UMN Features
- Small overactive spastic bladder
- Failure to store urine
Treatments
- intermittent catheterization (IC) for persons who can be trained
- Medications that allow for urine storage:
- Anticholinergics (e.g. oxybutynin, tolterodine)
- β-3 stimulant (mirabegron)
- Botulinum toxin
- condom catheter (+/- tamsulolin) for reflex voiding
- indwelling catheter for patient unable to perform IC
LMN Features
- large areflexic, flaccid bladder
- failure to empty
Treatments
- IC for persons who can be trained
- Credé manuever (exert manual pressure on the abdomen at the location of the bladder, just below the navel)
- Valsalva maneuver
- Indwelling catheter for patient unable to perform IC or persons unable to maintain continence between IC.
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References
Cardenas D, Ciodo A, Samson G. Management of Bladder Dysfunction. In: Braddom R, editor. Physical Medicine & Rehabilitation. 4th Edition ed. St. Louis, MO: Elsevier Health Sciences; 2014.
Dorsher, P, McIntosh, P. Neurogenic bladder. Advances in Urology 2012:1-16.