Bowel, Bladder, and Sexual Function
After a spinal cord injury (SCI), nerve impulses from the bladder may no longer tell your brain that your bladder is full, or allow you to void on your own.
Neurogenic bladder refers to any changes in bladder function that occur due to SCI. Depending on your level of injury, two general kinds of bladder dysfunction may occur:
- Hyperreflexic (overactive, reflex, or spastic) bladder tends to hold less urine than before SCI. The bladder muscle may spasm and contract on its own. You may have frequent small urinations or not be able to empty at all. The bladder may not empty with each contraction. This type of bladder is common with SCI above the sacral level.
- Areflexic (flaccid) bladder has lost its ability to contract and can be easily stretched, allowing large amounts of urine to accumulate. Because the muscle does not contract, the bladder can overfill and leak. The urine “spills over” like a glass that’s too full of water. This type of bladder activity is common when SCI affects the spinal nerves in your sacral spinal cord.
The main goal of bladder management is to protect kidney function. If the bladder is not functioning well, the kidneys may stop filtering the blood.
The second goal of bladder management is to avoid incontinence. Wet skin can promote pressure ulcers. Incontinence also is not socially acceptable.
The bladder should be emptied regularly and completely. A number of tests can evaluate the structure and function of the urinary system. Genitourinary testing during routine annual checkups with your SCI doctor is recommended.
One common form of bladder emptying is intermittent catheterization procedure (ICP). You will want to limit your bladder volume to around 300 to 500 ml each time you cath. More than 500 ml in the bladder overstretches your bladder muscle and can lead to infection or reflux. Adjustments may have to be made in frequency of catheterizations and your fluid intake in order to maintain cath volumes of less than 500 ml per cath.
Another type of bladder emptying is an indwelling catheter. Two types of continuous drainage are urethral (Foley) and suprapubic catheters.
Neurogenic bowel is a condition that affects the body’s process for storing and eliminating solid wastes from food. Generally two basic patterns of neurogenic bowel occur after SCI:
- Reflexic bowel usually results from SCI at the neck or chest level. This type of SCI interrupts messages between the colon and the brain that are relayed by the spinal cord. Below the level of injury, the spinal cord still coordinates bowel reflexes. Because you don’t feel the need to have a bowel movement, stool builds up in the rectum and can trigger a reflex bowel movement without warning. With a reflexic bowel, a bowel program using digital rectal stimulation and stimulant medications help to push the stool out according to a set time.
- Areflexic bowel usually results from SCI that damages the lower end of the spinal cord or the nerve branches that go out to the bowel. In this case you have reduced reflex control of your anal sphincter. You can’t feel the need to have a bowel movement, and your rectum can’t easily empty by itself. This type of neurogenic bowel is typically managed with digital evacuation.
Medications, alcohol and other drugs, and diet can all affect bowel function. A well-designed bowel program can help prevent accidents and can improve quality of life after SCI.
SCI impacts an individual’s sexuality on both a physical and emotional level. Issues with sexual health and reproduction may vary by individual; thus, treatment programs should be individualized.
Depending on the level of injury, men with SCI may not be able to achieve or maintain an erection, and women with SCI may not be able to produce adequate vaginal lubrication.
Men with SCI may need to utilize reproductive technology in order to conceive.
Women with SCI are able to conceive and have children, but they must be followed closely by SCI professionals in order to make sure that medications, bowel and bladder programs, skin, spasticity, and other issues related to SCI are adequately managed throughout pregnancy.