Living With a Spinal Cord Injury (cont.)
IN THIS ARTICLE
You may not have control of your bladder after a spinal cord injury (SCI). You may not realize that your bladder is full and you need to urinate, or you may not be able to use the muscles that control your ability to urinate. Good bladder management can improve your quality of life and prevent bladder problems, which is one of the biggest concerns for people who have SCIs.
Poor bladder management can lead to urinary tract infections (UTIs), kidney and bladder problems, sepsis (a bloodstream infection), and in rare cases, kidney failure. For information on testing for, treating, and preventing UTIs, see the topic Urinary Tract Infections in Teens and Adults.
Your kidneys and bladder work together to make urine and remove it from your body. The kidneys filter waste products and water from the blood to form urine. The urine moves from the kidneys through tubes called ureters to the bladder, which stores the urine until it is full. The bladder is made of muscle (detrusor muscle) and can stretch to hold about 2 cups [16 fl oz (475 mL)] of urine. From the bladder, urine leaves the body through another thin tube, the urethra. Sphincter muscles at the top of the urethra control the flow of urine from the bladder. See a picture of the male and female urinary systems.
In normal urination, when the bladder is full, a message is sent from the bladder to the brain. The brain sends a message back to the bladder to squeeze (contract) the detrusor muscle and relax the sphincter muscles so you can urinate. After the bladder starts to empty, it normally empties all of the urine.
What an SCI does
After an SCI, the kidneys usually continue to filter waste, and urine is stored in the bladder. But messages may not be able to move between your bladder and sphincter muscles and your brain. This can result in the:
A bladder management program lets you or a caregiver empty your bladder when it is easy for you and helps you avoid bladder accidents and prevent UTIs. You and your rehabilitation team decide which bladder management program is best for you. You need to consider where your spinal cord is injured and how it has affected your bladder function. You also need to consider your lifestyle, how likely you are to get bladder infections (susceptibility), and whether you or a caregiver is able to use a catheter.
Your doctor may do some tests to help find out about your bladder function. These may include:
Common ways to manage bladder function include the following:
You may use just one program or a combination of methods. In general, any of the first three methods can be used if you cannot store urine (spastic bladder), and an ICP is used if you cannot empty your bladder (flaccid bladder).
The most important factors in bladder management are monitoring the amount of fluids you drink, following a regular schedule for emptying your bladder, and being sure that you empty your bladder completely. Your rehab team will help you set up a schedule based on your needs and the amount of fluids you generally drink.
A number of medicines are available to help you manage your bladder. These include:
Research continues on bladder management. New methods include surgically implanted components that stimulate the bladder through a radio control.
Note: Bladder problems can trigger autonomic dysreflexia, a syndrome in which there is a sudden onset of very high blood pressure and headaches. If not treated promptly and correctly, it may lead to seizures, stroke, and even death. Although autonomic dysreflexia rarely leads to these more serious complications, it is important to know the symptoms and watch for them. Autonomic dysreflexia is more common in people with an injury to the thoracic nerves of the spine or above (T6 or above).
eMedicineHealth Medical Reference from Healthwise
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