Most of us have been there — a group of wheelers get together, “SCI locker room talk” ensues, and it takes about four minutes for the conversation to turn to plumbing. Bladder Matters, our new e-newsletter column, brings that dialog into the open. We’ll talk with experienced wheelchair users, researchers and doctors to answer your questions and help you maintain a healthy bladder.
And this is serious stuff — urinary system complications are the fifth leading cause of death for people with SCI, according to a U.S. Department of Health study. Good bladder management is more than just keeping dry. Many of us have forgotten, or just don’t practice, the basics. Worse yet, in these times of insurance-driven “instant rehab,” many new SCI folks don’t learn the basics in the first place, which can cause social and — sometimes very serious — physical problems.
In this issue, we take a look at two — possibly related — topics: stinky leg-bags and bladder cancer.
Chances are you know a member of the stinky-leg-bag club. The problem is, we get used to our own odor, so you might be that member. If so, it is unlikely that even your close friends will tell you. Here is a hint — if people seem to give you a lot more personal space than everybody else, you may want to do some checking. If you suspect you may be a member, consider your equipment and your urine.
Equipment-wise, if you wear a leg bag, it is a good idea to flush the bag and tubing with hot — but not boiling hot — water on a daily basis. But often, just plain water isn’t enough. Bacteria can colonize in the tubing and bag and end up producing a nasty smell. Urological companies offer cleaning solutions specifically aimed at getting rid of the bacteria — and smell. If you’re on a budget and your insurance balks at cleaning solutions, you can mix your own by adding a teaspoon of bleach to 1 quart of warm tap water. Fill the tubing and bag, shake it a bit, let it sit for 15-20 minutes, rinse, and you’re good to go. Even better, if you have two leg bags, clean one, open the drain and let it dry for 24 hours, and alternate bags. Don’t forget to clean your cushion and toss the cover in the wash while you’re at it. Suddenly, you will notice people getting a little closer.
It may be your urine itself that smells. The list of things can cause stinky urine ranges from a bacterial infection to what you eat or drink. Foods like asparagus or certain vitamins will change the odor of urine. Dehydration, which can also make you feel run down and achy, is also at the top of the list. Be sure to drink enough liquids to keep your urine in the clear to light-yellow range. Staying hydrated is good for your system, and if you do have bacteria in your urine, it gives your body a fighting chance to wash it out before it can latch on to the bladder wall and cause a urinary tract infection. Be sure to empty your bladder frequently enough; 400cc-600cc should be the maximum output — more than that and you risk stretching and damaging your bladder.
UTI also ranks high on the smelly urine list. If you have ruled out suspects like vitamins and asparagus, and you are staying hydrated, and you still have smelly urine, it’s probably a good idea to schedule a visit to your doc, give a urine sample and have it cultured to see if there is some type of nasty bacteria trying to make a stronghold. Smelly urine combined with fever, chills, back pain, or sudden increase in spasticity strongly suggest that a UTI has taken hold and it’s time to get to the doc right away. After you give a urine sample and the specific bug is identified, be sure to finish the full course of antibiotics prescribed to kill the bacteria. Otherwise you can create an environment conducive to a strain of antibiotic-resistant bacteria.
Over the long haul, UTIs may cause more than smelly urine and fever. According to a 2007 Craig Hospital article, frequent, severe UTIs are one of the possible culprits contributing to bladder cancer. Sadly, bladder cancer has taken the lives of some of our best, including former New Mobility editor Barry Corbet, Paralympian and motivational speaker Skip Wilkins, and founder of Challenge Air, Rick Amber. Although statistics vary among medical journals, researchers agree that people with SCI have a higher incidence of bladder cancer than the general population, and that bladder irritation — over time — is a primary cause.
The Craig article lists bladder stones, catheters that aren’t well-lubricated, inadequate fluid intake and smoking, as irritants that increase the risk of bladder cancer. The journal articles point to long-term use of indwelling catheters as the main perpetrator when it comes to bladder cancer. The Craig article suggests folks that currently use indwelling catheters switch the leg bag from one leg to the other each day — the idea being that the balloon in the bladder won’t irritate the same spot all the time. It goes on to say if you use an indwelling catheter and have concerns about bladder cancer, it would be wise to consult with your urologist about other bladder management options.
When it comes down to it, basic bladder care, the kind that helps “reduce the stink,” is also helpful in reducing your risk of bladder cancer. Make sure catheters are well-lubricated, stay well hydrated and empty your bladder often enough. Don’t smoke. Have your bladder and kidneys monitored by a physical medicine and rehab doc or urologist on a regular basis, and if you have concerns about long-term use of an indwelling catheter, this is the perfect time to explore other options.