BLADDER MANAGEMENT

INTRODUCTION TO THE URINARY SYSTEM

How the urinary system works 

The function of the kidneys is to filter the blood and remove excess water and waste materials, turning them into urine. From the kidneys, the urine flows down small tubes called ureters into the bladder.

The bladder is a sac lined with muscle; called the detrusor muscle that stores urine until it can be eliminated from the body. At the exit from the bladder, a circular outlet muscle called the sphincter acts as a gate; when the sphincter muscle contracts, it tightens and prevents urine from flowing; when the sphincter relaxes, it allows urine to flow out through the urethra.

Normally, the process of urination requires coordination between different sets of nerves and muscles. First, sensory messages tell your brain that your bladder is full. Then, when you want to urinate, you can open the sphincter and allow the muscle lining the bladder wall to contract, squeezing the urine out of the bladder.

WHAT DO I NEED TO KNOW?

A spinal cord injury can interrupt the coordination between the brain and bladder causing changes to urination. When the functioning of the urinary system is affected by spinal cord injury, the result is a condition called neurogenic bladder. Everyone’s situation is different and requires individual evaluation and management.

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Types of neurogenic bladder

Spastic bladder (reflexic): A spastic or reflexic bladder is from an Upper Motor Neuron (UMN) spinal cord injury at or above T12.

The bladder and sphincter muscles become tight and spastic. The partial or total loss of communication from the brain can limit ability to feel bladder fullness and control the sphincter muscle to hold the urine in. The bladder is spastic (overactive) causing involuntary reflex voiding and incontinence. There can also be loss of coordination between the bladder and sphincter muscle called detrusor sphincter dyssynergia (DSD). This is where the bladder contracts to empty but the sphincter muscle stays tight. When this happens the urine can be forced back up the ureters to the kidneys (called reflux), possibly causing kidney damage.

Flaccid bladder (areflexic): A flaccid or areflexic bladder is from a Lower Motor Neuron (LMN) spinal cord injury below T12.

The partial or total loss of communication from the brain limits the ability to feel bladder fullness. The bladder muscle cannot contract to empty the bladder causing it to overfill (urinary retention); this can cause urine to be forced back up the ureters to the kidneys (called reflux), possibly causing kidney damage. The sphincter muscle may also be relaxed causing urine to leak out when the bladder overfills or with coughing, sneezing and activities such as transfers, lifting and playing sports.

Complications

People with spinal cord injury need to be aware of possible complications so they can take steps to prevent them. See below for the most common recurring complications of living with a neurogenic bladder:

WHAT CAN I DO?

What you can do to manage your bladder health

Over time you may come to recognize patterns of symptoms that are typical for you. When you know the signs of a urinary tract infection, you should contact your family doctor who can help you with advice and treatment. Make sure you follow their advice carefully, and take all your medication if prescribed.

If you have more serious symptoms such as a high fever, back pain and AD, seek more immediate help. If you have problems with repeated UTIs over time, this may indicate a problem with your bladder program.

As a person with a spinal cord injury, you are at risk for a number of potential urinary system complications. Healthy habits and proper bladder care is the best way to prevent problems and maintain your short and long term health.

For the health of your urinary system here are some basic recommendations:

Understand the importance of a Bladder Management Program

A bladder management program will allow you to empty your bladder in a way that is suitable to you. Depending on your level of injury, there will be different methods to empty your bladder and keep your urinary system healthy. You’ll work with your health care team to develop, monitor and change your bladder management program.

The method you use depends on the needs of your urinary system and other circumstances like your ability to perform your own self-care or to get assistance.

Method Options are:

• Intermittent catheterization(IC) – this involves inserting a catheter into the bladder on a regular schedule to empty the bladder. It is important to use good technique and proper cleanliness when you use IC, in order to reduce the risk of infections.

• Indwelling catheters – also known as a Foley catheter. In this case, the catheter stays in the bladder and continually drains into a collection bag and is usually changed once per month. The indwelling catheter may be inserted into the bladder via the urethra or into the lower abdomen; called a supra pubic catheter. Since indwelling catheters have the most long-term complications, your health care team will only use them as a last resort when other methods are not an option.

• External Condom Catheters – a condom connected to a urine drainage bag, used for males only.

SELF-MANAGMENT/PROBLEM-SOLVING

Understanding how to manage your bladder after a spinal cord injury is a very important part of staying healthy. Over time, you will adapt your bladder program to changes in your body and your lifestyle, and as you learn more, you will become more skilled in your self-care.

From time to time, you may encounter problems with your bladder program. Leaks and incontinence, UTIs and other complications can have a major impact on your daily life.

When you’re having a problem and you’re not sure what to do, the best option is to use this problem-solving approach to tackle it:

Step 1: Identify the problem. Start by getting a clear picture of what’s wrong. If you’re having problems with urinary tract infections, pay attention to when they happen and what seems to cause them.

Step 2: Gather information. Try to get a better understanding of what may be causing your problem, and some different ways you might try to solve it. This may involve doing research or consulting health care providers. You may also find it helpful to speak with peers, people who have had similar experiences. Make sure you evaluate the reliability of the information you find, and try not to rely on information from only one source.

Step 3: List possible solutions. Based on the information you find, list some things you might try. For example, to deal with recurring UTIs, you might want to drink more water, take cranberry supplements, and pay special attention to hygiene.

Step 4: Try one & evaluate the results. Using your list of solutions, choose the one that seems best and give it a try. It’s important to make only one change at a time so you can tell whether it works or not. Make sure you keep track of what you do and what the results are. If you solve the problem, that’s great! If not, you may want to go back to step 3 and choose another option. Problem-solving can involve lots of trial and error.

Step 5: Know when to ask for help. Don’t try to take everything on by yourself. You can ask your health care team for information and help with your problem-solving, as your needs change over time.

WHO CAN HELP ME? 

Taking care of your urinary health is a life-long priority for people with a spinal cord injury. Many of your spinal cord injury care team may help you in managing your bladder and responding to concerns.

CONCLUSION

The key to a healthy urinary system is learning healthy bladder management techniques and developing good habits of cleanliness, drinking adequate healthy fluids and regular bladder assessments. Be aware of physical signs and symptoms that might be telling you something is wrong with your bladder function or that something has changed. Sometimes your bladder will physically change over time, which may require a change in your bladder management program.

RESOURCES

• Bladder Management – An infographic on all matters related to the bladder.
• Condom Catheters – Further information on the use of condom catheters, and possible issues.
• Foley Catheters – Further information on the use of a foley catheter, how to take of your foley catheter, and possible issues.
• Intermittent Catheterization For Women – Further information on the use and procedures of intermittent catheterization for females.
• Intermittent Catheterization For Men – Further information on the use and procedures of intermittent catheterization for males.

Be sure to check out the Video Playlist for this chapter!