Bladder management is an essential tool to learn when dealing with a spinal cord injury because it can make the struggle more manageable as you learn to work with your body as you adjust to new life. While it doesn’t fix the problems caused by an SCI, it can help make the process of dealing with bladder issues run smoother.
What bladder problems can an SCI cause?
Following an SCI your bladder is typically affected. The way your bladder is affected will depend on your level of injury and the extent to which your spinal cord has been damaged. Typically, most people either experience urinary incontinence as they lose the ability to squeeze and control urine flow. The sphincter may tighten and relax on its own which is what causes urinary incontinence.
Other people with an SCI may experience the opposite issue, where their bladder is unable to fully empty. This is just as difficult to manage as if you are unable to urinate, it can cause a high-pressure build-up in the bladder which can be the reason for many kidney-related issues such as infection, stones and even severe damage.
Bladder Management options
As issues arise throughout spinal cord injury, there are numerous bladder management options, each with solutions that may or may not work for you depending on your situation. Here at Aspire Law, we have sourced some of the most common bladder management solutions for you to consider.
Intermittent catheterisation
Intermittent catheterisation is the insertion of a catheter into your bladder which you or someone else can insert. This is a catheter that requires changing as often as needed, and sometimes you will need medication or botox injections to keep your bladder at a minimum to prevent leaking or high pressures.
This is a method that may not work for those who cannot catheterise themselves or are without someone to help them. If your bladder is small or overactive, it is best to look at other options.
The great solution of intermittent catheterisation is that you do not need to wear an internal or external catheter and leg bag all of the time – and it will also stimulate normal bladder filling, maintaining normal bladder size.
Indwelling Catheterisation
Indwelling catheterisation is a solution for ongoing protection from urinary retention or urinary incontinence. This method uses a catheter and urine collection bag that stays in place at all times. Once the catheter is placed in your bladder, the balloon-based at the tip can be inflated to keep the catheter from falling out or deflating when it’s time to change the catheter.
There are two types of indwelling catheters, called urethral catheters and suprapubic catheters.
Urethral Catheters
A urethral catheter can be inserted through your urethra by yourself, a nurse or a trained family member similar to intermittent catheterisation. However, instead of replacing the catheter when your bladder is empty, this catheter stays in your bladder and is held in place by a small balloon. The collection bag must be emptied several times throughout the day to prevent it from getting too full. If it gets too full, pressure may build and stop the urine from flowing down the tube. A urethral catheter is removed roughly around once a month, and a new one is put in its place.
Indwelling suprapubic catheter
To insert an indwelling suprapubic catheter, a doctor is required to make a small incision below the beltline performed under an anaesthetic. Urine will drain from the catheter stored in the collection bag that is placed outside of your body. This type of catheter is changed every month just the same as a urethral catheter would.
The incision will heal, leaving a small hole so that the catheter can be replaced with ease. Research has shown that suprapubic tubes have caused fewer bladder infections than any other type of catheter or bladder management solution. You are less likely to cause infection than if you were to use a urethral catheter because it is easier to keep clean and there is less discomfort and pain involved.
Reflex voiding
Reflex voiding is an option predominantly used by men with bladders that fill and squeeze on their own. This method uses an external condom catheter, which is placed around the penis and is connected to the tube and collection bag. The great solution to this method is that you do not need to limit your liquids, but someone who uses a reflex voiding option may need to have their bladder drain directly into protective undergarments, which require frequent changing to prevent skin rash.
Credé voiding – saying goodbye to an old-fashioned approach
Credé voiding is a method that was once popularly advised in the 60s and 70s before catheters became the recommended solution. The method included pushing inwards with a closed fist over your bladder to empty it. This type of bladder management did not require a catheter or any kind, but the constant pushing on your bladder was known to cause problems over time such as hernias and haemorrhoids.
As time has gone on and techniques have advanced, Credé voiding has become a practice of the past and is not advised in modern times.
Cystoplasty surgery
Cystoplasty is a type of abdominal surgery option for bladder management that is performed to make the bladder larger. It’s a method that is performed after a patient has used self-catheterisation for a period of time.
The procedure includes making an incision in the abdomen, where the surgeon then cuts open the bladder at the top to prepare it for enlarging. A section of the intestine is then removed and the surgeon cuts open that link of the bowel and attaches it to the top of the bladder – leading the bladder and bowel to be sewn together to increase the bladder size.
Mitrofanoff procedures
The mitrofanoff surgical procedure assists with bladder emptying and was initially developed for use in children. In recent years, this method has become a surgical option for people living with spinal cord injuries.
Mitrofanoff procedures have been known to work best for women, who have difficulty with self-catheterisation through the urethra. During surgery, a small channel is formed with the appendix or with part of the colon. Since the appendix is not necessary to keep you alive, it can be removed entirely to create the channel.
After this procedure, the bladder will hold urine as normal, and when it is time to self-catheterise, a catheter is inserted through the channel in the abdomen into the bladder. The urine is then drained into a toilet or cup and discarded with ease. Once the bladder is empty, the catheter is removed and the channel will seal itself shut to prevent any leakage between catheter changes.
Spinal cord injury lawyers with a difference
Aspire Law is a specialist law firm, specifically for people with SCI. We are dedicated to providing information and support for everyone affected by spinal cord injury – from advice on bladder management to legal help when you need it.
For information and spinal cord injury legal advice, get in touch: give us a call on 0800 030 20 40.
