As you are well aware the urinary system is used to filter waste out of the blood stream in the form of urine. The urine travels from the kidneys into the bladder where it is stored until the bladder is filled and your body tells you that you need to go to the toilet. When a SCI occurs your urinary system is always affected in some way, as the nerves affecting your bladder are down in your tail bone. Everyone is different as to how they are affected as no one’s injury is ever exactly the same. Your level and how complete your injury is, will affect your function.
There are two ways your bladder can be affected. You can have either a spastic (reflex) bladder or flaccid (non-reflex) bladder. When your SCI is above the T12 level you generally have a spastic bladder. A spastic bladder reflexively empties itself when it is filled. A spastic bladder generally involves a lot of timing and ensuring you empty your bladder before it becomes full as accidents can occur. When you go into rehab you are put on a bladder program where you learn to use either an intermitted catheter program, a Foley catheter (permanent) or an external “condom” catheter.
If your injury is below the T12/L1 level your bladder is normally flaccid. A flaccid bladder’s muscles do not function how they are meant to (if at all) and depending on the position of your sphincter you run the risk of your bladder over filling and the urine running back up into your kidneys. People with flaccid bladders generally use an intermitted catheter program.
At any time when a bladder is over filled, the urine backs up into the kidneys, or a Urinary Tract Infection (UTI) takes place Autonomous Dysreflexia (explained in an up and coming section) can occur for people whose injury is at the T7 level, or above. This can be life threatening when not dealt with as it is your body’s way of telling you that you are in trouble.
There are surgical treatments that can be used when a person has an SCI. A person can have a Mitrofanoff where a passageway is created through the abdomen into the bladder where a catheter can be inserted.
When a person’s sphincter in their bladder does not relax to allow the urine to come out a Spincterotomy can be done to weaken the bladder neck and sphincter muscles. This procedure would require you to wear a Foley or external catheter full time as you would have no control over your bladder at all.
Finally some people have bladder augmentations to have their bladder enlarged. The benefits of this is that they can wait longer before having to worry about accidents, and it gives them more time to make sure they have a chance to relieve their bladder.
Any surgery or catheterisation should be taken seriously as the bladder is a sterile environment. It is much safer to use an external catheter or an intermitted catheter program than it is to use a Foley catheter, but if using a Foley catheter became necessary, the people at your rehab facility would show you ways of minimising UTIs.