Patients with spinal cord injury are often unable to urinate on their own. If urine is not drained in a timely manner, the bladder is prone to short-term distention and long-term kidney damage, which can even be life-threatening. There are many ways to drain urine and in the past, the most common method was to place a foley catheter.
However, foley catheter is prone to complications such as urinary tract infections, orchitis, epididymitis, urinary calculi, urethral stricture, and fistula.
The purpose of bladder training is to enable patients with spinal cord injury to empty their bladder in a timely and regular manner to minimize the need of using a foley catheter.
The focus of bladder training includes (a) control of water intake (b) bladder training (c) intermittent catheterization. Usually, at the beginning of the training, the patient catheterizes once every four hours and the volume of urine produced is the “post voided residual”.
Bladder training should begin with controlling the amount of water consumed. It is generally recommended that the patient drink 100 c.c. water per hour so that the patient can urinate 350-400 c.c of urine in the bladder before catheterization every four hours. If the 4-hour urine volume exceeds 500c.c., the amount of water should be reduced, and conversely, if the urine volume is less than 300, the amount of water should be increased.
Otherwise, too much urine will make the bladder too bloated and damage the muscles and nerves of the bladder wall. Too little urine, on the other hand, will make the bladder not easy to contrast, and can not dilute the bacteria and precipitates in the bladder, causing urinary tract infections and urinary tract stones. It is best to maintain a daily urine volume of 1,500-2,000 c.c.
Urination training methods are divided into two categories. After a detailed clinical physical examination and the urodynamic examination, the patient’s neuron in sacral segments and the functionality of the bladder itself to determine the appropriate patient’s method of urination. The following procedure is just for reference, not 100% will be prescribed by your doctor.
For patients whose bladder contractility is still functioning, various methods can be used, such as gently scraping the inner thighs with a finger, gently pulling the pubic hair, or gently tapping the lower abdomen above the pubic bone with a finger to induce contraction reflex of the detrusor muscle of vesical wall.
For patients whose urine functions in sacral segments are damaged where the bladder and urethral sphincter contraction force are not functioning, increasing abdominal pressure by squeezing is another way to make the urine out of the bladder: using the fist to squeeze the area above the pubic bone in the lower abdomen from above.
When sitting in a wheelchair, use support one’s body against the armrests to simulate the process of defecation so that the unparalyzed abdominal muscles and the diaphragm can contract to squeeze out the urine.
Intermittent catheterization can avoid the complications of long-term indwelling urinary catheters, and can also provide periodic exercises that is similar to the normal bladder expansion and contraction to preserve bladder elasticity.
As long as the patient empties his or her urine before going out, they can go out, meet friends, and participate in social activities as usual, which greatly improves the quality of life. Therefore, after training, patients should still urinate on a regular basis, especially before going to bed and waking up in the morning.
Water intake control and intermittent catheterization are transitional periods in the bladder training, when the post voided residual is less than 100 c.c., one can increase the daily water intake to 2000-2500 c.c., the frequency of intermittent catheterization can also be gradually reduced in accordance with the reduction of residual urine. If the post void residual is less than 100 c.c. every time, you only need the check the post voided residual at every 3 to 6 months at the medical clinic you trust.
According to the experience observed at the rehabilitation ward, the post voided residual is less than 100 c.c. indicates a high success rate, and the earlier the patient receives rehabilitation medical treatment, the shorter the time required for bladder training and the higher the success rate; if the patient receives bladder training more than six months after the injury, the training time is longer.
If you are undergoing the process of rehabilitation from spinal cord injury, please don’t be discouraged by your current conditions. CompactCath provides affordable, quality intermittent catheters for you to support you during this journey. Stay healthy and stay safe!
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