Hesperian Health Guides
Chapter 25: Urine and Bowel Management
Most persons with spinal cord injury or spina bifida do not have normal bladder or bowel control (control for peeing and shitting). This loss of control can be inconvenient, embarrassing, and cause social and emotional difficulties. Also, the loss of control can cause skin problems and dangerous urinary infections. For these reasons, it is important to learn ways to stay clean, dry, and healthy. Most of the methods are not difficult, so children should be able to do it themselves. This will help them feel more self-reliant.
The main goals of urine management are:
- to prevent urinary infection, and
- self-care in staying as dry as possible.
Prevention of urinary infection is extremely important. Infections of the urinary system (bladder and kidneys) are very common in both spinal cord injury and spina bifida, and are one of the main causes of early death. Therefore, any method used for self-care or staying dry must also help prevent urinary infections. Make every effort to prevent germs from getting into the bladder. Keeping clean is essential. Also, it is important to empty the bladder regularly as completely as possible. If some urine stays in the bladder, bacteria will grow in it and cause infection.
The ideal method of urine control empties the bladder completely and in a clean, regular, easy, and self-reliant way.
Different methods work best for different persons—depending mostly on what ‘type’ of bladder a person has. We discuss this on the next page.
‘Types’ of bladder —in persons whose feeling and control have been partly or completely lost.
|AUTOMATIC BLADDER: A person with paralysis whose legs have ‘reflex spasms’ (uncontrolled stiffening or jerking) usually also has reflex spasms in his bladder. As the bladder fills with urine, the walls of the bladder stretch and cause a reflex spasm. As the bladder squeezes, the muscles that hold back the urine relax, letting the urine flow out. This is called an ‘automatic bladder’ because it empties automatically when it gets full.||LIMP BLADDER (flaccid bladder): When a person’s paralyzed legs are limp and do not have spasms, usually the bladder is also limp, or flaccid. No matter how much urine fills the bladder, it will not squeeze to empty. The bladder stretches until it cannot hold any more and the urine begins to drip out. The bladder does not completely empty this way. Some urine stays in the bladder, increasing the chance of infection.|
The most simple methods of bladder management work well with an automatic bladder but do not work with a limp bladder. So try to figure out which type of bladder a child has.
For the first few days or weeks after the spinal cord has been injured, the bladder is almost always limp. Urine either drips out or does not come out at all. Then, as the ‘spinal shock’ wears off, persons with higher back injuries (above the 2nd lumbar vertebra) usually develop automatic bladders. In persons with lower back injuries, the bladder usually stays limp.
During the first weeks, usually a ‘Foley catheter’ is kept in the bladder all the time. However, after about 2 weeks, it is a good idea to test how the bladder works by removing the catheter and trying one of the methods described in this chapter. If the person is often wet, try another method for that type of bladder.