After spinal cord injury one loses control over bladder also called neurogenic bladder. How it is managed we will talk about it in detail but first let us know how the urine system works before and after spinal cord injury.
Before spinal cord injury.
Before spinal cord injury when the bladder becomes filled with urine, messages from bladder travel to the brain through spinal cord and you feel the urge to urinate. When environment is not suitable for urination the brain tells the sphincter muscles of the bladder to remain tight and not allow urine to flow out. When you find bathroom and conditions become appropriate to urinate, the brain tells the sphincter muscles of the bladder to relax and the destrusor muscles of the bladder to contract the neurogenic bladder and thus urine comes out of the body.
After spinal cord injury
After spinal cord injury as the flow of messages between brain and spinal cord is blocked so you neither feel the urge to urinate in case of filled bladder nor can contract the bladder at will to pass urine out of body. To solve this problem various techniques are used that are known as bladder menagment techniques. Purpose of these are to pass urine at appropriate time in a healthy manner so that you can lead a graceful, healthy and active life.
Types of neurogenic bladder after spinal cord injury.
Bladder after spinal cord injury is known as neurogenic bladder in which you neither can feel the urge to urinate when it is free nor can squeeze it at will to pass urine. Neurogenic bladder is of of two types.
1 . Spastic or Reflex neurogenic Bladder. In this kind the bladder try to contract and pass urine outside body when it is filled with urine. Such kind of bladder is often present in people with spinal cord injury above T12 level. Doctors often prescribe Anticholinergic drugs like oxybutynine for relaxing such kind of bladder.
2.Flaccid or non reflex neurogenic Bladder. In such bladder no reflex is present and the bladder doesn’t contract when filled with urine. Such bladder are overstretched by overfilling and doesn’t not empty completely. Doctors often prescribe sphincter relaxing medications like terazon for treating such bladder. Spinal cord injury people with injury below T12 have such bladder.
Bladder Management techniques
After spinal cord injury different techniques are used for emptying bladder. Which one is good for you that depends on your level of injury, health, activities and your life style etc. Below some common bladder management techniques are explained.
- Clean Intermittent Catheterisation (CIC).
It is the best method for bladder emptying. In this method a nelton catheter is pushed down the penis into bladder after 4,5 hours. It’s benefits are that if it is properly done in hygienic way then infection happens less. Bladder capacity doesn’t decrease and bladder empties properly due to which there is less chances of bladder, kionkey stone. It’s drawbacks are that one is on a strict routine to empty bladder and can’t drink more. For people with quadriplegia it is difficult to perform because of limited hand function.
- Condom Catheter.
In this method a a condom is applied around penis with a urine bag attached for urine collection. Benefit of this method is that no external object is inside the body so less chances of infection. Drawbacks can be that Destructor Sphincter Dyssenergia may occur in reflex bladder during which a reflex squeezes the bladder but sphincter muscles doesn’t open causing urine to flow back to kidneys and damaging it. Another problem is that bladder may not empty completely and increasing possibilities of bladder stone.
In this method a catheter is inserted inside the bladder with urine bag attached. It stays inside bladder for few days and is then changed, being made of rubber or silicone. change is must after two weeks if made of rubber and four weeks if made of silicon.
- Urethral catheter. It is the first type of indwelling catheter. It passes through urethra and goes into bladder
- Suprapubic catheter. It is inserted inside bladder through small operation. It has some advantages over urethral catheter. First a small portion of catheter is inserted inside body so less chances of infection. It is easy to clean and change and doesn’t damage urethra. It is a good choice for married male and quadriplegics.
Urinary tract infection. How to stop a bladder infection?
After spinal cord injury people often suffer from Urinary tract infection. It happens when when proper care is not taken of personal hygiene or during catheter changing procedure due to which bacteria get inside neurogenic bladder,increases their number and causes uti.
Initial signs of uti are cloudy and smelly urine with peep. In second stage one gets sick, shivers and feels headache and nausea. In people suffering from quadriplegia spasticity and attakes of autonamic desreflexia increase. If uti not treated at this stage, bacteria from bladder will travel to kidneys and infect it too. This is a very serious condition known as pyelonephritis which was a big cause of death in people suffering from spinal cord injury in past and indeed is in present also.
When signs of uti appears one should consult doctor and start treatment. Orange juice or vitamin c tablets can also be helpful in this regard.
Urinary catheterization complications
Every kind of urinary catheter has its own complications. Complications of urethral Catheterization can be irritation of urethra or blockage. Suprapubic catheter can also block at cause problems time to time. Condom catheter can cause destructor sphincter Dyssenergia or prevent complete emptying of neurogenic bladder.
Read also : Respiratory management following spinal injury