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Spinal Cord Injury Bladder Management-2

Spinal Cord Injury Bladder Management-2

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Published by: cpradheep on Feb 06, 2010
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Bladder Training and Catheters
This text is taken from the Body Care chapter in SIA’s publication ‘Moving Forward 3’ updated by Wendy Pickard. 
havesponsored the placing of this page in the Factsheets area
After injury
 Although there have been huge improvements (in 1917 almost half of all people withspinal cord injury died of urinary sepsis within two months), urinary tract (and hencekidney) complications are still one of the main causes of illness and death in spinalcord injured people. So correct bladder management is, literally, vital.In the first few weeks after injury, your bladder will commonly need to be emptiedregularly through a fine tube or catheter. This is either inserted every few hours by anurse through your urethra (the tube through which you void or ‘pee’) and up intothe bladder, and then withdrawn when the bladder is empty; or a small surgicalincision is made just above your pubic area, and a ‘suprapubic’ catheter inserteddirectly into your bladder and left in place. After a few weeks you will be gradually trained to empty your own bladder. Themethod used depends on the level of your lesion, your bladder behaviour andwhether you are male or female.
Bladder training
Bladder training is a process to teach the individual to manage and to empty theirbladder without the need for an instrument. Bladder training depends on yourbladder behaviour. Some bladders would require training to become reflex bladdersand others would need training as contractile bladders. All methods of bladdermanagement involve a degree of training and routine. In the past some people withspinal cord injury were taught to regularly transfer onto a toilet and to express or ‘bear down’, to expel urine, negating the need for catheters or drainage bags. Thismethod of management is no longer taught at spinal injuries centres as it may resultin stress incontinence, and cannot be relied upon as a sole method of bladdermanagement to achieve continence.It is important that your bladder strength and capacity is not reduced by allowingyour bladder to remain empty (ie. by indwelling catheter on free drainage). Tomaintain or increase bladder strength and capacity your bladder is trained toregularly hold a volume of urine.
Catheter valve
This is placed between the catheter tube and the urinary drainage bag. The valvehas a tap which when turned off stops urine from draining into the bag. Bladderstrength and capacity may be improved by gradually increasing the time that thecatheter valve tap is turned off. Some spinal cord injured people are able to use acatheter valve without a drainage bag, by opening the valve’s tap over a toilet or intoa urinal at regular intervals. Other people use a spigot to stop urinary drainage.
Bathing, swimming, wearing shorts or skirts is not a problem as a ‘spigot’ canbe put on the end of the tube [of an indwelling catheter] instead of the legbag. This effectively stops the bladder draining but it can be opened fordrainage straight into a toilet. These spigots work excellently, enabling the
tube to be just tucked away in a swimsuit or under clothing. I wished thesehad been made available to me at the
same time I started using thesuprapubic catheter, as I feel I would probably have used the leg bag less,and the spigots more.
Jean, T10/11 complete
Care should be taken when using a catheter valve or spigot if you easily developautonomic dysreflexia.
Warning signs of a full bladder
Training also involves learning to recognise the signs that your bladder needsemptying. These will vary depending on the level of your lesion, but may includebackache, abdominal fullness and, in high lesion paraplegics and tetraplegics,headache, sweating, flushing of the face, neck and shoulders and goose pimples.
Autonomic dysreflexia
In tetraplegics and paraplegics with lesions at T6 or above, an overfullbladder, or a bladder that is generating high pressure during passing water, are thecommonest causes of autonomic dysreflexia, a sudden and potentially life-threatening surge in blood pressure. It is vital that you know how to recognise thesigns of this and take appropriate action
(see 8.c).
Fluid intake
Given the difficulties with continence, it may be tempting to drink less fluid. This is amistake, especially if you use an indwelling catheter: you need a good fluidthroughput to keep your kidneys clean and bladder washed out and functioningproperly. If you are prone to urinary tract infections, then increase your fluid intake(preferably to at least 3 litres or 5 pints per 24 hours), make sure your urine isslightly acid and if necessary take vitamin C (but not the effervescent type) or drink cranberry juice to increase the acidity. Some people also take urinary antiseptics inconjunction with Vitamin C to maximise its effects.
Regular emptying
It is essential that your bladder is emptied regularly (preferably every 3–4 hoursduring waking hours) and as completely as possible. An overfull bladder may causeurine to reflux or ‘back up’ into your kidneys and can cause infection and damage. Intetraplegics it can cause autonomic dysreflexia
(see 8.c)
. Inadequate emptying of thebladder causes sediment and deposits to build up, increasing the likelihood of infection and bladder stones.
Make sure that your toilet at home is well adapted for you: easy to get in and out of,with hand rails in the right place, a handbasin at a suitable height, a padded toiletseat (important to avoid pressure sores), a low shelf or work surface and thesupplies you require within easy reach. If you are able to use one, a bidet can be agodsend. Alternatively, there are special combined toilet/bidets
(see 20.i).
Take carethat the water is not too hot.

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