Management Of Urinary Problems Caused By Spinal Cord Injury
Presented on October 13, 2009, by Stephen Burns, MD, Staff Physician, SCI Service, VA Puget Sound Health Care System, Associate Professor, Department of Rehabilitation Medicine, University of Washington. In addition, two individuals with spinal cord injury talked about their personal experiences with bladder management problems and solutions. Read the report or watch the video on this page.
How To Urinate After Surgery
This article was co-authored by Robert Dhir, MD. Dr. Robert Dhir is a board certified Urologist, Urological Surgeon, and the Founder of HTX Urology in Houston, Texas. With over 10 years of experience, Dr. Dhirs expertise includes minimally-invasive treatments for enlarged prostate , kidney stone disease, surgical management of urological cancers, and mens health . His practice has been named a Center of Excellence for the UroLift procedure, and is a pioneer in non-surgical procedures for ED using his patented Wave Therapy. He earned his undergraduate and medical degrees from Georgetown University and was awarded honors in pre-medical studies, urology, orthopedics, and ophthalmology. Dr. Dhir served as chief resident during his urological surgical residency at University of Texas at Houston / MD Anderson Cancer Center in addition to completing his internship in general surgery. Dr. Dhir was voted Top Doctor in Urology for 2018 to 2019, one of the top three Best Rated Urologists in 2019 & 2020 for Houston Texas, and Texas Monthly has named him to the 2019 & 2020 Texas Super Doctors Rising Stars list.There are 7 references cited in this article, which can be found at the bottom of the page.wikiHow marks an article as reader-approved once it receives enough positive feedback. In this case, 90% of readers who voted found the article helpful, earning it our reader-approved status. This article has been viewed 111,729 times.
What Is Bladder Management
Bladder management is an ongoing set of treatments and practices that help keep your bladder and kidneys healthy and free from infection and other problems.
- Bladder management cannot fix or solve the problems caused by your SCI, but it can help you manage them to improve your health and quality of life. With appropriate management you can prevent incontinence and damage to the kidneys.
- You can work with your doctor to choose which bladder management option fits into your lifestyle and maintains bladder and kidney health.
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Predictors Of Eventual Pour
After a median of 8 days for the overall treatment, the VV ratio among the patients who achieved POUR-free status was 72.5%. In a Cox multivariate analysis of the prognostic factors of eventual POUR-free status, intraoperative FC , previous spinal surgery , operative level , lumbar fusion , and TV at POUR were significant prognostic factors . The primary management method for POUR and medication use were not significant prognostic factors of eventual POUR-free status.
How Long Does It Take For Bladder To Heal After Hysterectomy
After a hysterectomy, you can usually go home the same day. But it takes at least 4 to 6 weeks for the incision to heal after both vaginal and abdominal surgery, and longer in older people or those who have health problems.
Incision care is important during this time because your wound will be more susceptible to infection.
You must also make sure your bladder does not become overfull. This can be a problem if you have a condition that causes rapid or large amounts of urine, such as urinary infection
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Risks Involving Bladder Surgery
- Strictures Scar tissue inside the bladder, ureters, or intestines.
- Obstruction of the intestines or ureters.
- Blood clots in the lungs or legs.
- Infection at the surgery site.
- Damage to organs near the bladder.
- Some forms of bladder surgery, due to a cancer for example, make the patient infertile because reproductive organs may be removed in the process.
- If men had their prostate and seminal vesicles removed during surgery, then they may experience erection problems.
- Women who have part of their vagina removed during surgery may experience sex problems.
What Is A Laminectomy
A laminectomy surgery is a common type of spine surgery. During the procedure, a spine surgeon removes a small section of bone from the lower spine. This is often used in the lower spine but may also be needed in the neck or the middle of the back .
The lamina are bone pieces that stick out from back of the spine. Their removal during surgery releases pressure from compressed nerves or the spinal cord which can lead to improved quality of life and function.
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Types Of Bladder Surgery
- Bladder Suspension Surgery . A prolapsing, dropping, or sagging bladder is returned to its correct position. It treats stress incontinence, which is urine leakage when a person coughs, sneezes, or laughs. There are several ways to perform bladder suspension surgery. The surgeon may make incisions in the abdomen and pull up the bladder neck. To keep the bladder neck in place, they sew the bladder neck to surrounding tissue or bone. A newer more common method is to use a sling or hammock-like structure to support the bladder neck. The structure can be made out of body tissue or man-made materials such as polypropylene.
- Transurethral Resection with Fulguration. A thin lighted tube called a cystoscope is inserted through the urethra to the bladder. While inside the bladder, surgeons use a tool with a small wire loop to burn away cancer formations. Its effective on tumors as well.
- Segmental Cystectomy. Part of the bladder is removed in segmental cystecomy. It can be performed in some instances of bladder cancer invading the muscle wall. As long as the cancer is only in one part of the bladder, segmental cystectomy is an option.
- Radical Cystectomy. If bladder cancer has spread to the muscle wall or inflicts a large part of the bladder, the patient may undergo radical cystectomy. In this surgical procedure, the surgeon removes the bladder and any lymph nodes or organs that contain cancer.
The Neck Bones Connected To The
Your neck contains several important structures, including but certainly not limited to the seven cervical vertebrae, the enclosed spinal cord, and the spinal canal.
The spinal canal is formed by the bones of your spine and protects your spinal cord, which is a big bundle of nerves that allows you to move, feel, and control important bodily functions like bladder and bowel control.
If any kind of damage occurs in this area, your bladder, among other organs, can be affected.
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Can A Laminectomy Treat Spinal Stenosis
Yes, your spine surgeon may consider laminectomy surgery to treat spinal stenosis. Stenosis is a gradual narrowing of the spinal canal . The narrowing space crowds nerve roots and the spinal cord, which may cause severe pain or make it difficult to move in certain ways. Spinal stenosis often happens as your body ages, when tissues in the spine slowly wear down over time.
Stenosis in the lower back is a common cause of low back pain.
Lumbar spinal stenosis may cause:
- Pain when you walk or bend over.
- Numbness or tingling near your legs, groin or lower back.
- Bladder or bowel problems .
Deterrence And Patient Education
Preoperatively, patients at the most considerable risk for the development of postoperative urinary retention require education about their increased potential for developing POUR. This factor is essential to set expectations and avoid undue stress if a patient were to develop a complication which they do not envision connected to their planned surgery.
If POUR does develop, patients should be reassured that with catheterization and time, most people return to baseline voiding function and will not require longterm catheterization, medication, or urologic surgery.
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What Is Cauda Equina Syndrome
Cauda equina syndrome is a rare condition but has serious consequences if not treated promptly. It is most often caused by a large disc herniation in the lower back that compresses the nerve roots at the end of the spinal cord . These nerve roots are bundled together and resemble the tail of a horse. This is how they get their name. Cauda equina means “horse’s tail” in Latin.
Unlike most back problems that are longstanding or chronic, cauda equina is an acute event, like a stroke or heart attack. It most often develops rapidly, within as few as 6 to 10 hours. Classic symptoms of back pain, coupled with a sudden onset of numbness in the genital area and sudden urinary retention, are signs of a medical emergency. Relieving compression quickly can determine whether one resumes a normal life or lives with incontinence and paralysis of the legs.
Less often, in people with recurrent back problems, cauda equina can come on gradually, with a slow progression of urinary symptoms. Because cauda equina syndrome is a disorder of the nerves that control the bladder, its symptoms can be similar to those caused by bladder or prostate problems.
Is Urinary Incontinence Normal After Hysterectomy
The most common after-hysterectomy problem is pelvic floor dysfunction. However, the most common type of pelvic floor dysfunction is urinary incontinence, and often after the surgery. But not all women suffer from it only about 30% or so experience one or more symptoms of post-surgical SUI/stress voiding.
Hysterectomy does not cause urinary incontinence. Loss of support for the bladder neck and urethra is what causes it.
The incidence of urinary incontinence after hysterectomy varies depending on which surgical technique is used. The highest incidence is after vaginal hysterectomies because these procedures disrupt supporting structures of the bladder more than abdominal procedures.
About half of patients who have vaginal hysterectomy experience urinary incontinence after their surgery, most often due to injury to the urethra or bladder neck during the procedure.
After an abdominal hysterectomy, about 10-20 percent of women will experience stress-related urinary incontinence, but the risk seems to increase to 40-50 percent when combined with other pelvic surgery such as bladder or vaginal surgery.
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How Effective Is Laminectomy
Most patients experience significant back pain relief and symptom improvement after laminectomy surgery. Surgery does not correct the underlying problem thats causing spinal tissues to wear down gradually. For that reason, your symptoms may come back.
Some people continue to experience pain and worsening symptoms after laminectomy surgery.
How Can I Know If My Bladder And Sphincter Are Working Correctly
Doctors can do a urodynamics test to see how well your bladder and sphincter are working:
- A catheter goes up through your urethra into the bladder.
- Your bladder is slowly filled with fluid.
- Doctors then measure how your bladder and sphincter respond to the fluid in the bladder.
- The test can help inform which bladder management option is best for you.
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Kidney And Bladder Stones
Stones are common in people with SCI. They can develop early on because large quantities of calcium leave the bones in the first few months after injury. It is more common to get stones later, and this is due to infections over the long term. Bacteria break down urea into chemicals that form stones, which can cause blockages, kidney damage and serious infections.
Clinical Characteristics Of The Recovery
The prognosis for recovery of urinary continence in dogs with non-compressive T3-L3 spinal cord injury seems similar to those with a compressive injury, with 9198% of dogs with hind limb dysfunction and present deep pain regaining urinary continence . However, interestingly, 1523% of dogs remain faecally incontinent in the chronic phase of recovery , suggesting that the injury perhaps affects spinal cord tracts differently to acute compressive intervertebral disc herniation. Indeed, contusive and vascular lesions induce more centrally located damage than is induced by compressive intervertebral disc extrusion, likely affecting the descending inhibitory control of the defecation reflex. The possibility of persistent fecal incontinence should be conveyed to owners of these cases.
Secondary lesions of the lower urinary tract in the acute and then chronic phases of spinal cord injury are poorly described in companion dogs. There is a clear occurrence of urinary tract infections that is discussed alongside the management methods to drain the bladder in the following parts of this article. But the histopathological changes of the bladder or kidneys are not described in companion dogs although there are data in experimental dogs .
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Urinary Incontinence And The Bladder
Spinal disorders or injuries that cause nerve compression or damage may cause Neurogenic Bladder Disorder also termed Bladder Dysfunction. NBD means the patient has problems with urination. The term neurogenic refers to the nerve tissues that supply and stimulate an organ or muscle to function properly. In the case of NBD, nerves that control the bladder and muscles involved in urination cause the bladder to be overactive or underactive.
NBD symptoms may include:
- Limited or no voluntary control
- Involuntary urination
- Feel sudden urge to urinate
- Frequent bathroom visits
- Bladder does not completely empty
- Bladder overfills and pressure causes accidental leakage of urine
- Bladder is unable to hold urine
The brain and spinal cord are the central chains of command that transmit signals and messages to and from the bladder. Photo Source: 123RF.com.
What Is Difficulty Urinating After Surgery
Difficulty urinating after surgery is a condition called postoperative urinary retention . POUR is the inability to voluntarily urinate after surgery despite the bladder being full. It occurs when surgery interferes with normal bladder function. Bladder control involves both the voluntary and involuntary nervous systems. There are also two phases of bladder controlfilling and voiding.
When the bladder is filling, smooth muscles stay relaxed. The strong sphincter muscles contract during filling to keep urine in the bladder. When nerve signals tell the brain the bladder is full, you become aware of the need to urinate. Voidingor releasing urine from the bladderis the part you can control voluntarily. You decide when you will urinate. Once you are ready, the smooth muscles around the bladder contract to squeeze it and you relax the sphincter muscles to let urine flow. Surgery can interfere with the smooth muscle function, the nerve signals, or your ability to voluntarily relax the sphincter muscle.
Difficult urination after surgery is very common. Up to 70% of people having surgery will experience it to some degree. The risk is higher in men, people older than 50 years, and people with certain medical conditions, such as . It is also more common with certain types of surgery, such as pelvic surgery, and with anesthesia medicines. The amount of time under anesthesia can also contribute to postoperative urinary retention.
- Difficulty starting to void
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What You Need To Know
- Your spinal cord injury might limit your ability to control your urine. You might not be able to stop urine from flowing, or you might not be able to release it.
- Uncontrolled urination or inability to empty your bladder can have a negative effect on your quality of life and cause bladder and kidney infections and other problems.
- Appropriate bladder management can help keep your bladder and kidneys healthy.
- Each type of bladder management option has pros and cons.
- Your doctor can help you choose the bladder management option that best meets your needs and lifestyle, and keeps your bladder and kidneys healthy.
Management Of Bladder Function After Outpatient Surgery
Research Study Coordinator.
Received from the Department of Anesthesiology, University of Washington School of Medicine, Seattle, Washington. Submitted for publication July 10, 1998. Accepted for publication February 15, 1999. Supported by a grant from the Anesthesia Patient Safety Foundation, Pittsburgh, Pennsylvania.
Address reprint requests to Dr. Pavlin: 1959 NE Pacific Street, Box 356540, Seattle, Washington 98195. Address electronic mail to:
Janet D. Pavlin, Edward G. Pavlin, Dermot R. Fitzgibbon, Meagan E. Koerschgen, Terryn M. Plitt Management of Bladder Function after Outpatient Surgery . Anesthesiology 1999 91:4250 doi:
This study was designed to test a treatment algorithm for management of bladder function after outpatient general or local anesthesia.
Urinary retention affected 0.5% of category 1 patients and none of category 2 patients. Median time to void after discharge was 75 min in category 1 patients discharged without voiding. Fluids administered did not alter incidence of retention or time to void. Retention occurred in 5% of high-risk patients before discharge and recurred in 25% after discharge.
In reliable patients at low risk for retention, voiding before discharge appears unnecessary. In high-risk patients, continued observation until the bladder is emptied is indicated to avoid prolonged overdistention of the bladder.
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Regaining Bladder Control After Spinal Cord Injury: Key Points
Loss of bladder control is one of the most common outcomes of spinal cord injury. While it might be possible to improve bladder control, the outcomes of every SCI are different.
Learning to manage bladder problems is essential to avoid accidents and prevent further complications from developing.
Hopefully, this article helped you better understand how spinal cord injury can affect bladder functions and how to manage complications to improve your quality of life. Good luck!
What Are The Causes
A large ruptured disc can cause cauda equina syndrome. During a herniation, the gel-like center of a spinal disc can bulge or rupture through a weak area in the disc wall and compress the nerves. In the majority of cases, the disc herniation occurs at the L4-5 or L5-S1 discs in the lumbar spine. A sports injury, fall, or car accident can fracture the spine or tear a muscle and damage nerves. Other causes include a narrowing of the spinal canal , a tumor, an infection, or a hemorrhage.
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