Good bladder management can
improve your quality of life by preventing bladder problems, which is one of the
biggest concerns for people who have spinal cord injuries (SCIs).
Normally, the kidneys filter waste
products and water from the blood to form urine, which is stored in the bladder . When the bladder is full, a message is sent from the bladder to the
brain. The brain sends a message back to the bladder to squeeze the
bladder muscle and relax the sphincter muscles that control the flow of urine. After the
bladder starts to empty, it normally empties all of the urine.
After an SCI, the kidneys usually
continue to filter waste, and urine is stored in the bladder. But messages may
not be able to move between your bladder and sphincter muscles and your brain.
This can result in the:
- Inability to store urine. You cannot control when your bladder
empties (reflex incontinence). This is known as reflex or
- Inability to empty the bladder. Your bladder is full, but you
can't empty it. It stretches as it continues to fill with urine, which can
cause damage to the bladder and kidneys. This is known as a flaccid
Not taking good care of your bladder can lead to
urinary tract infections (UTIs), kidney and bladder problems,
sepsis (a bloodstream infection), and, in rare cases,
kidney failure. For information on testing for, treating, and preventing UTIs,
see the topic
Urinary Tract Infections in Teens and Adults.
A bladder management program
lets you or a caregiver empty your bladder when it is easy for you and helps
you avoid bladder accidents and prevent UTIs. You and your rehabilitation team
decide which bladder management program is best for you. You need to consider
where your spinal cord is injured and how it has affected your bladder
function. You also need to consider your lifestyle, how likely you are to get
bladder infections, and whether you or a
caregiver is able to use a
The most important things in bladder
management are monitoring the amount of fluids you drink, following a regular
schedule for emptying your bladder, and being sure that you empty your bladder
completely. Your rehab team will help you set up a schedule based on your needs
and the amount of fluids you typically drink.
Common ways to manage bladder function include the
- Intermittent catheterization programs (ICPs) are often used
when you have the ability to use a catheter yourself or someone can do it for
you. You insert the catheter—a thin, flexible, hollow tube—through the urethra
into the bladder and allow the urine to drain out. It is done at scheduled
times, and the catheter isn't permanent.
- Intermittent Catheterization for Men
- Intermittent Catheterization for Women
- If you can't use intermittent catheterization, you can use a
permanent catheter known as an
indwelling Foley catheter . Urinary tract infections are more likely to occur with
long-term use of an indwelling catheter than with an ICP.
Caring for the catheter is important to avoid
- If you use an indwelling Foley catheter, after a period of time
you may be able to change to a suprapubic indwelling catheter. This is a
permanent catheter that is surgically inserted above the pubic bone directly
into the bladder. It does not go through the
- If you can't use intermittent catheterization and can't (or don't want to) use an indwelling catheter, you may be able to choose surgery that creates a urostomy. An opening (stoma) is made between your bladder and the skin of your belly. Urine then drains into a bag attached to your skin at the stoma. Intermittent catheterization can be used through the stoma, if needed.
- For men, a
condom catheter can also be used. Condom catheters are only for short-term use, because long-term use
increases the risk of urinary tract infections, damage to the penis from
friction with the condom, and a block in the urethra.
- If you have a spastic bladder, you may be able to "trigger" the
bladder to contract and avoid having to use a catheter. To do this, you can try
tapping on the bladder area, stroking your thigh, or doing push-ups in your
wheelchair. Or you can use
Valsalva maneuvers, which are efforts to breathe out
without letting air escape through the nose or mouth.
- It is also possible to use
absorbent products, such as adult diapers.
You may use just one method or a combination.