Bladder > Bladder Problems > Spinal Injuries

Spinal Injuries

Spinal cord injury nearly always affects control over the bladder. This is because the nerves controlling this internal organ are attached to the base of the spinal cord and then pass down through the cauda equina, the 'horse's tail'. Messages are no longer passed between the bladder muscles and the brain, resulting in a loss of control of the bladder.
 
There are various methods which can help you to manage your bladder and bowel control problem. These include the use of movement, implanted electrodes and/or medication to stimulate muscles which no longer respond to your brain; diet and/or drugs to slow down or speed up the way the body handles fluids and solids; the use of tubes and drainage bags; and re-routing of the body's drainage channels.
 
Acontractile & Reflex Bladders 

If your injury is T12 or above, you usually have what is called a reflex or 'automatic' or 'spastic' bladder. With an injury below the T12 level you will usually have an acontractile or 'flaccid' bladder.
 
A reflex bladder allows automatic, involuntary control of the bladder so when the bladder fills above a certain level it contracts and urine flows out automatically. The reflex can be triggered by 'tapping' with the side of the hand at the base of the stomach, just above the pubic area; however, a rapid movement, laughter or spasm can also trigger bladder emptying when least expected.

Acontractile bladder is a result of an injury below the T12 level. With a lower lesion injury, the reflex arc is also damaged, the bladder has no muscle tone and doesn't contract to empty automatically. Instead, it continues to fill and small amounts of urine may eventually dribble out. The bladder can be emptied at regular intervals by intermittent self-catheterisation.

After injury

In the first few weeks after injury, your bladder will normally need to be emptied regularly through a fine tube or catheter. This is either inserted every few hours by a nurse through your urethra and up into the bladder, and then withdrawn when the bladder is empty; or a small surgical incision is made just above your pubic area, and a suprapubic catheter inserted directly into your bladder and left in place.

After a few weeks you will be gradually trained to empty your own bladder. The method used depends on the level of your lesion, your bladder behaviour and whether you are male or female.

Bladder training

Bladder training is a process to teach the individual to manage and empty their bladder without the need for an instrument. Bladder training depends on your bladder behaviour. Some bladders require training to become reflex bladders and others will need training as contractile bladders.

It is important not to allow your bladder to remain empty as this will reduce its capacity and strength. To maintain or increase bladder strength and capacity your bladder is trained to regularly hold a volume of urine.

Fluid intake

It is important to drink enough fluid each day. Drinking enough is essential to keep the bladder healthy. The bladder will work at its best when you drink the right amount of fluid. When you are not drinking enough, the bladder gets used to holding smaller amounts of urine and can become sensitive - especially if your urine becomes more concentrated as then it is more likely to irritate your bladder.

Try to drink at least 1.5 - 2 litres(6-8 glasses) of fluid each day - remembering that many foods already contain plenty of water in them. 

It may be tempting to reduce your fluid intake especially if you are experiencing continence problems, however this is a mistake. Increasing the amount that you drink may sound counter-intuitive. Indeed, in the short term it may well seem to make your problems worse, but this will only be temporary. In the longer term your bladder will learn to hold more urine, will become less sensitive and irritable, and will be less likely to harbour infections.

Regular emptying

It is essential that your bladder is emptied regularly and as completely as possible (preferably every 3-4 hours during waking hours). An overfull bladder may cause urine to reflux or 'back up' into your kidneys and can cause infection and damage. Inadequate emptying of the bladder causes sediment and deposits to build up, increasing the likelihood of infection and bladder stones.

Further Information

This information has been provided in association with the Spinal Injuries Association.

For more detailed information and support about SCI please visit the Spinal Injuries Association's website at www.spinal.co.uk.

You can also contact them via their helpline number on Tel: 0800 980 0501.

You may also find the Duke of Cornwall Spinal Treatment Centre a usual resource. Please visit their website for more information. 

For information on specific continence problems, including treatment and product options, please use the drop down menu below.

If you are concerned about your bladder problem and it is starting to affect your day to day life make an appointment to see your doctor, continence nurse or specialist physiotherapist. A continence nurse and specialist physiotherapist are healthcare professionals who specialise in bladder and bowel problems. You can also call our specialist helpline on 0845 345 0165 (24 hour answerphone) for medical advice, or visit our Continence Clinic Database facility in the Specialist Services section to find out where your nearest clinic is or call our general enquiries line on 01536 533255 for details.