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척수손상 후 신경인성 방광 및 장의 재활

Rehabilitation of neurogenic bladder and bowel after spinal cord injury

대한의사협회지 2020년 63권 10호 p.603 ~ 611
김정환, 서정환,
소속 상세정보
김정환 ( Kim Jung-Hwan ) - National Rehabilitation Center Rehabilitation Hospital and Research Institute Department of Rehabilitation Medicine
서정환 ( Seo Jeong-Hwan ) - Chonbuk National University Medical School Department of Physical Medicine and Rehabilitation

Abstract


Neurogenic bladder and bowel refers to the dysfunction of bladder and bowel caused by neurogenic etiology. Spinal cord injury is a major cause of this dysfunction, which seriously affects the injured person’s quality of life. The injury causes not only motor weakness of abdominal and perineal muscles, but also sensory changes and autonomic dysfunction of bladder and bowel. Spinal cord injuries involve multiple systems, and thus affect the normal functioning of the bowel and bladder in several ways: difficulty in urination and defecation, frequent or infrequent voiding, decrease of the sensation of fullness, incontinence, autonomic dysreflexia, perineal hygiene, deterioration of renal function, fecal impaction, psychological burden, etc. Thus, this review aims to provide updated practical guidance for the evaluation and management of neurogenic bowel and bladder by the clinicians who want to provide better care for their patients. Management of neurogenic bowel and bladder starts with carefully recording the patient’s history, including their bowel habits prior to the spinal injury. In general, evaluation of the neurogenic bladder requires more clinical tests than for the neurogenic bowel. The patients’ problems can be alleviated by adopting various measures: proper daily water and food intake, simultaneous pharmacologic treatments for the bowel and bladder, physiologic reflexes, bladder catheterization, rectal irrigation, surgical measures, etc. Priority should be given to the management of the neurogenic bladder with clean intermittent catheterization and decompression of the bladder pressure, and management of the neurogenic bowel by pharmacological treatment.

키워드

Neurogenic bladder; Neurogenic bowel; Diagnosis; Rehabilitation; Treatment

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