study recognizing intermittent catheterization for treatment of bladder dysfunction among patients with Parkinson’s disease.
[Article in French].
Catheters Used for Intermittent Catheterization.
https://doi.org/10.1007/978-3-319-14821-2_2
Author and Origin
Goetz LL, Droste L, Klausner AP, Newman DK.
US
Summary
Review of catheters used for intermittent catheterization.
Conclusions
Patient choice and ease of use are important aspects in the process of catheter selection
in intermittent catheterization. Patient lifestyle, hand function, and caregiver abilities are other
important factors.
Comments
Publication highlighting important aspects around catheter use for users of intermittent catheterization.
Effect of quantitative assessment-based nursing intervention on the bowel function and life quality of patients with neurogenic bowel dysfunction after spinal cord injury.
https://www.ncbi.nlm.nih.gov/pubmed/29193471
Author and Origin
Zhang Y, Xia X, Zhuang X.
China
Summary
A randomized controlled trial of 184 patients with neurogenic bowel dysfunction after spinal cord injury, evaluating a quantitative assesment-based nursing intervention.
Conclusions
Quantitative assessmentbased nursing intervention contributed to recovery of bowel function and
improvement of quality of life and satisfaction.
Comments
Study showing that nursing is important in treating s patients with spinal cord injury who have
neurogenic bowel disorder.
Rehabilitation Nurses’ Knowledge, Attitudes, and Behaviors for Preventing Urinary Tract Infections From Intermittent Catheterization.
https://www.ncbi.nlm.nih.gov/pubmed/29244034
Author and Origin
Dawa T, Randolph M, Moyers P, Finch Guthrie P, Frie B, Filer D.
US
Summary
Observational survey of knowledge, attitudes, and behaviors of rehabilitation
nurses for preventing urinary tract infections (UTI) in people requiring intermittent catheterization.
Conclusions
The survey found that nurses report adequate knowledge and training but 28% incorrectly identified the root cause of UTI.
Comments
Survey identifying some knowledge gaps in nurses’ role in preventing UTI among people requiring intermittent catheterization.
Telenursing Intervention for Clean Intermittent Urinary Catheterization Patients: A Pilot Study.
https://www.ncbi.nlm.nih.gov/pubmed/28692432
Author and Origin
de Souza-Junior VD, Mendes IAC, Mazzo A, de Godoy S, Dos Santos CA.
Brazil
Summary
Observational study of acceptability and usability of a telenursing intervention in care delivery to urology outpatients using intermittent catheterization.
Conclusions
Over 5 weeks, 21 telenursing care sessions took place; 62% by telephone and 30% by email. The majority of sessions (62%) were the result of spontaneous contact by patients and 38% were the
result of active search by healthcare professionals.
Comments
Study evaluating the potential of telenursing in the care of people in need of intermittent catheterization.
This blog post is an extract of the Science Alert from January 2018 (76040-USX-1801)
