Bladder Management
Introduction
Bladder dysfunction in persons with spinal cord injury (SCI) can be disabling medically, physically, and socially. Most people with SCI have some degree of bladder dysfunction.
Normally, the bladder is able to store urine with detrusor (i.e., bladder wall muscle) relaxation, at low pressures, until it is socially appropriate to void. At the appropriate time, the sphincter muscles relax, detrusor contracts, and bladder emptying is achieved in a low pressure, coordinated manner. This coordinated function is achieved by the pons micturition centre and timing is controlled by the frontal cortex. The ability to fill the bladder under low pressure is of utmost importance in maintaining health of the kidneys and maintaining continence. The ability to empty the bladder completely on a regular basis in a low pressure manner is also important in maintaining kidney health and preventing urinary tract infections.
After spinal cord injury, the tracts to the pons and cortex are disrupted, hence the loss of coordinated bladder filling and emptying. Although the main types of bladder dysfunction after SCI will be discussed below, it is important in treating people with bladder dysfunction after SCI to appreciate that there are main goals, as follows: achieving regular bladder emptying and avoiding stasis; avoiding high filling and voiding pressures; maintaining continence and avoiding frequency and urgency; and preventing and treating complications such as urinary tract infections (UTIs), stones, strictures and autonomic dysreflexia.
In the present chapter, the literature has been classified into sections pertaining to type of bladder dysfunction i.e., neurogenic overactivity (hypperreflexia) or areflexia, and then methods of treating these either pharmacologically or non-pharmacologically. This includes a section describing literature addressing various bladder management methods. Prevention of complications is best achieved with proper management of the type of bladder dysfunction. The last section focuses on UTI prevention and treatment.
