How Paraplegics Pee: Bladder Management Methods

Paraplegia is a form of paralysis affecting the lower half of the body, including the legs. The condition results from a spinal cord injury (SCI) that disrupts communication between the brain and other body parts, including the bladder. This loss of bladder control necessitates consistent management strategies to maintain health and quality of life.

The Effect of Spinal Cord Injury on Urination

The process of urination relies on information flowing between the bladder and the brain through the spinal cord. As the bladder fills, its walls stretch, sending signals to the brain that create the urge to urinate. The brain then instructs the bladder muscle to contract and sphincter muscles to relax, releasing urine.

A spinal cord injury interrupts this signaling highway, a condition known as a neurogenic bladder. Because nerve impulses are blocked, an individual may not feel when their bladder is full or be able to voluntarily empty it.

The type of neurogenic bladder depends on the injury’s location. An injury at or above the T12 level of the spine often leads to a spastic or reflex bladder, which may contract automatically without warning. An injury below the T12 level results in a flaccid or non-reflex bladder, where the muscle does not contract to empty, leading to urine retention.

Common Bladder Management Techniques

The most common bladder management techniques involve catheterization, using a thin, flexible tube to drain urine. The method chosen depends on the type of neurogenic bladder, an individual’s physical capabilities, and personal preference, as determined with their healthcare team.

Intermittent catheterization is a widely used method. It involves inserting a catheter through the urethra to drain urine and then immediately removing it. This process is performed on a set schedule, every four to six hours, to prevent overfilling. It is a clean technique that can be done at home with good hygiene.

An indwelling catheter remains in the bladder for an extended period. A Foley catheter is inserted through the urethra and held in place by an inflated balloon. A suprapubic catheter is inserted into the bladder through a surgical incision in the abdomen. Both types connect to a drainage bag.

An external catheter, or condom catheter, is an option primarily for men. This device is a sheath placed over the penis that connects to a drainage bag. This method manages incontinence but does not help a bladder that cannot empty on its own.

Associated Health Considerations

Using catheterization requires careful attention to potential health issues. The risk of urinary tract infections (UTIs) is higher, as the regular insertion of a catheter can introduce bacteria into the urinary tract. If the bladder is not fully emptied, the remaining urine can become a breeding ground for bacteria.

Kidney health is another concern. If the bladder is not drained regularly, high pressure can build inside it, causing urine to back up into the kidneys. This condition can lead to kidney damage over time, and recurrent UTIs can also contribute to long-term kidney problems. Adhering to a strict management schedule helps preserve kidney function.

For people with spinal cord injuries at the T6 level or higher, a full bladder can trigger autonomic dysreflexia (AD). AD is a sudden, uncontrolled spike in blood pressure caused by an irritating stimulus below the level of injury. A distended bladder is one of the most common triggers, with symptoms including a pounding headache, flushing, and sweating. Regular and complete bladder emptying is a direct way to prevent this complication.