Bladder Management Program After Spinal Cord Injury

GENERAL INFORMATION:

What is a bladder management program? Having a spinal cord injury (SCI) can interrupt the nerve pathways from your brain to your bladder (the organ where urine is stored). You may not be able to tell when your bladder is full. This condition is called neurogenic bladder. You may lose some or all of your bladder control. Caregivers can teach you how to develop reflexive elimination. This practice will help teach your body to urinate at specific times each day. It will help prevent urine from building up and overflowing from your bladder. A bladder management program includes reflexive elimination and other methods to empty your bladder.

What should I do while on a bladder management program?

• Decrease the amount that you drink: Drinking enough liquid is very important to help your kidneys work correctly and to prevent urinary tract infections. While you are learning your bladder program, caregivers may want you to decrease the amount of you drink. This may mean that you need to drink about two quarts (eight 8 ounce cups, or 64 ounces) of fluids. If you are not on a fluid restriction, you are encouraged to drink three quarts (12 eight ounce cups, or 96 ounces) of fluid every day. Ask your caregiver how much fluid you should drink. Water is the best liquid to drink. Avoid drinking coffee, tea, and alcohol because they can dehydrate you (draw fluids out of your body). They also can irritate and stimulate your bladder.
  
  
• Measure your intake and output: Caregivers may ask you to measure how much liquid you are drinking, and how much you are urinating. It is important that you are urinating about as much urine as you are drinking liquids. This also is important to find out how well your kidneys are working, and to time your bladder program.
  
  
• Learn methods (ways) to empty your bladder: There are four common methods to empty your bladder. You may use one or more methods depending on the kind of bladder problems you have. Caregivers can work with you to develop a bladder management program that works for you. Ask caregivers for more information about catheterization (kath-e-ter-i-ZA-shun) to learn how to do this for yourself.
  
  
  • Intermittent catheterization: For this method, you will place a sterile catheter (tube) into your bladder every couple of hours to drain your bladder. At first, caregivers will do this at least every four hours until your bladder empties on its own.
    
    
  • Reflexive bladder techniques:
    
    
    • Triggering: This method is used to help the body's reflexes empty the bladder. Triggering works if you have spastic bladder. Types of triggering include tapping on the abdomen over the bladder, stroking the thighs, tugging pubic hairs, and doing chair push-ups. To do tapping triggering, use your fingertips to tap on your abdomen over your bladder. Tap about eight times and then rest for three to five seconds before you repeat the tapping. It should only take a few seconds to work. If you have a condition called sphincter dyssynergia, the urinary sphincter may remain closed. Caregivers will teach you other reflexive bladder techniques if you have this condition.
      
      
    • Bladder stimulation: This device, put under your skin, sends signals through electrodes to the nerves that lead to the bladder. It works like a heart pacemaker but you control it with a hand-held device. When you push the buttons on the hand-held devise, electrical signals tell the bladder to contract, and release urine.
    
    
  • Foley Catheter (KATH-e-ter): This is a tube that may be put into your bladder and kept in place with a balloon around the tip of the catheter. The catheter drains your urine into a bag. Do not pull on the catheter because this may make you bleed. Do not kink the catheter because the urine cannot drain. Do not lift the bag of urine above your waist. If you do this, the urine will flow back into your bladder. This can cause an infection.
    
    
  • External Condom Catheter: This looks like a condom used for sexual intercourse that is put over a man's penis. The tip of the condom catheter is a tube that connects to the urine bag. This method may work for you if you have a spastic bladder. A condom catheter may not work if you have dysnergia. This is because the sphincter will not open to allow the urine to drain out.

What should I do if I have an accident when I am in a public place or around other people? Having an accident is embarrassing for you and for other people, but it is normal. Do not just sit there and try to ignore it. If possible, leave and go to a bathroom as soon as you can. This will help make people feel more comfortable. It will also help protect your skin. Allowing urine to stay in contact with your skin can cause skin breakdown.

What is autonomic dysreflexia? Autonomic (aw-toe-NOM-ik) dysreflexia (dis-re-FLEK-se-ah) is a condition that happens when your body reacts to a problem. Common problems causing autonomic dysreflexia include having a full bladder, or being unable to have a bowel movement. It is also called "AD" or autonomic hyperreflexia (hi-per-re-FLEK-se-ah). AD causes your blood pressure to go dangerously high. It is most common in people who have a SCI at or above the 6th thoracic (chest) level (T6). Ask caregivers for more information about autonomic dysreflexia.

Where can I go for support?

• Having a spinal cord injury is life changing for you and your family. Accepting that you have a spinal cord injury is hard. You and those close to you may feel angry, sad, or frightened. These feelings are normal. Talk to your caregivers, family, or friends about your feelings. Let them help you. Encourage those close to you to talk to your caregiver about how things are at home. Your caregiver can help your family better understand how to support a person with a spinal cord injury.
  
  
• You may want to join a support group. This is a group of people who also have spinal cord injuries. Ask your caregiver for the names and numbers of support groups in your town. You can contact one of the following national organizations for more information:
  • Paralyzed Veterans of America
    801 Eighteenth Street NW
    Washington, DC, 20006
    Phone: 1-800-424-8200
    Web Address: www.pva.org
    
  • National Spinal Cord Injury Association
    6701 Democracy Blvd, Ste 300-9
    Bethesda, MD 20817
    Phone: 1-800-962-9629
    Web Address: www.spinalcord.org
    
  • American Spinal Cord Association
    2020 Peachtree Road, NW
    Atlanta, Georgia, 30309-1402
    Phone: 1-404-355-9772
    Web Address: www.asia-spinalinjury.org
    

Call your caregiver if you have:

• Chills, sweating, or a temperature greater than ____° F ( ____° C).
  
  
• Blood or blood clots in your urine.
  
  
• Nausea or vomiting.
  
  
• Increase in bladder spasms.
  
  
• Decreased urine output.
  
  
• Pain in your back around your waist (if you have feeling).

Seek care immediately if: You have the symptoms of autonomic dysreflexia that are not relieved by your bowel program or emptying your bladder, such as:

• A sudden increase in blood pressure.
  
  
• Cold, dry, skin with goose bumps below your SCI.
  
  
• Feeling anxious or nervous.
  
  
• Hot, sweating, flushed (red) skin above your SCI.
  
  
• Sudden throbbing headache.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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