Recent Blog Posts
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- Rodney Rogers, Paralyzed
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- New Jersey State to Cut Spinal Cord Injury Research Funds
- Recent Study on US Health Care System Performance
- Good Article on Making Babies After SCI
- "We have promising new treatments that would just die on the vine"
Bladder Function After SCI
An able-bodied person knows when they have to pee. If they have to pee and don't want to right at that moment, they have the ability to "hold" it.
A spinal-cord injured person does not have control of the muscles used to pee, the muscles used to completely empty the bladder and certainly not the muscles used to "hold it." In most cases of "complete" spinal cord injury, a person cannot even sense when they have to urinate.
Death By Bladder Infection
Without special medical equipment, the SCI'ed would exist in a constant state of incontinence, perpetually leaking urine with a full bladder. Before WWII, a spinal cord injury was a fatal sentence. It wasn't because of the paralysis of the muscles. It was the urinary system that finished you off a few days after your spinal cord injury. Immediately after injury, you lived a couple days while urine leaked out of your body until you died. The cause of death was kidney failure (from urine backing up and infecting the kidneys). So surprisingly it was the lost bladder function that finished you off.
The Catheter-A Simple Piece of Plastic That Keeps Us Alive
With the invention of plastics came the invention of the catheter. A catheter is a long tube inserted in the urethra to remove urine from the body. This is how the SCI'ed urinate. Catheters are what keep us alive.
Every time urine is removed from the bladder, a 12-14 inch plastic tube is inserted into the body. For the male, that means it is inserted down the urethra through the opening at the tip of the penis. Due to differences in anatomy, it is much more difficult to access the urethra and insert the catheter into the bladder for a female. As it can be imagined, this is an invasive process that is only possible because the SCI'ed lack the ability to feel pain below their injury level.
Most paraplegics and some quadriplegics practice what is known as "chronic intermittent catheterization". This means a new catheter is inserted into the bladder every time it needs to be emptied. This takes nimble fingers as it is difficult to thread a 14 inch plastic tube down the urethra. The lucky SCI'ed can perform this ritual on their own without assistance. Many times per day.
It Gets Worse if SCI Impairs The Function of Hands/Fingers (Tetraplegia)
For most quadriplegics without good hand and finger control, there are two options. The first is for a caregiver to perform intermittent catheterization for them. Every time that urine needs to be emptied from the bladder, another person inserts the catheter, collects the urine and disposes of it. Obviously, this requires that someone else (either volunteer or paid) to attend to waste management full-time. Insurance pays sometimes. The second option is an indwelling catheter. This is basically a tube connected to a bag that is permanently inserted into the bladder via the urethra. When the bag is full, somebody empties it and disposes of the urine. Because the bag is usually attached to the leg, it is known as a "leg bag." This is a permanent arrangement. You sleep, eat, shower and exercise with a leg bag. If your pants are too short, a big bag of urine is visible to the public.
Lets Play the Incontinence Game-Also Known as the "Try Not to Piss in Your Pants" Game
As described above, urinating with a spinal cord injury basically amounts to removing liquid waste from the bladder with plastic tools. However, that doesn't do it justice. If it were that simple, most people with SCI would be cool with that. The second challenge is determining when to empty the bladder--when "to cath."
The best way to describe the constant challenge of bladder maintainace with an spinal cord injury is to imagine you are playing a game each time you pee. The object of the game is to guess when your bladder is full and empty it before urine starts leaking out of you, soiling your clothes. A player wins if they are able to 1) Find a Toilet, 2) Empty their bladder without getting any urine on their clothes and 3) Deposit all of the urine into the toilet. If the player gueses right and empties their bladder before they urinate in their pants, their reward is to start over and play again. If a player waits too long and guesses wrong, they soil their clothing. At this point they can decide to change, or just sit in their wet, urine soaked clothes. Once again, the games starts over and the player must play again. The game continues until the player dies.
So you say, the able-bodied have to play this game too? From the time they are "potty-trained" as toddlers until they die? Yes, they do. However, the SCI'ed get to play the game with the following special rules:
1) They don't know when their bladder is full (Some can feel it a little bit, others not at all depending on the severity of injury, regardless--there is impairment)
2) They can't always get to a bathroom. Accessibility is not a given.
3) They can't hold it if their bladder is full. Those muscles are paralyzed too.
4) They have a limited number of catheters, which are very expensive. Most health insurance only covers a fixed number. Heaven forbid you forget them at home.
5) Those dependent on a caregiver aren't even playing the game for themselves. They have someone else playing it for them.
The whole thing basically amounts to a constant struggle against nature and incontinence. As one might imagine, at some point, its gets a little bit old playing this game with the odds stacked against them. The SCI'ed are constant slaves to their bladders, the zombie flesh attached to them.
This is bladder function with a Spinal Cord Injury (SCI).