After a complete spinal cord injury, most victims who suffer lower body paralysis lose sensation in their bowel and bladder. This poses many questions as to how using the washroom can be managed, and how regular functions will operate.
Loss of bowel and bladder control can have a negative impact on 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 that can have a damaging impact on mental health.
With the right information and resources about bladder and bowel management after a spinal cord injury, it is possible for victims to be fully capable of returning to their regular activities and increasing their quality of life. We are experienced Hamilton spinal cord injury lawyers and 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.
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 it is time to relieve the bowels and bladder. When the spinal cord is injured, the nerves are damaged and these messages are no longer able to send 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. All of these conditions will require specific management programs and routines in order to effectively avoid accidents and ensure the bladder functions properly.
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.
There are two ways that the urinary system is impacted after a spinal cord injury – it becomes either reflexic or areflexic. Both of these conditions lead to incontinence.
When the bladder is full, it stretches out to nearby nerves, which in turn send signals through the spinal cord. Those signals do not reach the brain, and instead return through the spinal cord to the bladder. When the signals return, the bladder contracts and the sphincter then expands to allow urine to be released. Since the brain does not receive the signals, urination can come at an unexpected time. This is known as a reflexic bladder.
Generally, when the body undergoes spinal shock, the urinary tract becomes areflexic. This means that the bladder is no longer capable of emptying by reflex because the signals sent by the bladder are unable to 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.
Spinal cord injury victims are at a high risk of contracting urinary tract infections (UTIs) on a regular basis, known as repeated or symptomatic UTIs. Further, UTIs are responsible for 20% of cases of re-hospitalization.
A UTI occurs when bacteria enters the bloodstream through the urethra and begins 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 make contact with the bladder, and stool contains some of the bacteria that can cause a UTI. Additionally, it is more difficult for a spinal cord injury victim to fully and completely 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 the use of antibiotics, but some bacteria can quickly become resistant to antibiotics. 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, it is important to seek medical attention as soon as possible.
With a proper bowel management program, constipation should be reduced. However, if constipation continues to occur, 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 fiber are at risk for constipation. This could also be an indication that the individual is not completely eliminating their bowels entirely 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 does not eliminate 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.
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 that is inserted into the bladder, either through the abdomen or the urethra. A balloon inside the bladder secures it in place, and it frequently drains the bladder to prevent it from filling.
Intermittent Catheter: The most common method of catheterization, an intermittent catheter is a tube that is inserted into the bladder multiple times per day, instead of remaining there permanently. This results in periodical draining. This is done every four to six hours on a regular schedule, and will require education by a medical professional on proper insertion techniques and maintenance.
Condom Catheter: This type of catheter is used for men and placed outside of 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 better fit for those who need a non-traditional shape.
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 either in a seated position in the washroom or laying 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 in order for the suppository to take its course. After this time, the individual will then perform digital stimulation every 15 or 20 minutes until the bowels are empty.
Being able to train 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.
For more severe cases, when typical catheter devices are not an effective option, certain surgical procedures may be suggested by a medical health professional. These include:
Sphincterotomy: A surgery wherein the sphincter is stretched or cut in order to heal a tear in the lining of the anus.
Mitrofanoff: This procedure involves aligning the appendix to form a connection between the surface of the skin and the bladder, creating a valve to assist in maintaining urine control.
Bladder Augmentation: During this procedure, the bladder is enlarged in order to create more room to hold urine.
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, and 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 any way we can.
Get in touch with us to learn more about the many ways we can assist you and the resources we can provide. You can contact our team by filling out an online contact form or calling our office at 905-333-8888.
*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)