One of the most common side effects for those who have suffered a spinal cord injury is an impediment to bladder function. The nerves that control the bladder and associated muscles are located at the base of the spinal cord and everything below the point of spinal cord damage is impacted from the injury. As a result, messages from the bladder are unable to reach the brain, leading to physical complications. There are, however, many management techniques for a loss of bladder control.
The main process affected by spinal cord injury, regarding the bladder, is the emptying of it. Fortunately, the kidneys and the ureters continue to fulfill their purpose because they involve involuntary processes which do not require signals from the brain.
The bladder of an individual without a spinal cord injury is part of a coordinated effort which includes the ureters, bladder, and associated muscles. This allows the urine to pass smoothly in and out of the bladder. Unfortunately, paralysis does not allow for such a coordinated action.
Messages are no longer able to pass between the bladder and the brain, as aforementioned, and often the detrusor and sphincter become overactive, due to this lack of brain control. This can lead to higher bladder pressure, and the related incontinence and various bladder infections.
The detrusor (bladder wall) is what gives the sphincter (the valve atop the urethra) the command to allow urine to pass. If these signals cannot pass properly, or begin to act inappropriately, the above-mentioned ailments can result. Professionals refer to the bladder after SCI as a neurogenic bladder. Often, individuals will find themselves in one of two categories.
Spastic bladder by definition is the unpredictable functioning of the bladder, meaning you often do not know when it may empty. The stretch receptors of the bladder wall are unnecessarily triggered, stimulating the motor nerves that are responsible for telling the muscle to empty the bladder.
Medication can assist with relaxing the bladder. Oxybutynin is a commonly prescribed medication, although it has side effects (mainly a dry mouth). The Food and Drug Administration (FDA) has also approved the use of botox in the bladder for detrusor overactivity, as it does not cause any known side effects in other areas.
Unlike the spastic bladder, the flaccid bladder is much less active and quite lethargic. This means the bladder often holds more than usual, and can stretch it, resulting in loss of muscle tone. It can also damage the detrusor wall, which can increase chances of infection.
Both medication and surgery can be recommended for a flaccid bladder, including sphincter relaxing medication i.e. terazosin, as well as surgery to reduce sphincter pressure, allowing urine to flow more easily (known as a sphincterotomy).
Depending on your individual situation and requirements, medical professionals can recommend various medication, surgery, and management methods to allow an individual to retain as much independence and dignity as is possible.
Many people turn to an intermittent catheterization program (ICP), which comprises of a catheter within the urethra to drain the bladder on a regular, pre-set schedule, to ensure effective emptying. Although some years ago this could have been a messy and somewhat unattractive situation, medical growth and development have transformed this into a simple and convenient strategy for dealing with poor bladder control.
Of course, ICP isn’t the only way to assist with poor bladder function after SCI. There are more specific methods for either a flaccid or spastic bladder, which can assist in maintaining a healthy continence program.
Be sure to speak with your doctor if you are having any questions about your bladder function after a spinal cord injury. Remember, you are not alone in this process and the medical professionals are here to help.
