Critical Care Trauma Centre


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.
  • 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
  • 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

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

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