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Cognitive impairment, dysphagia, communication issues, pain, spasticity, bladder dysfunction, sexual dysfunction and bowel incontinence are but a few problems frequently reported by individuals living with long-term neurological conditions. The management of long-term neurological conditions requires co-ordinated inputs from multiple disciplines, and this practical handbook facilitates this by combining physical, cognitive and psychological strategies to patient management. Featuring contributions from leading experts in neurology, health services and clinical rehabilitation, this book is a comprehensive overview of common neurological impairments and solutions. It adopts an evidence-based approach to both pharmacological and non-pharmacological options for alleviating neurological symptoms. An easy-to-refer to guide, bridging multiple disciplines, aided by current research, to provide effective, and practical management for all aspects and issues arising in the rehabilitation phases of the neurological patient. This unique pocketbook is intended for practitioners at all levels, and is ideally suited as a quick guide during ward rounds, out-patient clinics and therapy sessions.
This chapter discusses the role of the cortical and subcortical areas in the control of pelvic organs. It presents case histories, the lesion literature, effects of injury or disease at focal sites. The results of diffuse cortical and subcortical diseases are then considered. The temporal lobes have little or no apparent influence on bladder or bowel control but a major role in determining sexual behavior. Cerebrovascular disease is often accompanied by bladder dysfunction. The severity, extent and site of brain damage following brain injury are so variable that generalizations about the effect of traumatic brain injury on pelvic organ dysfunction are impossible. Recommendations have been made to treat specific aspects of sexual dysfunction following traumatic brain injury. An expected correlation is seen between the occurrence of a neurogenic bladder and the severity and extent of brain damage so that urodynamic abnormalities have been associated with motor deficits.
Sexual function is recognized as an important factor determining quality of life and dysfunction in neurological patients may significantly add to the burden of their disease. Any disruption in the sexual response cycle results in sexual dysfunction (SD). Laboratory testing should be tailored according to patient symptoms and risk factors. Fasting glucose and lipid profile may be measured to assess atherosclerotic risk factors for erectile dysfunction (ED). Oral drugs should be considered as first-line therapy for neurogenic ED. There are fewer evidence-based therapeutic options for treatment of female SD. However it is an area of increasing interest and marketing of therapies by pharmaceutical companies. Therapies relate to treatment of sexual desire, arousal, orgasm and/or sexual pain. The term hypoactive sexual desire disorder (HSDD) is used to describe low sexual desire and distress, and many therapies aim to address this aspect of female sexual function.
Pelvic Organ Dysfunction in Neurological Disease describes the neurological control of human bladder, bowel and sexual function and then details the dysfunctions which may arise as a consequence of various neurological diseases. Easy to read, the book will be of value to any healthcare professional managing patients in whom pelvic organ functions have been compromised by neurological disease. The book provides a structured approach to present day understanding of the neurological control of pelvic organs and the investigation and management of each type of organ dysfunction. A unique feature of this book is that it addresses the impact of specific neurological disorders on all three functions. The authors have all been associated with the Department of Uro-Neurology at the National Hospital for Neurology and Neurosurgery, London since it was established 20 years ago. This book is a timely review of their accumulated knowledge and the latest literature.
Evidence to support management of neurogenic bowel dysfunction remains sparse in comparison to other areas of care; such evidence as is available arises mostly from the spinal cord injury arena. This chapter discusses the clinical and investigational assessment, management of fecal impaction, gastrocolic reflex, abdominal massage, rectal stimulation, and feces evacuation methods. Dysfunction of the bowel has considerable implications for quality of life. Assessment of an individual for neurogenic bowel management is a multidisciplinary activity. Anorectal manometry tests can quantify more precisely the functional status of the anorectum. Irregular or too infrequent management is associated with incontinence and constipation. The majority of individuals with neurogenic bowel dysfunction will use the conservative methods to manage their bowel dysfunction. Biofeedback, Transanal irrigation, surgical interventions, and antegrade continence enema (ACE) are some useful options when conservative methods are not effective.