Urology cont....

Catheterization

A catheter is a small rubber or plastic tube inserted into the bladder to drain urine. If this is done several times a day, we refer to the process as an intermittent catheterization program, or ICP. ICP is generally done by the nursing staff on all SCI persons in the first stages after injury. It may also be continued at home.

A catheter that is left in the bladder is an indwelling catheter. It is often referred to simply as a "foley".

Another, less common, type of catheter is the suprapubic catheter. This type is placed through the abdomen into the bladder. The type of catheter use depends on many factors and will be discussed with you by your doctor or nurse.
Stimulated voiding

Some bladders can be mechanically stimulated to empty. Just as a spastic muscle may move when tapped or brushed, so may an Upper Motor Neuron bladder. We call this "tapping". The tapping is done on the abdomen over the bladder. A Lower Motor Neuron bladder may empty with firm pressure over the bladder called crede‚ (creh-DAY), or during straining or bending forward.

Spontaneous voiding

Some Upper Motor Neuron bladder muscles spontaneously contract. For those who have bladders that trigger on their own, or who have had a sphincterotomy (SFINK-turr-AH-tom-ee; surgery to open the bladder "gate"), wearing an external collecting device will keep you dry. There are many different types of catheters, and your SCI team will work with you to find the best method.

What Are My Goals in Managing My Bladder?

There are a number of basic goals in bladder management. They are:

  1. To have low bladder volumes
  2. To have low bladder pressures
  3. To avoid infections
  4. To keep your skin dry.
How Are Bladder Volumes Kept Low?

Bladder volumes are kept low by:

  1. Watching your fluid intake
  2. Routinely emptying your bladder.

    3.  
Intermittent Catheterization Program (ICP)

If you are on an intermittent catheterization program, the amount of urine that collects in your bladder between catheterizations needs to be 400 cc or less. You will be asked to limit your fluid intake to this schedule: 

                        400 cc at breakfast
                        200 cc at 10 AM
                        400 cc at lunch
                        200 cc at 2 PM
                        400 cc at supper
                        200 cc at 7 PM
With four to six carefully timed catheterizations throughout the day, your bladder will not get too full. When you drink more than your schedule allows or if you do not catheterize yourself on time, you run the risk of exceeding the 400 cc bladder limit.

IMPORTANT NOTE: More than 500 cc in your bladder will overstretch (over distend) your bladder muscle and make you prone to infection or reflux. Foley/Suprapubic Catheter

These catheters are always draining urine, so your bladder does not fill at all. In this case, you need to drink as much fluid as you can to flush the normal mineral deposits out of your urinary system. Foley catheters and suprapubic catheters should always be taped. Female catheters should be taped to the leg.

Spontaneous/Stimulated Voiding

If you are using these methods of voiding, you will need to carefully balance your fluid intake. Since a certain volume of urine will trigger an Upper Motor Neuron bladder to empty, you may want to know what this volume is so that you can time yourself to get to an accessible bathroom to empty your bladder. By knowing at what volume your bladder will trigger and by watching your fluid intake (usually 125 cc per hour), you may be able to establish a routine time for bladder emptying.

How Are Bladder Pressures Kept Low?

In some bladders, there is a buildup of very high pressures before the bladder empties. These high pressures can cause urine to "back up" or reflux into the kidneys, causing damage. High pressures can be caused by:

     1.Irritable bladder

          Your CMG or urodynamics study will measure and record the pressure and volume of  your bladder.
 

    2.Dyssynergia (DISS-inn-URR-jah)

        This happens when the bladder contracts and the sphincter will not open. It is like trying to press the air out of an air
        mattress with the plug closed.  Autonomic Dysreflexia can also occur with dyssynergia. To keep pressures low, keep
       your volumes low, and treat the dyssynergia. Dyssynergia can be treated by either the use of medication to relax the
       sphincter, or by surgery to open it.

Reflux can damage your kidneys without your knowing it. This is a silent problem. Therefore, regular examinations will detect the problem early. If this problem develops, your doctor will recommend a change in bladder management.

How Can I Avoid Infections?

  1. Maintain regulated fluid intake to "wash out" bacteria, to limit stone formation, and keep urine clear/yellow in appearance.
  2. Empty your bladder routinely and prevent over distension. More than 400 cc can weaken your bladder muscle in two ways. First, the muscle cells cannot fight off infection as well. Second, the muscle cannot contract as tightly and leaves behind a pool of urine in which bacteria can grow.
  3. While in the hospital, make sure you or your nurse uses sterile technique for your catheterizations. A "clean" technique is okay for home, but not in the hospital.
Sometimes, infections cannot be completely avoided, even with your best management.

How Do I Keep My Skin Dry?

The best way to keep your skin dry is to carefully follow your bladder management program.

  1. Routinely empty your bladder by the method that works best for you.
  2. Watch your fluid intake.
  3. Avoid infections. Infections may make your bladder irritable, which can cause frequent incontinence or leakage around foley or suprapubic catheters.
  4. Change your clothes as soon as they are wet.
The primary difference between the male and female urinary systems is the length of the urethras.
 

PROBLEM SOLVING

What if I get an infection?

People with SCI are at risk for infection because mechanical methods are needed to empty the bladder. Infections are caused by bacterial growth. Two sites of infection common to SCI are the kidneys and bladder. 

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