Do you often think about emptying your bladder multiple times per day? Staying continent? Locating the nearest bathroom? Does your bladder own you?
If you answered “yes” to any of the questions above, you are amongst the millions of people living with a neurogenic bladder. In fact, when an internet survey asked individuals with spinal cord injury (SCI) to rate what functional gain would improve their quality of life, bladder function ranked higher than walking amongst both paraplegics and tetraplegics. And, let’s get right down to it. Losing control of the bladder was rated the top concern for SCI individuals considering a sexual encounter.
If you have suffered any damage to your central nervous system, you may have problems with urinary leakage and bladder emptying. Where and to what extent the damage to the nervous system will help define the type of neurogenic bladder and the recommended ways to treat it. If you have a traumatic brain injury, stroke, spinal cord injury, multiple sclerosis or diabetes, you may need a daily catheterization program to empty your bladder. A simple pleasure of using the bathroom may not have been a preoccupation in the past, and the process of “potty training” as toddlers really underscores a complicated neurologic process. So, let’s go back to the basics of how we acquired urinary continence and the social confidence to drink that Venti Starbucks coffee.
Normal Bladder Function
There are 3 areas of the central nervous system that control the ongoing communication between the bladder and the brain: (1) cerebral micturition center, (2) pontine micturition center, and (3) sacral micturition center. The bladder has 2 main functions: storage and emptying of urine. Continence is then achieved if there is coordination of all three centers by the central nervous system.
As your kidneys continuously filter urine, the bladder functions to store and empty when the time is appropriate. Just like you don’t have to think about your heart beating or lungs breathing, normal bladder function also involves the autonomic nervous system-a part of the central nervous system that “automatically” controls our vital organs. While the bladder stretches during the filling period, messages through peripheral nerves are communicated to the sacral micturition center and brain via the spinal cord. The brain (cerebral micturition center) then determines when it’s time to empty the bladder by communicating with the brainstem (pontine micturition center) to coordinate the contraction of the detrusor muscle that wraps around the bladder and the relaxation of the outlet sphincters located in our pelvic muscles via the sacral micturition center.
Functional Classification of Neurogenic Bladder
Now, let’s talk about when this system goes awry.
*Quick recap: the bladder functions to store and empty urine. If the main problem is storage, this will lead to urinary incontinence, which is defined as involuntary urinary leakage. Alternatively, if the main problem is difficulty in voluntary bladder emptying, this leads to urinary retention.
Depending on the type and extent of injury to the nervous system, you may have a neurogenic bladder resulting in urinary incontinence, retention, or both. There are 3 types of neurogenic bladders: (1) spastic or hyperreflexic bladder, (2) flaccid or areflexic bladder, and (3) mixed bladder. An evaluation with a urologist and a variety of tests and procedures can determine the type and condition of a neurogenic bladder. These tests may include ultrasounds, CT scans and cystoscopy to evaluate the anatomy and urodynamics to determine bladder function. Generally, urologic evaluations are recommended annually or more frequently if you are having problems.
Bladder Programs
The goals of the optimal bladder program are to minimize medical complications such as urinary tract infections and damage to the kidneys; avoid bladder distention with adequate emptying of urine; and most importantly, choose the best option that fits your lifestyle and functional ability. Based on what type of neurogenic bladder you have, there may be several recommended bladder programs for you.
Among the methods to manage a neurogenic bladder, let’s highlight a preferred method called intermittent catheterization (IC). This is a method where a catheter is inserted into the bladder for drainage then removed several times per day. IC offers a means to empty the bladder without leaving a catheter in the bladder and wearing a urinary collection device, commonly a leg-bag. Studies have shown this type of bladder program minimizes the frequency of long-term medical complications such as hydronephrosis, autonomic dysreflexia, bladder and kidney stones, and urinary tract infections (UTIs). IC can be done by means of a clean or sterile technique. Clean intermittent catheterization (CIC) begins with hand washing and using a new or cleaned catheter. Sterile intermittent catheterization (SIC) uses a catheter in a closed bag or kit that protects the user from touching the inserted portion of the catheter (touchless catheter). IC is an optimal program for individuals who have adequate hand function to catheterize themselves, good compliance to adhere to a timed schedule, normal urethral anatomy and interest to not wear a collection device.
With normal bladder capacity of 500 ml, catheterizing the bladder every 4-6 hours prevents over distending the bladder but offers the potential for friction-related trauma to the urethra. With this frequency, a person will insert and remove a catheter 1500 to 2000 times per year! So, lubrication sounds like an obvious good idea right? Advanced technology now offers the use of many types of catheters. A traditional straight catheter will need lubrication prior to insertion, but has been found to not provide consistent lubrication through the urethra. Alternatively, a hydrophilic catheter may minimize the friction during insertion and removal due to its special coating as it passes through the urethra. Hydrophilic catheters are great options for men with enlarged prostate, those with difficulty in passing traditional lubricated catheters, and those with frequent UTIs or urethral irritation.
As there are medical, social and financial considerations in managing a neurogenic bladder, it is important to talk to your doctor to determine what method and bladder program is best for you.
Now, it’s time for you to own your bladder.
Resources:
www.pva.org “Bladder Management Following SCI: What You Should Know” and “Urinary Dysfunction and MS”
Article reprinted with permission from Astra Tech, Inc.
