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Bladder Management after SCI

After a spinal cord injury (SCI), 3 parts of the urinary system continue to function normally. The kidneys continue to make urine, and urine continues to flow through the ureters and urethra. These functions are involuntary responses, meaning they act without the need for the brain to tell them to act.

The bladder and sphincter are voluntary muscles that need the brain to coordinate the emptying of the bladder. Such messages are normally sent through nerves near the end of the spinal cord (the sacral level of the spine). However, those messages may no longer travel through the spinal cord after an injury. This means that individuals with SCI may not feel the “urge” to urinate when their bladder is full. They also may not have voluntary control of their bladder and sphincter muscles.

The bladder is usually affected in one of two ways:

  1. Spastic (Reflex) bladder is when your bladder fills with urine and a reflex automatically triggers the bladder to empty. One major problem with a spastic bladder is that you do not know when, or if, the bladder will empty.
  2. Flaccid (Non-reflex) bladder is when the reflexes of the bladder muscles are sluggish or absent. If you do not feel when the bladder is full, it can become over-distended, or stretched. The urine can back up through the ureters into the kidneys. Stretching also affects the muscle tone of the bladder.

The sphincter muscles may also be affected after injury. Dyssynergia occurs when the sphincter muscles do not relax when the bladder contracts. The urine cannot flow through the urethra. This results in the urine backing up into the kidneys. This is called “reflux” action. The bladder also may not empty completely. Treatments include medications or surgery to open the sphincter.

Bladder Management Methods

Although you probably lack the sensation, or “urge” to urinate, you still need to empty your bladder. If not, the bladder muscles stretch as the bladder fills, and urine backs up into the ureters and kidneys. This is called Reflux. Reflux damages the bladder, ureters and kidneys. Failure to empty the bladder to relieve pressure can result in serious health problems, even death.

Everyone is different, so you and your doctor will work together to choose a bladder management method that is convenient for you to empty your bladder. Keep in mind that an effective management program helps you avoid bladder accidents and prevent complications such as infections. You might also consider your mobility, finger dexterity, daily lifestyle, loss of normal urinary system function, and your susceptibility to infections.

If you have a Spastic (Reflex) bladder, your bladder management method will likely be an intermittent catheterization program (ICP), indwelling catheter (Foley or Suprapubic), or a male external condom catheter. ICP is usually the method of choice for individuals to empty a flaccid bladder.

Urinary System Care

As an individual with spinal cord injury, you are at risk for a number of potential urinary system complications. Proper bladder care is the best way to prevent problems and maintain your short- and long-term health. Following a self-care checklist is a great way to help you prevent potential complications.

Drinking the proper amount of water is one of the most important factors for bladder care. You might first consider your bladder management method to determine how much water you typically need daily.

  • Indwelling Catheter - it is recommended that each day you drink about 15 (8oz) glasses of water, which is about 3 quarts.
  • Condom and Intermittent Catheterization - it is recommended that you drink between 8 to 10 (8oz) glasses of liquid per day, which is about 2 quarts.

There may be circumstances when you need to drink

more water than is recommended. For example, you need to drink more water if you also drink beverages that contain sugar, caffeine or alcohol. You need more water because these drinks cause you to urinate more often, which means the body absorbs less water.

There may also be circumstances when you need to drink less than the recommended amount of water.. You may need less water if you have another health condition such as congenital heart failure. Of course, you should always consult your doctor if you have any questions.

Although a regularly scheduled ICP is preferred, there is really no "recommended" time between intermittent catheterization. If you drink the recommended amounts of water each day, you may only need to catheterize every 3 or 4 hours. You will need to catheterize more often if you drink more liquids or if your bladder capacity is less than normal (13-16 ounces).

Generally speaking, it is ideal to drink most of your fluids between breakfast (6am) and dinner (6pm). This time frame allows you to get your daily intake of liquids and empty your bladder just before going to bed (10pm). Because your body's organs usually slow while you sleep, you can usually sleep through the night without the need to catheterize before the next morning. If the 6 to 6 time frame does not suit your lifestyle, you can adjust the time frame to fit your schedule.

Using a "sterile" ICP technique can help you stay as germ-free as possible. Sterile ICP kits are one-time use catheters. These ICP kits are also known as "touch free" or "touchless," which refers to the ability to catheterize yourself without the need to touch the insertion tube.

Due to a revised reimbursement policy covering the use of intermittent catheters, most people who have insurance can now get a maximum of 200 intermittent catheters per month instead of the 4 catheters per month under previous policy. The change should allow most users to obtain the closed, sterile ICP kits. Ask your health care provider or contact your insurance provider for more information.

Although a closed, sterile system is preferred for ICP, many individuals with SCI still use a "clean" catheterization technique.

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