![]() ![]() You have to use BOTH history AND Physical examination to figure it out. Hope this helps!!! It’s very easy once you understand the total picture. Hx of stroke, hx or disk herniation, hx or uncontrolled diabetes, alcoholism, or B12 demyelination. In neurogenic causes, which can cause either an urge incontinence or overflow incontinence, look for some sort of brain, spinal cord, or peripheral nerve damage or history. Strictly overflow incontinence is caused by BPH or stone or some sort of urethra closing so look for enlarged prostate or colicky suprapubic pain or something to indicate BPH or stone. You’d differentiate between neurogenic and overflow based on history and PE. ![]() PHSA provides specialized health care services to communities across British Columbia, on the territories of many distinct First Nations. and post-void residual volume measure ment in improving diagnostic accuracy of cauda equina syndrome. Overflow incontinence will obviously have a post voiding volume of over 200mL. Broadway Vancouver, BC V6H 4C1 60 Ext: Emergency Care BC originated from and builds on the work of the BC Emergency Medicine Network. Management requires emergent neurosurgical evaluation. ![]() CT myelography may be used when MRI is contraindicated. What happens is the bladder fills up and Intravesicle pressure is higher than outlet spinchter pressure and the patient releases urine (usually at night/sleep time due to less guarding). Post-void residual > 500ml had OR of 4.0, which increased to 48.0 when combined with two of the three following symptoms: bilateral sciatica, subjective urinary retention, or rectal incontinence. In overflow incontinence, there’s an obstruction somewhere (stone in urinary tract or BPH in males). Those are the 3 components of neurogenic bladder (think of issue with the brain aka stroke, issue with the spinal cord aka herniation or cauda equina or issue with peripheral nerves like in diabetes, alcohol, or B12 demyelination) It’s called flaccid or spastic bladder or mixed. A bladder scan checking for a post-void residual volume should also be obtained to evaluate for urinary retention. Cauda equine syndrome: risk stratication, evaluation, and management in the emergency department. Cauda equina syndrome (CES) results from compression and disruption of the function of these nerves and can be inclusive of the conus medullaris or distal to it. So you can’t sense that you have to go pee or you can’t pee period. Post-void residuals may serve as a helpful diagnostic adjunct in the work-up of cauda equina syndrome. With neurogenic bladder, there’s an issue with either the input or output of nerves. Objective Post-void residual (PVR) scans of less than 200 ml are increasingly being used to rule out the likelihood of cauda equina syndrome (CES) and to delay emergency MRI scanning in suspected. ![]()
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