Nerve damage to the bladder is a common side effects of having a spinal cord injury, other injury, surgical procedures, and several disease processes. Having a consistent bladder program reduces accidents, infections, and the risk of autonomic hyperreflexia.
Neurogenic Bladder
A neurogenic bladder is one that takes voluntarily control of holding or emptying urine away from the person. Some people are unable to store urine (reflex/spastic) and this causes loss over control over emptying and leads to accidents. More commonly with a neurogenic bladder patients are unable to empty the bladder (flaccid) or pass urine at all without using a catheter. There are several types of catheters available and your doctor will help you choose which system is right for you.
Straight or Disposable Catheters
Disposable catheters may be used by patients who can empty their bladders at specific intervals. This process is done by the patient or caregiver by inserting the catheter through the urethra and into the bladder manually to drain urine. The catheter is withdrawn and disposed of once the bladder has been fully emptied.
Foley Catheters
A Foley catheter remains in place in the bladder through the urethra to allow the continuous collection of urine into a bag that is then emptied by the patient or caregiver as needed. This option is more frequently used by people who are unable to self cath or who can not tolerate repeated catheterization daily.
Suprapubic Catheters
This type of catheter is slightly different. Through surgery the doctor creates a stoma in the abdomen where a catheter is inserted directly into the bladder bypassing the urethra completely. The urine is collected in a drainage bag and emptied by the patient or caregiver.
Condom Catheters
Men also have the option of using a condom catheter. This catheter looks like a condom and slips over the penis and collects urine as it drains. Condom catheters are not the preferred method of collection due to the long term skin irritation of the penis. The condom catheter also allows an easier reentry of bacteria into the body as it is not a sterile or clean means of drainage.
Medications
There are several types of medications used to relax the muscles supporting the bladder to reduce spasms and prevent pain. Botox injections can be used to paralyze the bladder to reduce painful spasms.
Adult Diapers
There are many brands and styles of adult diapers on the market today. When using this method keeping yourself clean and dry must be your number one concern. Wet, soiled skin will break down quicker than clean, dry skin. Broken skin will allow bacteria to reenter the body causing infections and can lead to sepsis. Sepsis is an infection of the bloodstream that is life threatening and should be considered a medical emergency.
Autonomic Hyperreflexia
Autonomic hyperreflexia is a medical emergency that occurs when the patient spikes dangerously high blood pressure. This can be a result of a urinary tract infection, fecal impaction, or a bladder that is overly full. This condition is more common in patients who have a higher level of injury at T6 level or above.
Proper hygiene and keeping catheters sterile is extremely important. Improper handling of catheters will introduce germs and bacteria into the bladder causing infections and illnesses. Signs of infection include lower abdomen pain, decreased output of urine, burning, urine that has an unusual color or odor, and fever. Bladder infections can be life threatening, lead to kidney failure, and sepsis if left untreated. Patients who use an indwelling catheter such as a Foley or suprapubic are more likely to experience infections of the urinary tract. Bladder care is an important part of remaining healthy after a spinal cord injury. See your doctor for an appointment immediately if you suspect that you may have an infection.
