Managing Long-term Health

Managing UTI's

We're here to tell you living with a spinal cord injury and being in control of your bladder is possible. Armed with the right tools, medications and maybe even a helpful surgery, you can live life with a bladder that works with you. This portal will show you to all of the possibilities.

Get to know your bladder

Most people don't know the bladder basics. Did you know the bladder is a muscle that holds urine until you're ready to empty it? It's not an organ like many think. BUT this doesn't mean you shouldn't treat it with care, especially if you have a spinal cord injury. Listen and obey when you are told drink plenty of water. This is your ticket to good health in the years to come.

Tip: It may sound unappetizing, but drinking hot water is a very common way for people with spinal cord injuries. Try it; you may enjoy it more and find can consume more, even swallow easier if that's an issue. Drinking warm water helps your body temperature stay warm if you run cold, and it helps you hydrate faster since your body is already 98.6 degrees (it won't need to warm up the water first before it can digest it).

So how much water?

If you can stomach it, drink 2 liters of water a day (that's around 8 cups). The benefits will amaze you. The constant flow of water through your urinary system makes sure no bacteria lingers, preventing an unwanted urinary tract infection (UTI).

Some people say they just can't drink water. If this is you, try adding natural flavoring to your water like a splash of fruit juice or sliced fruit.

Bladder medications

After a spinal cord injury, your bladder is now considered a "neurogenic bladder," a bladder that no longer responds to signals from the brain. Quadriplegics tend to have spastic bladders, which means their bladders are more prone to clenching/spasming, which can cause incontinence. But don't fret, there are medications out there to stop this. The most popular choice is Oxybutynin. 

Make sure you find a well-reviewed urologist and go through your medication options. Although it works great, one of the biggest drawbacks of Oxybutyin, and other bladder medications that stop spasms, is that they can cause dry mouth. If this side-effect sounds unappealing, talk to your doctor about other options, like Botox.

Preventing UTI's

Trying to stop a UTI, aka an urinary tract infection, is tricky stuff after a SCI. D-Mannose is a popular supplement many with paralysis drink on a daily basis. A sugar-derived liquid, many report -Mannose has prevented UTIs for years. Learn more about D-Mannose. Drinking cranberry juice is an old stand-by that many swear by too. Also, don't forget the importance of good hygeine. When you keep everything clean, there is a lesser liklihood of infection. Daily sailine irrigation of the bladder can also keep the bladder free of infection-causing debris, aka bladder stones.

Signs of a UTI

If your preventitive measures weren't successful and you find yourself with strange symptoms, you may have a UTI. Signs of a UTI are generally the same handful of symptoms in people with SCI. These are increased spasticity, cloudy urine, blood in the urine, smelly urine, fever, nasue, fatigue, nausea, chills, Autonomic Dysreflexia (from the throbbing pain; usually presented with a headache, elevated blood pressure, increased spasms) and general discomfort. If you feel like you have a UTI, drop off an urine sample with a doctor right away. 

Typical UTI Treatment

If you've been diagnosed with a UTI, your doctor will most likely prescribe you an antibiotic to treat the infection. This is the most common treatment for UTIs. Many doctors are opting to stave off perscriptions more than ever lately however, which is changing due to many becoming immune to certain antibiotics. Drinking a ton of water helps flush out bacteria too.

How often should you go?

Depending on your level of injury, you may sense when you need to go to the bathroom. Many quadriplegics and those T7 or above use autonomic dysreflexia (AD), a reaction of the autonomic (involuntary) nervous system to overstimulation, as a signal to use the washroom. It is characterized by severely high blood pressure, throbbing headaches, profuse sweating, nasal stuffiness, and flushing of the skin above the level of the lesionand can be indicate a person’s bladder is full and needs to be drained. Most feel a slight tingling and develop a flushed face which alerts them it's time to head to the washroom.

If AD doesn’t work for you, you will have to create a schedule for draining your bladder. Draining your bladder 3 to 5 times a day at least is a must and it’s important to monitor what you're drinking throughout the day (alcohol and coffee will make you need to catheterize more often).

Paraplegics, meanwhile, have a flaccid bladder, which doesn't alert them to needing to be drained. These folks absolutely must keep track of their bladder throughout the day to ensure they drain it enough and on-time. Phone apps are a great way to stay on-top of this part of your life. It isn't easy adjusting, but it can be done.

Catheter options

As you can imagine, there are several catheterization options out there, but your level of injury and if you are male or female is the great decider in this area. In general, the running joke in the spinal cord injury world is that men have it easier because they can access their genitals much easier from a seated position.

Most male paraplegics and low-level quadriplegics will IC (intermittent catheterization) or condom catheterization, involves inserting a catheter into the penis independently throughout the day, draining urine into a bottle.

If intermittent catheterization isn’t possible, there are other options, an indwelling/Foley catheter, where an inflated balloon keeps the catheter in at all times, or a Superpubic catheter (this is an option for both men and women). This option involves a minor surgery which sees a catheter inserted into the side of the abdomen. This option includes a catheter connected to a drainage bag too. This is not the most glamorous of things, but it does work well.

Another surgical option both men and women with SCI can try is the Mitroffanoff procedure, which creates a hole in the belly button where a catheter can be inserted. While getting this surgery, you can opt for an augmentation, where the doctor enlarges your bladder to allow it to hold more urine throughout the day. Trust us, you won't regret this procedure. One of the bonuses of this procedure is the ability to catheterize in public without anybody knowing.  Many especially appreciate this procedure while flying overseas.

A few more important tips

  • Yearly testing: Even though it's terribly boring, you'll want to make sure you do the right thing and get your urinary system tested yearly. Call your doctor and set this up if you're overdue. An urologist can order this test for you. This test looks at your kidneys and bladder to make sure everything is working the way it should. It will also test how much your bladder can hold. Why in the world do they do this?  This helps the doctor decide how healthy your bladder is, and it's good for you to know. It can help you decide how often you should catheterize. 
  • This test also looks for any stones that are hiding out in your kidneys or bladder.  Kidney and bladder stones are common after a spinal cord injury. These hard masses, which vary in size and shape, can be spiked or circular and are usually comprised of hardened calcium. Drinking too much milk is a common cause so get your calcium from vitamin D supplements instead.
  • Botox: If your bladder spasms often, and the medicine we talked about above (oxybutyin) doesn't seem to work, you can also try Botox, a purified form of botulinum, injected in minute amounts especially to treat muscle spasms. This is one of the latest developments in the spinal cord injury bladder world, and people are very excited about it. 
  • With Botox, a doctor injects the medicine into the outside of an inner wall of the bladder. This makes the bladder flaccid and no longer prone to spasming. Even though it only gives six months of relief, for many people it's worth it.
  • Hygiene & Diet: Also, don't forget basic stuff like good hygiene downstairs, especially after sex (particularly for the ladies). This will really help prevent bladder infections. Eating healthy helps too, especially a diet rich with greens (kale, spinach), lots of water, high protein, healthy fiber and carbs and even cranberries. Whether you drink cranberry juice or eat them dried, consuming some form of cranberry does help.

Please watch the following video with tricks on managing UTI's after a spinal cord injury, and afterwards check out the Takeaway Points below.

Video: Management of Urinary Problems Caused by Spinal Cord Injury

Takeaway Points

  • Drink as much water as you can each day (8 cups a day)
  • Oxybutynin and Botox can help prevent bladder spasms
  • Intermittent catheterization, Foley catheters, Superpubic catheters and the Mitroffanoff procedure are the most common cathing options
  • Get your bladder tested yearly for stones
  • A healthy diet can help keep your bladder healthy

Helpful Resources