Spinal Cord Injuries and Neurogenic Bladders
Although spinal cord injuries don’t cause damage to the structure of the bladder, they disrupt communication between the brain and the bladder, leading to the development of neurogenic bladder. Neurogenic bladder is caused by nerve damage, which leads to urinary retention, overflow incontinence, frequency, urgency, and incontinence.
Urinary retention and overflow incontinence are both caused by the bladder’s inability to sense when it’s full and contract to squeeze the urine out. In this case, urine is retained, sometimes overflowing out of the bladder, and needs to be drained with intermittent catheters.
According to the National Spinal Cord Injury Statistical Center, an estimated 291,000 people in the U.S. are living with a spinal cord injury, many of whom experience bladder dysfunctions.
Urinary incontinence means the bladder has lost the ability to hold urine in, leading to involuntary leakages, frequent bathroom trips, and the sudden uncontrollable urge to urinate.
What is the spinal cord?
The spinal cord is a long, tube-like structure running from the brain through you back and ends between your hips. As part of the central nervous system, the spinal cord relays information between the brain and the rest of the body, playing a vital role in maintaining bodily processes.
The spinal cord has four regions: cervical, thoracic, lumbar, and sacral. Each region is responsible for communication within a different area of the body. Therefore, the effects of an SCI depend heavily on which region the injury occurs.
What is a spinal cord injury?
A spinal cord injury (SCI) is damage to the spinal cord which results in a loss of function and mobility below the level of injury. Injuries to the spinal cord can damage the spinal nerves and nerve cells, which will no longer carry signals between the brain and the rest of the body. While some people with spinal cord injuries recover significantly, most live with long-term effects.
Spinal cord injury causes
The main causes of SCI are:
- Vehicle crashes
- Medical reasons/surgeries
Spinal cord injury symptoms and complications
People with spinal cord injuries may experience the following symptoms:
- Loss of mobility
- Loss of sensation
- Muscle spasms
- Sexual dysfunction
- Loss of bowel and bladder control
- Digestive problems
- Respiratory problems
- Severe pressure or pain in the head, neck, or back
- Pressure sores
- Abnormal lumps on the head or spine
- Abnormal positioning of the neck or back
- Burning sensation
- Numbness or tingling
- Changes in heart rate or blood pressure
SCI Levels and Functions
We can characterize SCI in the following ways:
Is the injury complete or incomplete?
- Incomplete Injuries: some sensation or function below the level of the injury
- Complete Injuries: no sensation or function on both sides of the body, below the level of the injury
Which parts of the body are functioning?
- Quadriplegia: the most severe form of SCI, resulting in loss of sensation or function in all limbs
- Paraplegia: loss of sensation or function in the lower half of the body
- Triplegia: loss of sensation or function in one arm and both legs, usually as a result of an incomplete SCI
Where in the spinal column is the level of the injury?
- Cervical SCI (C1-C7)
- The most severe injury type
- Results in quadriplegia
- Potential loss of sexual function, bladder and bowel control, respiratory function, sensation, and body temperature regulation
- Thoracic SCI (T1-T12)
- Results in paraplegia
- Potential loss of sexual function, bladder and bowel control, and core strength
- Lumbar SCI (L1-L5)
- Results in paraplegia
- Potential loss of sexual function, bladder, and bowel control
- Sacral SCI (S1-S5)
- May result in a loss of sexual function, bladder, and bowel control, as well as leg and hip function
The ASIA rates SCIs on a scale of A-E.
SCI effects on the bladder: neurogenic bladder
Neurogenic bladder is another common effect of SCIs. You can read more about the neurogenic bladder in our previous blog post. There are two types of Neurogenic Bladder:
- Spastic bladder/reflex bladder (occurs in injuries at or above T-12): results in urinary incontinence, in which urine is excreted involuntarily when the bladder is full, often occurs at inappropriate times
- Flaccid bladder/non-reflex bladder (occurs in injuries below T-12): urine is not excreted, only leaking out when the bladder is too full
People with flaccid bladders cannot empty their bladders voluntarily. Due to nerve damage, their bladders cannot sense when they’re full, not can they contract with sufficient force to squeeze the urine out. When untreated, urinary retention can lead to life-threatening conditions:
- urine can “reflux” back up the ureters and into the kidneys, causing kidney damage and infections which are potentially deadly.
- the bladder can burst due to high internal pressure (this situation is very rare)
Thankfully, this can be avoided with timely catheterization. However, if one does not practice proper catheterization technique, and leaves the bladder chronically incompletely drained, this can lead to frequent UTIs. Bacteria can build up in the bladder leading to a higher chance of infection. Having a bladder infection then increases the risk of kidney infections (which are dangerous) since bacteria travels upward along the urinary system. Mineral crystals can also form as a result of retained, highly-concentrated urine, leading to the development of bladder stones.
There are three main types of urinary catheters for treating flaccid bladder:
- Intermittent Catheters: allows users to self-cath (catheterize by themselves) by inserting a catheter multiple times a day to drain the bladder either directly into the toilet or into a bag
- Foley Catheters (Indwelling): inserted by a professional and left for long periods of time, draining into a bag to collect urine. One type of indwelling catheter is a suprapubic catheter, which you can read more about here.
- Condom Catheters (External): a male catheter, worn like a condom which is then connected to a bag to collect urine.
Many people choose to use intermittent catheters as they offer more independence compared to indwelling or condom catheters.
CompactCath was designed at Stanford d.school. It won two iF product design awards (2016, 2017), two grants (BioDesign Spectrum grant, LPCH Pediatric Innovation grant), and was covered by CNN Money. CompactCath was FDA-cleared in 2014 and holds six patents for its innovative designs.
Living with Spinal Cord Damage
Meet Daniel: “An Emergency Medicine Physician, business leader, healthcare innovator, patient advocate, and wheelchair user” among much else, Daniel lives with a T7/8 SCI after a mountain biking accident in 2017. Since then, Daniel has not only learned to navigate the effects of his injury, but also use it to accomplish more both personally and professionally.
Meet Misty: While Misty’s spinal cord damage comes from a neurological condition rather than a SCI, she faces many of the same challenges. A talented wheelchair basketball and sled hockey, Misty is now training in hopes to one day make the U.S. Women’s National Sled Hockey Team!
Meet Tamara: An award-winning “bilingual motivational speaker, actress, host, model, ambassador, survivor and eternal optimist”, Tamara has created a platform for herself after a car accident that left her with a T2 SCI. Tamara is widely recognized for her advocacy as she continues to inspire people to reach their full potential.