|Bladder Drainage in Spinal Cord Injury|
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.
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
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
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.
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.
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.
Clinical Educator, CCTC
May 11, 2001
W. (1987). Neurological management in patient with acute spinal cord injury.
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MA. (1987). Nursing consideration in acute spinal cord injury. Critical
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