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Bowel and Bladder Management after a Spinal Cord Injury
After a complete spinal cord injury, most victims who suffer lower body paralysis lose sensation in their bowel and bladder. This poses many questions about how washroom use can be managed and how regular functions will operate.
Loss of bowel and bladder control can hinder a victim’s ability to reintegrate into society and can be regarded as one of the most socially disabling aspects of their injury. These individuals can become self-conscious and worried about suffering from leaks or accidents in public. Often, this can prevent an individual from being willing to leave the home and result in increased isolation, which can have a damaging impact on mental health.
With the correct information and resources about bladder and bowel management after a spinal cord injury, victims can be fully capable of returning to their regular activities and increasing their quality of life. We are experienced Hamilton spinal cord injury lawyers who have assisted victims throughout Ontario who have dealt with these frustrations and difficulties. Through this experience, we have developed a strong network of resources and reliable information that can be incredibly valuable during your spinal cord injury rehabilitation and recovery.
How a Spinal Cord Injury Impacts the Bladder and Bowels
Messages between the various elements of the urinary system are sent to the brain through the spinal cord. This allows the brain to understand when to relieve the bowels and bladder. The nerves are damaged when the spinal cord is injured, and these messages can no longer be sent properly.
Depending on where the specific level of injury is and which type of spinal cord injury you have suffered from, the bladder or bowels will be affected in different ways. These conditions require specific management programs and routines to avoid accidents and ensure the bladder functions properly and effectively.
Incontinence and Neurogenic Bladder
Neurogenic bladder refers to the inability of the body to control bladder function, leading to incontinence. Approximately 80% of spinal cord injury victims suffer from neurogenic bladder.
The urinary system is impacted in two ways after a spinal cord injury: it becomes reflexes or areflexic. Both of these conditions lead to incontinence.
When the bladder is full, it stretches to nearby nerves, sending signals through the spinal cord. Those signals do not reach the brain but instead return to the bladder through the spinal cord. When the signals return, the bladder contracts, and the sphincter expands to release urine. Since the brain does not receive the signals, urination can occur unexpectedly. This is known as a reflexic bladder.
Generally, the urinary tract becomes areflexic when the body undergoes spinal shock. This means that the bladder can no longer be emptied by reflex because the signals sent by the bladder cannot reach the spinal cord at all. As a result, the bladder will continue to fill until it overflows, as the body does not receive instructions to empty it.
Complications of a neurogenic bladder include urinary tract infection, renal impairment, and/or bladder or kidney stones. Individuals with spinal cord injury are also 20% more likely to develop bladder cancer as a result of loss of urinary function. In addition to these physical complications, the individual may also suffer from social and emotional complications, as the worry about public accidents can lead to anxiety and paranoia.
Urinary Tract Infections in Spinal Cord Injury Victims
Spinal cord injury victims are at a high risk of contracting urinary tract infections (UTIs) regularly, known as repeated or symptomatic UTIs. Further, UTIs are responsible for 20% of cases of re-hospitalization.
A UTI occurs when bacteria enter the bloodstream through the urethra and begin to multiply. When an individual has a spinal cord injury and relies on a catheter for bladder management, it becomes easier for that bacteria to enter the bladder. It also becomes easier for stool to contact the bladder, and stool contains some bacteria that can cause a UTI. Additionally, it is more difficult for a spinal cord injury victim to fully empty the bladder, which can lead to remaining urine that could cause a buildup of bacteria.
Symptoms of symptomatic UTIs include foul-smelling urine, blood in the urine, chills, headache, or fever. A UTI can be managed with antibiotics, but some bacteria can quickly become resistant. When an individual suffers from repeated UTIs, antibiotics can become ineffective. A medical professional will prescribe the right solution for a victim’s UTI on a case-by-case basis.
UTIs can lead to autonomic dysreflexia, which is a sudden onset of extremely high blood pressure that can lead to a stroke, seizure, or even death. Autonomic dysreflexia symptoms include headache, hot flashes, cold or clammy skin, nausea, and a stuffy nose. When this condition occurs, seeking medical attention as soon as possible is important.
Risk and Complications of Constipation
With a proper bowel management program, constipation should be reduced. However, if constipation continues, the individual may need to consider some alternative aspects of their diet and lifestyle. For example, individuals who do not drink enough fluids or consume enough fibre are at risk for constipation. This could also indicate that the individual is not eliminating their bowels through their bowel management program.
Constipation can cause significant gastrointestinal issues as well as kidney failure in any individual. As waste builds up in the kidneys and is not eliminated from the body, it can cause cramping, abdominal pain, and early signs of colon cancer. However, spinal cord injury victims are in a particularly vulnerable situation as they do not have sensation in the bowels or abdomen to determine the signs of constipation.
Living with a Catheter
Individuals with loss of bladder and bowel function and sensation often use a catheter to void waste when the urinary system has complications. There are different types of catheters and methods of catheterization that could be utilized, depending on certain factors.
- Foley or Suprapubic Catheter: a foley/suprapubic catheter is a tube inserted into the bladder through the abdomen or the urethra. A balloon inside the bladder secures it in place, frequently draining it to prevent it from filling.
- Intermittent Catheter: The most common method of catheterization, an intermittent catheter, is a tube inserted into the bladder multiple times per day instead of remaining there permanently. This results in periodical draining. It is done every four to six hours on a regular schedule and requires education by a medical professional on proper insertion techniques and maintenance.
- Condom Catheter: This type of catheter is used for men and placed outside the body. A device that resembles a condom sits on the edge of the penis and is connected via a tube to a drainage bag. Usually, the drainage bag is attached to the leg. Condom catheters are changed daily and are less invasive than other types of catheters.
- External Continence Device (ECD): Similar to the condom catheter, the ECD attaches to the penis but only to the tip. It is designed to work the same way as the condom catheter but with less risk of skin irritation and a better fit for those who need a non-traditional shape.
Developing a Bowel Program
Some spinal cord injury victims may undergo a routine bowel program that is designed to teach the bowels to follow a schedule. This program can take anywhere from 30 to 60 minutes and can be done in a seated position in the washroom or lying down on their side if they are prone to pressure ulcers.
First, a suppository is inserted. Then, the individual waits approximately 15 to 20 minutes for the suppository to take its course. After this time, the individual will perform digital stimulation every 15 or 20 minutes until the bowels are empty.
Training the body to adhere to a specific schedule is beneficial for spinal cord injury victims, as they are better able to predict their urinary movements. This way, these individuals worry less about inconveniently timed accidents and can enjoy a better quality of life.
Treatment Options for Post-Spinal Cord Injury Bladder and Bowel Management
For more severe cases, when typical catheter devices are not a practical option, a medical health professional may suggest specific surgical procedures. These include:
- Sphincterotomy: A surgery wherein the sphincter is stretched or cut to heal a tear in the lining of the anus.
- Mitrofanoff: This procedure involves aligning the appendix to form a connection between the skin’s surface and the bladder, creating a valve to assist in maintaining urine control.
- Bladder Augmentation: During this procedure, the bladder is enlarged to create more room for urine.
Contact a Hamilton Spinal Cord Injury Lawyer
A Hamilton spinal cord injury lawyer can be an asset during your recovery. For over 15 years, we have been assisting spinal cord injury victims throughout Ontario and providing valuable resources for their recovery. Working closely with these victims has allowed us to understand the frustrations and difficulties that can come with recovering from a spinal cord injury. It has allowed us to develop a network of connections we are happy to provide to you. From assisting in transportation to recommending top specialists in the province, we can help in any way we can.
At Lalande Personal Injury Lawyers, we take pride in being trusted Hamilton personal injury lawyers since 2003. Over the years, we’ve helped our clients recover more than $45 Million in settlements and verdicts in personal injury, disability, and employment law cases. Whether you’re dealing with a life-changing injury, a denied disability claim, wrongful death, a hurt child or employment termination, we are here to provide compassionate and experienced legal representation. If you believe you have a case, call us today—we’re ready to help you secure the compensation you deserve.
Call Lalande Personal Injury Lawyers today, no matter where you are in Ontario at 905-333-8888 for your free consultation. Alternatively, you can contact us online, confidentially, by filling out a contact form.
Spinal Cord Injury Bladder Health
*This information has been obtained from our experience and knowledge of spinal cord injury law as well as Medical Peer Reviewed Journals and Medical Studies from SCIRE (Spinal Cord Injury Research Evidence)