Spinal Cord Injuries – Bladder problems and Management
Spinal cord injuries are seen in 10-20% of cases of vertebral column injuries – cervical injuries being commoner than the lumbar.
Spinal cord and Bladder Control
Sacral spinal cord controls bladder function, bladder and bowel external sphincters, sexual functions (including erections and ejaculation in men and responsiveness in women). A very important part of voiding involves the sacral spinal cord. Sacral micturition center receives and sends signals directly to and from the bladder. When the bladder becomes filled with urine, it sends signals to the sacral spinal cord. If this communication is disrupted, through disease or injury, the message is delayed or not received. The result is incontinence.
Bladder injuries can be either Upper Motor Neuron (UMN) or Lower Motor Neuron (LMN) type:
|Level||Above S2||S2 and below|
|Reflex center of bladder||Takes over||Lost|
|Controlled by||Reflex center||Intrinsic plexus of bladder|
|Emptying by||Involuntary (No sensation of vesical filling)||Voluntary|
|Residual urine||Minimal||Large >200-300 ml|
|Goal in either case is to attain an automatic reflex emptying of the bladder.|
1. Treatment of Acute Spinal Cord Injury:
- Methylprednisolone 30 mg/kg as soon as possible and 5.4 mg/kg/hr for next 23 hours
2. Treatment of bladder problems:
For 24-48 hours: Urinary retention catheter is placed in the bladder
After 48 hours:
- Intermittent catheterization is started
- Bladder range of motion exercises (if intermittent catheterization is not available) are performed by clamping the catheter tube for 50 minutes and opening for 10 minutes every hour to allow the bladder to develop a reflex pattern of emptying.
- If reflex emptying with residual bladder urine volume of less than 100 cc does not occur within 6-9 months, urological procedures like external sphincterotomy or bladder neck resection is done to achieve a balanced bladder.
3. Adjunct measures:
- Frequent turning
- Special bed to prevent pressure sores
- Splint extremities to prevent flexion contracture
- Movement of joints
- Pulmonary embolus prophylaxis
- Limb is rested in elevated position (to prevent edema)
Apart from the above mentioned treatments which may take time to deal with urinary issues, the patient has to deal with the daily urinary problem by the time it gets solved. So for that, there are adult daipers. There are various types of adult daipers which can be purchased online or from supermarkets. LIFREE is one of the known brands for adult daipers that provide the best solutions for your urinary problems.
To know how to wear adult diapers, you can refer the given link below:-