Neurogenic Bladder After Spinal Cord Injury

WHAT YOU SHOULD KNOW:

Neurogenic Bladder After Spinal Cord Injury (Discharge Care) Care Guide

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, or be able to stop it from emptying. This condition is called neurogenic bladder. Dysnergia flaccid bladder, or spastic bladder are conditions that may develop after a spinal cord injury. A bladder management program can help you regain bladder control. You may also be able to have surgery to treat your bladder condition.

AFTER YOU LEAVE:

Take your medicine as directed.

Call your primary healthcare provider if you think your medicine is not helping or if you have side effects. Tell him if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency.

Ask for information about where and when to go for follow-up visits:

For continuing care, treatments, or home services, ask for more information.

What kind of bladder or sphincter problems may I have?

The bladder or sphincter muscles may be affected after a SCI. Following are three conditions that you may have after a spinal cord injury:

  • Dysnergia: Urine cannot leave the bladder and flow through the urethra if the sphincter muscles do not relax when the bladder contracts. Urine may back up through the ureters into the kidneys. This is called reflux. Reflux may cause a kidney infection. The bladder may not empty completely if the sphincter muscles cannot open fully. Caregivers may use medicine or surgery to open your sphincter.

  • Flaccid bladder: This is also called non-reflex bladder because the bladder muscles are flaccid (weak or absent). You may not feel when the bladder is full. With time the bladder gets over full and stretches. You may also have reflux with this condition.

  • Spastic bladder: This is also called reflex bladder. When your bladder fills with urine, a reflex causes it to automatically empty. With spastic bladder, you do not know when your bladder may empty.

Can anything be done about neurogenic bladder?

You may lose some or all of your bladder control depending on what type of a spinal cord injury you have. Caregivers can teach you how to develop reflexive elimination. This practice teaches your body to urinate at specific times each day. Doing this prevents urine from building up and overflowing from your bladder. A bladder training program includes reflexive elimination and other methods to empty your bladder. Ask caregivers for more information about bladder management programs.

Is it possible to have surgery to fix my urinary tract problems?

Some surgeries are possible to help the bladder store more fluid or to fix problems with the urinary sphincter. Ask your caregiver if you want more information on any of these procedures.

  • Balloon dilation: A balloon catheter is used to dilate (stretch) the urinary sphincter.

  • Bladder augmentation: A piece of intestine is used to make the bladder larger so it can hold a larger amount of urine.

  • Sphincterotomy or transurethral resection: The sphincter or bladder neck is cut using a knife or a laser to make it looser. This surgery is used to treat dysnergia.

  • Stent placement: Caregiver use a cystoscope to put a stent (a very small tube) through the sphincter to keep it open.

  • Urinary diversions: Urinary diversions like ileal conduit are done to drain urine into a pouch made from a piece of intestine. After surgery, you will wear a bag to collect urine.

What other problems may happen after a spinal cord injury?

  • Autonomic dysreflexia:

    • Autonomic dysreflexia 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. This very serious emergency can be life threatening. AD causes your blood pressure to go dangerously high. High blood pressure can cause a stroke, seizure, and even death. It is most common in people who have a SCI at or above the 6th thoracic (chest) level (T6).

    • Noxious stimuli are things that the body considers bad or hurtful. AD is most often caused by noxious stimuli, such as bowel or bladder problems. An over full bladder, being constipated, or having a bowel obstruction are the most common causes of AD. Other things also can cause AD, such as a bladder infection or blood clot in your leg or in your lungs. A pressure sore, a wrinkle in clothing, or an erection also can cause AD. Ask your caregiver for more information about autonomic dysreflexia.

  • Urinary tract infection: This is also called a “UTI”. It is normal for people with SCIs to have bacteria in their bladder often. Bacteria are germs that live on the skin and in the urethra, and can cause infection. The bacteria can be carried into the bladder during catheterization. It may grow there when urine is not emptied completely from the bladder. Call your caregiver if you have a high temperature or feel unwell. This may be a symptom of a UTI or some other illness.

    • Signs and symptoms of a UTI: Having a UTI makes you feel unwell. You may have a fever, chills, and feel sick to your stomach. You may feel burning when you urinate, or pain in your abdomen or low back. You may also have more bladder spasms than usual. It is very important to get treatment for a UTI because UTI's may lead to autonomic dysreflexia.

    • How do I prevent a UTI? It is easier to prevent a UTI than to treat one.

      • Drink plenty of fluids. Check with your caregiver to find out how much liquids you should drink. While you are learning the bladder management program caregivers may have you drink 2000 cc (about 68 ounces, or eight and one-half, eight-ounce cups) of liquids. You may be told to increase your liquids to about 3000 cc (about 101 ounces, or 13 eight-ounce cups) when you are managing your bladder program well.

      • Keep your skin clean. Bathing and cleaning your genital area frequently is very important to help decrease the risk of infection.

      • Empty your bladder at the same times each day.

      • Clean personal care supplies, and leg and bed urine bags. Ask caregivers for more information about urinary catheterization, and keeping your supplies as clean as possible.

      • See your caregiver regularly, and keep appointments for regular exams.

    • How do I treat a UTI? Antibiotics are a type of medicine used to treat UTIs. Always take your medicine as directed by caregivers. Call your caregiver if you think your medicines are not helping or if you feel you are having side effects. Do not quit taking your medicines until you discuss it with your caregiver. Take your antibiotics as ordered, until they are all gone, even if you feel better.

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
    • American Spinal Cord Association
      2020 Peachtree Road, NW
      Atlanta, Georgia , 30309-1402
      Phone: 1- 404 - 355-9772
      Web Address: www.asia-spinalinjury.org
    • National Spinal Cord Injury Association
      1 Church Street, Suite 600
      Rockville , MD 20850
      Phone: 1- 800 - 962-9629
      Web Address: www.spinalcord.org

Wellness Hints:

  • Eat a variety of healthy foods. Eating healthy foods may help you feel better and have more energy. It may also help you heal faster. Ask your caregiver if you need to be on a special diet.

  • Drink six to eight (8 ounce) cups of liquid each day. Follow your caregiver's advice if you must change the amount of liquid you drink. Good liquids to drink are water, juices, and milk. Limit the amount of caffeine you drink. Caffeine may be found in coffee, tea, soda and sports drinks and foods.

  • Having a spinal cord injury can be very stressful. Stress may slow healing and cause illness later. Since it is hard to avoid stress, learn to control it. Learn new ways to relax (deep breathing, meditation, relaxing muscles, music, or biofeedback). Talk to someone about things that upset you.

CONTACT A CAREGIVER IF:

  • You have a fever.

  • You see blood or blood clots in your urine.

  • You have nausea (upset stomach) or vomiting (throwing up).

  • You have an increase in bladder spasms.

  • You have a decrease in urine output.

  • You feel pain in your back around your waist.

SEEK CARE IMMEDIATELY IF:

You have the symptoms of autonomic dysreflexia that are not relieved by your bowel program or emptying your bladder. These may include:
  • Sudden increase in blood pressure.

  • Blurred vision or seeing spots.

  • Cold, dry skin with goose bumps below your SCI.

  • Hot, sweating, flushed (red) skin above your SCI.

  • Sudden throbbing headache.

© 2013 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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