Incontinence or other bladder problems got you over a barrel? Regain control over your life with a good bladder program
Millions of people have incontinence problems — from occasional minor leaks to total involuntary loss of urine — and may curtail their activities and social interactions to avoid embarrassment.
Common among people over age 50, urinary incontinence — the occasional or constant loss of bladder control — is a symptom of one or more underlying conditions. Nervous system disorders resulting from spinal-cord injury (SCI), spina bifida, stroke, diabetes, and neuromuscular diseases such as multiple sclerosis, muscular dystrophy, and cerebral palsy can lead to incontinence. Muscles weakened by childbirth, prostate problems, infections, certain types of surgery, hormone imbalance after menopause, severe depression, and some medications can also cause this problem.
Weak pelvic muscles cause stress incontinence, when urine leaks after coughing, sneezing, or exertion. Urge incontinence is a frequent sudden need to urinate, and those affected often do not make it to the bathroom. People with overflow incontinence leak often, especially during the night, because their bladders never completely empty. Functional incontinence affects people with disabilities who are unable to get to a toilet.
Dignity is an issue for everyone with incontinence. Self-esteem is affected when people lose control of a basic bodily function. People with disabilities who can improve or eliminate urinary incontinence through their own efforts gain a measure of self-confidence. Following SCI, what are the options for bladder management?
Before SCI, people generally don’t pay much attention to the urinary system because urinating is so automatic. During the first few months after injury, they and members of their SCI team spend a great deal of time establishing and managing a bladder program that eventually becomes quick and routine.
After SCI, nerve impulses from the bladder can no longer get to and from the brain to warn that the bladder is full or to allow voiding. Two general kinds of bladder dysfunction occur, depending on level of injury. In upper motor neuron bladder (reflex or spastic bladder), common in most SCI above the sacral level, the bladder tends to hold smaller volumes of urine, leading to frequent, small urinations. For SCI at the sacral level, lower motor neuron bladder (flaccid bladder) is when the bladder muscle can’t contract, stretches easily and holds large amounts of urine, which “spills over” like a glass that is too full of water.
If a person has an incomplete SCI, he or she may regain all or some voluntary bladder control. With a complete injury, one or a combination of bladder-emptying techniques become part of the bladder management program:
• Catheterization (intermittent, Foley or suprapubic)
• Stimulated voiding (“tapping,” or pressure)
• Spontaneous voiding (condom catheter)
People with SCI have an increased risk of kidney or bladder infection when they need mechanical methods to empty the bladder. An important goal of bladder management is to avoid these infections.
Symptoms of a kidney infection include:
• Chills
• Fever
• Flank pain
• Bloody Urine
• Urinary frequency
• Cloudy, thick urine
• Foul-smelling urine
• Sediment
• Burning upon urination
• Increased spasticity
• Autonomic dysreflexia (injury at T6 or above)
Except for fever and chills, these are also signs of a bladder infection.
Treatment for kidney and bladder infections includes antibiotics and increased fluid intake. For kidney issues, a Foley catheter also may be prescribed.
Note: Always consult a physician before making any changes in bladder management.
Sources: Yes, You Can! A Guide to Self-care for Persons with Spinal Cord Injury, edited by Margaret C. Hammond, MD, et al. (pva.org) and “Take Control,” by Ed Stephenson (PN, September 1997).
