Neurogenic bladder dysfunction is when your bladder doesn’t function properly due to neurologic damage.
After spinal cord injury, you may not be able to tell when your bladder is full, which can interfere with your quality of life.
Proper management of neurogenic bladder dysfunction is crucial to keep you dry, prevent urinary complications, and reduce embarrassing accidents.
Your Bladder Before Spinal Cord Injury
Before we get into neurogenic bladder dysfunction after spinal cord injury, it’s important to understand how your bladder normally works.
A reflex that senses urine in the bladder causes your sphincter to contract in order to empty it. Then, your S2, S3, and S4 sensory nerves travel from the bladder to the spinal cord to the brain.
To prevent yourself from going to the bathroom every time urine starts to collect in your bladder, the brain helps inhibit the contraction. This allows urine to collect in your bladder until your bladder is full.
When you finally decide to use the bathroom, your brain removes that inhibitory signal, allowing your sphincter to contract so that you can empty your bladder.
So normally, when your bladder relaxes, the sphincter contracts and when the bladder contracts, the sphincter relaxes.
Your Bladder After Spinal Cord Injury
After a spinal cord injury, you may experience spinal shock, which is the temporary loss of reflexes due to inflammation of the spinal cord.
Spinal shock can last anywhere from a couple of days to 3 months.
When you’re in spinal shock, all the areas below your site of injury experience paralysis.
This means that none of your bladder functions are working, so you get a lot of urinary retention because you’re unaware of your bladder filling.
During this stage, you’ll likely need to use a catheter to empty the bladder.
Suprasacral Neurogenic Bladder Dysfunction
Neurogenic bladder dysfunction can be split into 2 types: suprasacral and sacral.
In the case of a suprasacral SCI, the bladder reflex works just fine. However, the inhibition signal from the brain can no longer travel through your spinal cord.
As a result, you can no longer control when you empty the bladder and it becomes spastic.
The detrusor (a muscle that makes up the wall of the bladder) and sphincter both contract, meaning that your bladder is trying to empty while sphincter is trying to hold urine in.
This results in high bladder pressure, incontinence, and leaking.
When your bladder becomes too full and you don’t do anything about it, urine can travel up to your kidneys and cause damage.
Sacral Neurogenic Bladder Dysfunction
In contrast, sacral neurogenic bladder occurs when the injury occurs in the sacral region of your spinal cord.
Injuries to the sacral region affect your bladder differently because the S2, S3, and S4 nerves of this region are responsible for bladder function.
When you injure these nerves, it affects your bladder reflex and you get flaccid bladder.
This is similar to the state your bladder was in during spinal shock. Essentially, the detrusor is thin and flexible, so there’s low pressure and you can retain a lot of urine.
It’s the opposite of what happens with a suprasacral injury and your bladder becomes underactive.
Because the muscles are all loose and relaxed, leaking can occur when you sneeze or laugh.
Managing Neurogenic Bladder Dysfunction
You must regularly empty your bladder to prevent complications of neurogenic bladder dysfunction like incontinence, hydronephrosis, UTIs, stones, and renal impairment.
Important factors to consider for bladder management after spinal cord injury are your lifestyle, extent of motor function in your hands, and whether you need a caregiver.
You want your neurogenic bladder management to be as convenient and hygienic as possible so that it won’t interfere with your quality of life.
A catheter is a thin tube that helps drains urine from your bladder.
Intermittent catheterization is when you temporarily insert a catheter every 4-6 hours to completely empty the bladder.
Drinking too many fluids can cause your bladder to fill up very quickly.
It’s impractical to frequently use your catheter when you’re out and about, so limiting your fluid intake is necessary with intermittent catheterization.
This might be favorable to those who do not want to be connected to a catheter all the time.
Indwelling catheterization is when the catheter is connected to your body at all times.
A benefit of using an indwelling catheter is that you don’t need to watch your fluid intake. You can see when the catheter is full and can promptly empty it.
Other Options for Managing Neurogenic Bladder Dysfunction
Other options for managing neurogenic bladder dysfunction include:
- Electrical stimulation is when an implant sends electrical currents that mimic brain signals to the sacral nerves and stimulate normal bladder function.
- Anticholinergic medications can relax the bladder muscles to prevent spastic bladder.
- Bladder augmentation is when you surgically get your bladder enlarged to combat spastic bladder and prevent upper tract complications.
- Botox injections can temporarily denervate spastic bladder muscles to prevent overactive bladder symptoms.
Learning to manage neurogenic bladder dysfunction is a crucial step towards transitioning back to everyday life after spinal cord injury.
Be sure to speak to your doctor about what the best option may be for you and your lifestyle.
Good luck and stay dry!