Which of the following manifestations can the nurse expect in a client with upper motor neuron deficit related to a spinal cord injury?
A.
A leakage
B.
B anuria
C.
C flaccid bladder, inability to voluntarily void
D.
D spastic, involuntary voiding
The Correct Answer and Explanation is :
The correct answer is D. spastic, involuntary voiding.
Explanation:
Upper motor neuron (UMN) deficits are characterized by damage to the motor pathways in the brain or spinal cord. In the context of a spinal cord injury, the manifestations of UMN deficits can be distinctly different from those associated with lower motor neuron (LMN) deficits.
Upper Motor Neuron (UMN) Injury and Bladder Function:
In a client with a spinal cord injury, the bladder function can be significantly affected due to UMN injury. The spinal cord injury, particularly above the sacral level, disrupts the neural pathways responsible for voluntary control of bladder function. The following are key characteristics:
- Spastic Bladder: UMN injuries typically result in a spastic bladder. This means that while the voluntary control of bladder function is lost due to the injury, reflexive activity is preserved. The bladder becomes overactive, leading to frequent and involuntary contractions. This reflexive activity can cause the bladder to empty uncontrollably, which is often referred to as “spastic, involuntary voiding.”
- Involuntary Voiding: Due to the preserved reflex activity, patients with UMN bladder dysfunction often experience involuntary voiding. This is in contrast to a flaccid bladder, which is more common with LMN injuries where there is a loss of reflexive control leading to an inability to void spontaneously or maintain continence.
- Inability to Voluntarily Void: The inability to voluntarily control the bladder is a result of disrupted communication between the brain and the spinal cord below the injury level. While reflexes may still be present, conscious control is lost.
- Contrast with LMN Deficit: In contrast, a flaccid bladder associated with LMN injury (typically seen in injuries at or below the sacral level) results in an inability to void reflexively or voluntarily, leading to urinary retention and potentially anuria.
Therefore, in a client with UMN deficits from a spinal cord injury, you can expect manifestations of spastic and involuntary bladder voiding due to preserved reflexes despite the loss of voluntary control.