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Spinal Cord Injury and Incontinence

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Disconnect in the "down low": Spinal Cord Injuries and Incontinence

Many people today know someone affected by, or have fallen victim themselves, to a spinal cord injury resulting from trauma or disease (Multiple Sclerosis, Spina Bifida, and other deformities/diseases effecting the spinal cord). This type of injury, regardless of cause, typically results in incontinence; also referred to as "neurogenic bladder" and "neurogenic bowel" in medical terms. Neurogenic, meaning arising from the nervous system, is the root of the term, hence injury to the nervous system via the spinal cord.

Spinal cord injuries disrupt communication between the brain and other parts of the body, causing them to dysfunction or not function at all. This is because the spinal cord plays a significant role in sending and receiving information from various parts of the body. For example: When a "normal" individual's bladder is full, it triggers the sending of a signal from the cells in your bladder, to the connected nerves, to the spinal cord. The spinal cord is then responsible for transmitting the signal to your brain so that it may respond appropriately and communicate back via the same pathway the information was sent. When injury or disease is present in the spinal cord, this inhibits the brain from communicating appropriately with the body.

Depending on where the injury occurred in the spinal cord or disease has progressed to (looking at the spine from bottom to top), determines how much function and control one will have over their body. The higher up the spinal cord injury or disease has occurred, the more loss of function one will have. Because the nerves communicating between the bladder/bowels enter into the very bottom of the spinal cord, you will find that people with spinal cord injuries almost always have issues with incontinence.

Neurogenic Bladder

Depending on the type of injury or disease, one may experience the following symptoms relating to urinary incontinence:

  • -total loss of bladder control (no function)
  • -inability to completely empty bladder (not enough function)
  • -frequent need to urinate (too much function)

The following are possible treatments for neurogenic bladder:

  • -specialized medications prescribed by a physician
  • -intermittent self catheterization
  • -continuous indwelling catheter
  • -surgery
  • -bladder training by health care provider

Neurogenic Bowel

Depending on the type of injury or disease, one may experience the following symptoms relating to fecal incontinence:

  • -total loss over control of bowels (no function)
  • -constipation (not enough function)
  • -frequent bowel movements (too much function)

The following are possible treatments for neurogenic bowel:

  • -specialized medications prescribed by a physician such as stool softeners and laxatives
  • -anal irrigation such as enema
  • -surgery

Take Home Tips!

Make sure you are emptying your bladder fully as prescribed by your physician (typically at least every 6 hours)! Talk to your physician regarding a proper toileting routine based on your unique condition. The longer urine sits in your bladder, the more likely you are to acquire an infection as urine in the bladder is the perfect environment for bacteria to grow. Urinary Tract Infections (UTI) can cause hospitalization, and if they occur frequently, can also contribute to the development of bladder cancer. If you do contract or have signs of a UTI, be sure to contact your doctor immediately to receive treatment, typically antibiotics.

If you have a neurogenic bladder or bowel, make sure to take your medication as ordered and follow the toileting schedule and instructions given to you. Never stop a medication or therapy without consulting your doctor first as serious conditions requiring hospitalization can occur if you fail to comply with your prescribed regimen.

Take good care of your skin in your private areas! Wounds, rashes, and sores can develop from incontinence protection pads/briefs/devices if not used appropriately. Be sure to keep these parts of your body clean and dry as urine and feces is very abrasive to the skin. If you have decreased sensation in these areas it is a good rule of thumb to go to the bathroom and ensure your skin and incontinence protection are clean and dry, changing and cleaning self when soiled.

Reposition yourself frequently! Individuals that suffer from spinal cord injuries often have decreased to no sensation below the area of injury in their body. For this reason, people often cannot sense when areas, most commonly one's bottom or tailbone, become sore from being in the same position too long. If you do not change position frequently so that boney parts of your body are not putting pressure consistently on the same area of your skin, you will likely develop a pressure ulcer in the area of pressure which can be very difficult to heal and sometimes require multiple surgeries. Problem areas to watch for are your tailbone, hips, heels, and other bony areas with little muscle or fat cushion between the bone and skin. Repositioning should occur at least every two hours.

Mayo Clinic Staff (2012). Neurogenic bladder and bowel management for spinal cord injury. Mayo Clinic. Retrieved July 30, 2014, fromhttp://www.mayoclinic.org/tests-procedures/neurogenic-bladder-bowel-management/basics/definition/PRC-20013781

Woodward, S. (2012). Wee Answer Wednesday: Spinal Cord Injuries and Incontinence. Men's Liberty. Retrieved July 30, 2014, fromhttp://blog.mensliberty.com/blog/bid/250931/Wee-Answer-Wednesday-Spinal-Cord-Injuries-Incontinence


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