We’re here to tell you that 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 all of the possibilities you have when it comes to taking control of your bladder.
Get to know your bladder
Most people don’t know the bladder basics. Did you know that 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 to drink plenty of water. This is your ticket to good health in the years to come.
Tip: This may sound unappetizing, but drinking hot water is a very common way that people with spinal cord injuries use to consume water. Try it; you may enjoy it more and find that you can consume more—it may even help you swallow easier, if swallowing is 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 (meaning, your body won’t need to warm up the water first before it can digest).
So, how much water?
If you can stomach it, drink 2 liters of water every 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 sustaining 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 and 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 to help you go through your medication options. Although they work great, one of the biggest drawbacks of Oxybutynin 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 spasticity control options, such as Botox.
Preventing UTIs
Trying to stop a UTI can be tricky after a SCI. D-Mannose is a popular supplement that many people with paralysis drink on a daily basis. A sugar-derived liquid, many report that D-Mannose has helped them prevent UTIs for years. Learn more about D-Mannose. Additionally, drinking cranberry juice is an old UTI trick that many swear by. Also, don’t forget the importance of good hygiene. When you keep everything clean, there is a lesser likelihood of infection. Daily saline irrigation of the bladder can also keep the bladder free of infection-causing debris, aka bladder stones.
Signs of a UTI
If your preventative measures weren’t successful and you find yourself with strange symptoms, you may have a UTI. Signs of a UTI include increased spasticity, cloudy urine, blood in the urine, smelly urine, fever, nausea, fatigue, nausea, chills, Autonomic Dysreflexia (from the throbbing pain; usually presented with a headache, elevated blood pressure, increased spasms) and general discomfort. If you think you have a UTI, go to a doctor and drop off a urine sample 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. Antibiotics are the most common treatment for UTIs. Drinking a lot of water can help 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 and above use autonomic dysreflexia (AD) — a reaction of the involuntary nervous system to overstimulation — as a signal to use the washroom. AD is characterized by severely high blood pressure, throbbing headaches, profuse sweating, nasal stuffiness, and flushing of the skin above the level of the lesion. AD can indicate that a person’s bladder is full and needs to be drained. Most feel a slight tingling and develop a flushed face, which alerts them that 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 at least 3 to 5 times a day is a must, and it’s important to monitor what you’re drinking throughout the day (for example, consuming alcohol and coffee will make you need to catheterize more often).
Paraplegics, meanwhile, have a flaccid bladder, which is a bladder that doesn’t alert the person about 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. Adjusting to this new way of life isn’t easy, but it can be done.
Catheter options
As you can imagine, there are several catheterization options out there, but your level of injury and your gender are the two great deciders 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 use IC (intermittent catheterization) or condom catheterization, which 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, an option for both men and women. This option involves a minor surgery which involves inserting a catheter into the side of the abdomen. A Superpubic catherter includes a catheter connected to a drainage bag, as well. This option is not the most glamorous, but it does work well.
Another surgical option that 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 getting 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. This test will also determine how much your bladder can hold. Why in the world do they do this? Urology tests help 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 of these stones, so get your calcium from vitamin D supplements instead.
- Botox: If your bladder spasms often, and Oxybutynin doesn’t seem to work, you can try Botox: a purified form of botulinum injected in minute amounts to treat muscle spasms. Botox 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 botox only gives six months of relief, for many people, it’s worth it.
- Hygiene & Diet: Also, don’t forget the 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 and spinach), lots of water, high protein, healthy fiber, 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 for tricks on managing UTIs 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 catheterizing options
- Get your bladder tested yearly for stones
- A healthy diet can help keep your bladder healthy
Helpful Resources
- Bladder Management – Reeve Foundation – http://www.christopherreeve.org/site/c.mtKZKgMWKwG/b.4453411/k.BF84/Bladder_Management.htm
- Spinal Cord Injury (SCI) & Bladder Management – Univ. of Washington – http://rehab.washington.edu/patientcare/patientinfo/articles/sci_bladder.asp
- Bladder management – United Spinal Resource Center – http://www.spinalcord.org/resource-center/askus/index.php?pg=kb.page&id=249
ideas@spinalpedia.com
