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BLADDER MANAGEMENTWhat Is This Section About?
Before your spinal cord injury, you probably did not pay much attention to your urinary system because urinating occurred so automatically. During the first few months after injury, you and certain members of the spinal cord injury team spent what seemed like a great deal of time establishing and managing your bladder program. Eventually, your bladder program became quick and routine for you.
Now we will explain:
What is the urinary system?
- What is the urinary system.
- How it has changed since your SCI.
- The whys of bladder management.
- How to recognize and avoid problems.
The urinary system consists of the kidneys, the ureters (u-re-ter), the bladder, and the
urethra (u-re-thra).How Does My Urinary System Work?
The kidneys remove wastes and excess water from your blood stream and process them into urine. The urine then flows down the ureters (which are small tubes) to your bladder. The bladder is a muscular sac that stretches to hold urine until you are ready to void (urinate). When voiding occurs, the bladder (also called the detrusor muscle) contracts and the sphincter (which is a circular muscle acting as a gate) opens. Urine then passes through the urethra and you urinate.
Normal Urination
Urination is due to a finely balanced coordination of bladder and sphincter muscles. This coordination involves both voluntary and involuntary (or automatic) control by the nervous system. When the bladder becomes full, messages are sent to the sacral level of the spinal cord. Messages are then sent to your brain to let you know that your bladder is full. At this time you can decide to either urinate or hold the urine. This is the part under voluntary control. If you want to void, the brain will send messages (nerve impulses) back to the urinary system. The involuntary part involves the opening of the sphincter muscle and bladder muscle contraction.
How Is Bladder Function Changed by Spinal Cord Injury?
Nerve impulses from the bladder can no longer get to and from the brain to let you sense that your bladder is full or to let you void. There are two general kinds of bladder dysfunction that can occur depending on your level of injury. Because there can be individual variations, you will probably have some tests to diagnose your particular bladder type.
These types of bladder dysfunctions are described next.
Upper motor neuron bladder (reflex or spastic bladder)
In this condition, the bladder tends to hold smaller volumes of urine than before SCI. Just like your other muscles may have spasms and contract on their own, so can the bladder muscle. The result is that you may have frequent, small urination without control. This bladder type is common in most spinal cord injuries above the sacral level.
Lower motor neuron bladder (flaccid bladder)In this condition, the bladder muscle has lost its ability to contract and can be easily stretched. Therefore, large volumes of urine can be held by the bladder. Because the muscle cannot contract, urine leaves the bladder when it is over-distended (overfilled). The urine "spills over" like a glass that is too full of water. This bladder type is common when SCI affects the sacral level of the cord (cauda equina injuries).
What Tests Are Done to Check My Bladder Function?
There are a number of tests that can evaluate the structure and function of the urinary system. Because they are all commonly done, they are described.
What is an intravenous pyelogram (IVP)?
An IVP is done by injecting dye containing iodine into a vein. This is excreted by the kidneys and shows up on X-ray. This X-ray will show the size, shape, and working order of the kidneys, ureters, and bladder.
PLEASE NOTE that if you have ever had an allergic reaction to IVP dye, be sure to tell your physician.
Your bowel needs to be empty for this test, so do a good bowel program the evening before or the morning of the test. You may also have to refrain from eating and drinking the night before the test. The nursing staff will let you know if other preparation is necessary.
What is a renal scan?
The purpose of a renal (REE-null) scan is to assess the function and the blood supply of the kidneys. It is done by injecting a radioactive substance into a vein and then X-rays are taken of the kidneys. The amount of radioactivity is extremely low.
What is an ultrasound?
This test is useful in identifying tumors, cysts, and stones in the urinary tract. In an ultrasound, sound waves (like sonar) are bounced off tissue surfaces, and an electronic picture is produced on a screen. Variations in the color of the image can detail the structures or anatomy and thus define problems.
What is a cystourethrogram (siss-toh-yurr-EETH-roh-gram)?
This is also called a cystogram, and is another X-ray study which shows the size and shape of the bladder. Dye is inserted through a catheter into the bladder, and this shows up on X-ray. Among other things, this test shows if urine moves backward through the system from the bladder up to the kidneys. This condition is called reflux. Reflux is due to excess pressure in the bladder. This is one cause of kidney damage and needs to be detected early.
What is a cystometrogram (siss-toh-METT-roh-gram) (CMG)?
A CMG shows how your bladder reacts when it is filled with either carbon dioxide (CO2) or water. This mimics the way it usually reacts when filled with urine. A catheter is inserted for this test. A CMG helps determine if you have a UMN (Upper Motor Neuron) or LMN (Lower Motor Neuron) bladder type. The amount of pressure which builds in your bladder will also be measured by this test.
What is urodynamics (yurr-oh-die-NAMM-icks)?
A urodynamics evaluation consists of a series of studies that provide information about the mechanics of voiding.
Tests which may be part of this urodynamics evaluation include a cystometrogram, a study of urine flow, a study of urethral pressures, and your response to medication that can affect voiding. These tests also give information on sphincter activity and urethral pressures, during bladder filling and emptying. This aids in planning the best bladder management program.
What is a cystoscopy (siss-TOSS-koh-pee)?
Cystoscopy involves the urologist looking at the insides of the urethra and bladder through a lighted, hollow, specialized catheter inserted through the urethra. This is used in diagnosing problems occurring inside the bladder.What other laboratory tests are done? There are a number of tests evaluating the blood and urine that show how the urinary system is functioning:
Creatinine (kree-AT-en-een) clearance: This test involves collecting all of your urine for a 24-hour period. It is an important indicator of kidney function.
Urine cultures: In this test, a sterile urine specimen is sent to the laboratory to look for bacteria. When a sensitivity is also ordered, specific antibiotics that kill these bacteria can be determined.
Urinalysis: Urine is analyzed for a number of different chemical and cellular products.
How Do I Empty My Bladder after SCI?
If you have an incomplete injury, you may in the long run regain all or some voluntary control of your bladder.
If you have a complete injury, one or a combination of the following bladder emptying techniques will become part of your bladder management program.