Synopsis
Identify storage, emptying and bowel dysfunction caused by neurological disease, protect renal and skin health, recognise spinal emergencies and build an individual catheter, continence and bowel programme with specialist teams.
- Describe bladder symptoms as storage—urgency, frequency, nocturia, incontinence—or voiding—hesitancy, weak stream, straining, incomplete emptying and retention—then add sensation, catheter use, infections and renal history.
- Ask bowel frequency, stool form, urgency, passive or urge leakage, straining, digital stimulation or evacuation, impaction, abdominal symptoms, diet, fluids, mobility, toilet access and the current timed programme.
- Neurological context includes spinal cord injury or compression, multiple sclerosis, spina bifida, cauda equina or peripheral neuropathy, Parkinsonism, stroke, dementia and autonomic disorders; the same diagnosis can produce mixed physiology.
Key red flags
Interrupted flow, high voiding pressure, incomplete emptying and recurrent infection in a suprasacral cord disorder suggests simultaneous sphincter and bladder contraction, a pattern capable of upper-tract damage.
Investigation priorities
Quantify fluids, voiding, catheter volumes, leakage, stools, interventions, symptoms and timing in the person's usual environment.
Management branches
Urinary retention or altered sensation appears with back pain, radicular symptoms, saddle change, leg weakness or new bowel or sexual dysfunction.
- Perform ABCDE and analgesia, document onset and bladder volume, examine legs and perineal sensation and assess renal function, infection and medication contributors without repeatedly traumatising the patient.
- Contact the emergency spinal or neurosurgical service and arrange MRI through the local cauda equina or cord-compression pathway; catheterise retention using appropriate technique while preserving measurements.
Constipation, prolonged evacuation, impaction, autonomic symptoms or leakage persists despite an existing neurological bowel routine.