	About Us		Patients, Families & Visitors		For Health Professionals		Careers		Research & Training		Ways to Give

Critical Care Trauma Centre

EDUBRIEFS in CCTC

_{Maintaining
Bladder Function in Spinal Cord Injury}

Bladder Drainage in Spinal Cord Injury

In spinal cord injury, bladder sphincter relaxation is absent, leading to urinary retention.
As soon as hourly urine output is no longer necessary, the indwelling bladder catheter should be removed to reduce the risk of urinary tract infections (a life-threatening complication of acute spinal cord injury).
Intermittent catheterization decreases the risk for urinary tract infections.

Considerations

Immediately following acute spinal cord injury, spinal shock develops. Spinal shock is characterized

by flaccid paralysis (loss of bladder tone) below the level of the injury, and loss of spinal cord

reflexes including bladder and bowel sphincter control. Spinal shock often coincides with

neurogenic shock, which is evidenced by loss of autonomic control (bradycardia, vasodilation,

hypotension). Spinal shock can persist for several weeks, and is associated with an inability to

retain urine or bowel contents. Although urinary incontinence may be present, bladder emptying is

also dysfunctional, making some form of catheterization mandatory.

When spinal shock ends, spinal reflexes begin to return. Bulbocavernal, bladder and rectal

sphincter reflex are amont the first responses to appear and are generally signs that the spinal shock

phase is ending. The ability to retain urine is restored, and spastic movements of the paralyzed

limbs may appear (care should be taken not to mistake these involuntary movements for a return of

voluntary movement).

Although bladder and bowel sphincter tone may allow the paralyzed individual to maintain

continence of urine and feces, the cord injury prevents the individual from contracting the bladder

and relaxing the sphincters to facilitate elimination. This places them at risk for autonomic

dysreflexia.

As soon as hourly urine output is no longer needed, routine intermittent catheterization should

commence. Catheterization should be performed q 4 h initially. The goal is to perform

catheterization frequency to keep bladder volume < 500 mL. Catherization frequency can be

increased if adquately maintaining this goal.

Care must be taken to ensure that catheterization frequency is sufficient to prevent bladder

distention, as a full bladder can trigger autonomic dysreflexia. Bladder distention may also reduce

blood supply and increase the risk for infection. Intermittent catheterization frequency should

increase when fluid intake rises or diuretics are administered.

Following catheter removal, incomplete bladder sphincter control may cause some urinary

incontinence. Condom drainage can be used to protect skin and linen, however, it is important to

continue to perform intermittent catheterization, as complete bladder emptying will not occur. In

lower cord or incomplete injuries, some patients may be trained to persist.

Brenda Morgan
Clinical Educator, CCTC
May 11, 2001

References:

O'Donnell, W. (1987). Neurological management in patient with acute spinal cord injury. Critical Care Clinics. July. pp
599-608.

Reed, MA. (1987). Nursing consideration in acute spinal cord injury. Critical Care Clinics. July. pp 680, 687-688.

LHSCHealth Professionals