The spinal cord is a vital part of the human body, responsible for transmitting messages to and from the brain. Damage to this delicate structure can have life-changing consequences for the individual involved.
When the spinal cord is seriously damaged, one of the first things people focus on is the lack of mobility and sensation below the area of the injury. While these may be the most notable symptoms of a spinal cord injury, however, they are not the only ones.
Here we take a look at how bladder control is affected following a spinal cord injury and how this symptom can be managed.
The bladder is essentially a storage facility for the urine that is produced by our kidneys. It’s essentially a muscle wrapped bag that can expand to hold liquid body waste. When it’s empty, the bladder is about the size of a pear.
Once the bladder is full and a person wants to go to the toilet, the muscles squeeze and pass the urine down through valves to the urethra and out of the body.
The lower urinary tract is served by a set of three parasympathetic nerves and these play a major role in being able to maintain bladder control. Damage to this part of the body will have an impact on how well the bladder works.
The nerves that attach to the bladder are found in the lower part of the spinal cord in an area called the sacral micturition. If there is damage to the spine above this region, it can mean that the nerves don’t perform their function properly.
In normal circumstances, for example, if someone wanted to go to the toilet but had to wait, the brain will send a message to the bladder to hold on. If that message can’t get through, however, they may not be able to control the flow of urine.
Without the input of the brain, the sacral micturition might send its own messages to the bladder and this can cause a variety problems. These include not only loss of control but may also, for example, prevent the kidneys from draining, potentially causing an infection.
The higher the level of spinal cord injury, the more likely the bladder will be affected. This is commonly called a neurogenic bladder, something which can manifest in a number of different ways.
This is a condition that occurs when the injury is higher up the spinal cord, at T12 or above. Once the bladder fills, there is an automatic reflex that tells it to empty without any input from the brain. Unfortunately, there is no telling when this might happen.
Bladder management following a spinal cord injury, in this case, might involve medication to help relax the muscles and control its function better as well as the use of a catheter to collect waste.
In contrast, a flaccid bladder is where the muscles are less responsive. The bladder may get distended or overfull and the person will not be able to empty their bladder effectively.
Again, medication may be used to control the bladder or a surgery performed with reduces the pressure on the exit valve or sphincter making urine flow easier. Management is usually combined with an intermittent catheter which collects the urine.
While urine flow and management are key, there is always the potential for problems such as urinary tract infections in individuals with a spinal cord injury. In the case of dyssynergia, where the valve at the end of the bladder fails to work properly, urine can back up to the kidneys and cause infection.
The problem with some kinds of bladder management techniques is that bacteria can easily be introduced into the urethra from the equipment used. That means there needs to be meticulous attention to hygiene when using devices like catheters. Other ways to prevent urinary tract infections include:
Impaired bladder function as a result of paralysis can be challenging, but there are ways to effectively manage the situation.
The most common is intermittent catheterization which involves inserting a tube connected to a bag to collect urine. This is often used in conjunction with medication, for example with botox injections, to prevent the bladder from leaking when the catheter is not in use.
Indwelling catheterization is more permanent and involves inserting the catheter which is then held in place in the bladder by a small balloon. This can be achieved either through the urethra or directly into the bladder via a small incision below the navel.
Alternatives to catheters are Valsalva and Crede voiding techniques which are appropriate if there is an issue with getting the bladder to squeeze. They both involve manually pressing or massaging the bladder to empty it.
After a spinal cord injury, the management of kidney and bladder function is important. Most people will work with their doctor to find a solution that works for them and one which they can manage effectively on their own.
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