Spinal Cord Injuries & Incontinence

This week’s Wee Answer Wednesday will be squarely focused on incontinence after a spinal cord injury. In the immediate aftermath of a spinal cord injury, there’s a lot to take in. Your life has changed in so many ways that it can be a challenge to get a handle on all the information coming your way. Some problems are bigger than others. In a recent survey of paralyzed veterans, incontinence was identified as the #2 most important issue for those in wheelchairs.

So whether you’re new to the issue or an old hat at managing your incontinence, here are some of the most common incontinence questions men ask after a spinal cord injury.

1. How does a spinal cord injury affect my bladder?

Spinal cord injuries change the way your bladder muscles work and disrupt the messages that are supposed to travel between your bladder and your brain. According at Apparlyzed, when approximately 250 to 300cc of urine are in the bladder, messages from stretch receptors in the bladder are sent through nerves which enter the spinal cord near it’s end in the sacral level of the spine. If the spinal cord is damaged, the action of coordinating the relaxation of the sphincter muscle and contracting the detrusor muscle may be affected, resulting in an inability to urinate properly. In addition to not being able to urinate, the sense of a full bladder may also be lost, as sensory signals from the bladder will not be able to travel to the brain through the damaged spinal cord.

Depending on the level and completeness of your injury, your bladder may empty too often, not frequently enough or in an uncoordinated way. The sphincter muscle may also work incorrectly by not contracting completely or by not relaxing when voiding.

2. Are all individuals with spinal cord injuries incontinent?

There are no absolutes; however, the vast majority of men in wheelchairs as a result of a spinal cord injury are incontinent of urine. This is because the control of your bladder and bowel is connected to your sacral nerve, which sits towards the base of your spine. In general, the higher your injury, the greater the loss of function you may experience. The vast majority of spinal cord injuries occur above the sacral nerve suggesting there will be some bladder dysfunction.

3. What is spinal shock and how long does it last?

According to the National Association for Continence, spinal shock is the temporary loss of all spinal cord reflexes below the level of injury. This could last from days to weeks. When spinal shock ends, spasticity or stiffness starts to occur below the level that the spinal cord was injured. Spinal shock cannot be prevented and must resolve on its own.

While spinal shock is ongoing, patients are generally catheterized as the bladder will not contract and constant drainage is required. Once spinal shock has passed, doctors will complete several bladder tests to determine function and appropriate bladder management tools.

4. Who should I talk to about my incontinence?

Talk to your doctor!! Incontinence is a normal part of life after a spinal cord injury but there are ways to manage it that can let you be comfortable and independent. Your doctor can discuss the detail of your particular injury and its impact on your bladder as well as suggesting potential management options.

5. What kind of complications should I keep an eye out for when dealing with incontinence?

For individuals with SCI, it is important to monitor your bladder function and your management products for complications. These products are associated with some serious complications that you need to be vigilant to prevent.

Infections: Urine is an excellent medium for bacterial growth. The longer an individual retains urine, the more likely they are to develop a urinary tract infection (UTI). UTIs are extremely common among men who use an indwelling Foley catheter or intermittent catheterization for urinary management. Long term catheterization, bladder irritation and repeated UTIs are also associated with a heightened risk of bladder cancer.

Do not take UTIs lightly. Treatment may require a doctor’s visit and antibiotics. If left untreated, UTIs can lead to more serious infections like sepsis and require hospitalization.

Wounds, Rashes and Bedsores: Wounds and infections can develop under diapers, pads or condom catheters because they allow the skin to be exposed to urine for extended periods of time. If the skin is compromised and left untreated, deeper wounds can result. Most men can use an external continence management device such as Men’s Liberty to eliminate dampness and reduce the possibility of wounds.