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Bladder Management

A spinal cord injury can affect nearly every bodily function. Changes in bladder habits are also common as the injury blocks messages coming to and from your brain preventing your body from knowing when you need to empty your bladder. This video explores how the nature of the SCI contributes to changes in the bladder and how important it is to listen to your body and respond with a good bladder management routine.

The Living With a Spinal Cord Injury series is made possible by a gift from David and Barbara Loeb.  

View other videos in this series


Narrator: Spinal cord injury can affect nearly every bodily function just as you may experience changes in movement sensation body temperature and circulation. Changes in your bladder habits are also common. Your injury can block the messages to and from your brain preventing you from feeling and controlling when you need to empty your bladder. The level of your spinal injury will determine the type of neurogenic bladder changes, you may experience.

Quinque:Based on the patient's level of injury will determine if they have an upper motor neuron or a lower motor neuron bladder. So that information is gained through the ASIA exam or also known as the  ISNCSCI exam. So, typically T12 and above will lead us to go towards an upper motor neuron bladder program and T12 and below will lead us to go towards a flaccid bladder program.

Narrator:An upper motor neuron bladder is spastic or tight and can have muscle spasms causing incomplete emptying.

Quinque: Spastic bladder means that they're hyper reflexes, so they're overactive. The muscles are tensing out of the control of the patient. They can't or may not be able to feel it or control it at all. The muscles are just contracting on their own. So, that can be a problem with a bladder that can lead to accidents. That miss coordination of the contraction can also force your and back up into the kidneys, which puts them at risk for kidney injuries and further infections.

Narrator: A lower motor neuron bladder is flaccid or asleep and doesn't get messages to empty.

Quinque: With a flaccid bladder, that muscle is limp. It's not really active and it doesn't give the person the signal to contract. So, the urine just sits in the bladder. So, we have to come up with a program to help empty that bladder in a timely manner or else it's just going to come out on its own, kind of slowly leaking from that loose or flaccid bladder.

Narrator: Establishing a regular bladder program will ensure that your bladder empties fully and at a time that is right for you. This helps prevent infections, bladder accidents, and for some people, episodes of autonomic dysreflexia.  Sometimes your doctor will prescribe a medication to help your bladder empty fully but many people with spinal cord injuries will rely on timed catheterization to empty their bladder. The four most common ways to manage your bladder are through the use of: Intermittent Catheterization (ICA), a Foley Catheter, a Condom Catheter, or a Suprapubic Tube. There are additional surgical options to improve bladder functioning for some individuals who have not done well with these more common management strategies. It's important to work with your SEI team and doctor to determine the best bladder program for you.

Ed H.: In the very beginning they were giving you a straight catheter tube. And I kept getting infections, like bladder infections, and stuff like that. And just doing it, you know because they would give you a jug to go in you know. And I don't know how many times I’d knock that damn thing over. It’s like, “Oh my god!"

Chris: I wear like a condom catheter. So it was basically a condom on me connected to a tube that I plug into the condom that empties into a leg bag.

Ed S.: The self-catheterization is, I do that every four hours, with a closed system catheter now. Which seems to be helping a lot, because I had some issues with infections. I still have some issues with infections. But I do that like every four hours or more, if needed, like depending on how much water I'm drinking. You know, I can kind of get a sensation when my bladder’s full. Cuz, I start to like sweat.

Allison: Ileoscopic plastomy with a bladder augmentation was just big fancy words for basically they made a channel using part of my colon. They re-enlarged my bladder and made a channel to where what was my belly button is now what's called a stoma and that's where I intermittently catheterize through.

Quinque: Great way to prevent UTIs, is sticking to your bladder program. Whatever program that may be, whether that's a Foley catheter, whether that's intermittent catheterization, whether that's time voiding. Whatever your program is, stick to it every day, the same times, making sure that you're emptying your bladder.

Goodman: To prevent the kidney stones, you want to make sure that you're drinking at least 2,000 CC's of fluid a day. Make sure you're flushing your kidneys. You want to make sure that you adhere to your bladder program, whether you're doing CIC straight cathing every four or six hours. Just make sure that you're emptying your bladder and you're not retaining that urine in the bladder If you have a device such as a Foley catheter or a super pupa catheter, you want to make sure checking your urine make sure there's no blood, stones, or sediment in there. If you have a fever, to check that. Just to make sure that you're flushing your kidneys to prevent any urinary tract infection.

Narrator: Urinary tract infections can be prevented by following your bladder program, which includes drinking the volume of fluids you are allowed. Typically, if you do intermittent catheterization, you should drink up to two liters daily. If you have a Foley catheter or suprapubic tube three liters daily or more. If a UTI progresses, it may also cause more serious symptoms of fever chills nausea, increased spasms, and autonomic dysreflexia. Depending on your injury, you may also experience pain or burning when you urinate or pain in your back or pelvis. If you notice any of these additional symptoms, contact your doctor immediately. Routine follow up with a urologist is also important as specialty studies called urodynamics can be ordered and will provide additional information to assure you keep your bladder and kidneys healthy for a lifetime. Listening, learning, asking questions, and following up with your rehabilitation doctor and the rehab team will provide you with the best education and recommendations to assure you stay healthy and limit the potential bladder complication you might experience as someone living with an STI.

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