Airline Bladder Management

When I first started Bladder Matters in 2008, my goal was to provide information from experienced wheelchair users, researchers and doctors to answer your questions and help you maintain a healthy bladder. I knew the column would be popular because, in my experience, every time a group of wheelers gets together, “SCI locker room talk” ensues, and it takes about four minutes for the conversation to turn to plumbing.

As I wrote in the first column, 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.

Writing the columns also enlightened me. It isn’t just folks with SCI who need bladder advice, but also people with MS, spina bifida and other conditions that affect the urinary system.

Nonetheless, I’ve found I’m receiving fewer questions now, and it’s hard to find topics I haven’t covered. The column seems to have run its course, so this will be the final installment of Bladder Matters. I hope this means I’ve addressed most of your concerns when it comes to bladder management. If you are looking for answers on a bladder-related subject, you can view the past four years of Bladder Matters columns here.

For further questions, a great resource is National Spinal Cord Injury Association, a program of United Spinal Association. Go to “Resource Center” and pull down “Ask Spinal Cord Central.”

The holiday season being upon us I thought it appropriate to end the column with holiday travel advice.

Q. I’m in my fifth year as a T6 paraplegic. I’m planning to fly from Los Angeles to New York to visit my family for the holidays. I have taken short flights before but nothing this long. I’ve got a nonstop flight, and it looks like it will take me at least six hours. How do wheelchair users manage their bladder on long flights?

— Patrice

A. Great question, Patrice. I’m in my 26th year as a T10 complete para and fly quite a bit. Part of the answer depends on how you manage your bladder, as well as how good you are at transfers.

I find the most important thing is planning. I plan to spend extra time on the plane, stuck on a runway. To that end, I make sure and take a daypack with extra catheters and a change of pants. (I also put all of my medications in the pack, in case my suitcase ends up at another airport.)

The next thing I suggest is limiting fluid intake, starting about four to five hours before the flight. And make sure to avoid any caffeinated drinks like coffee, tea or soda — caffeine is a diuretic and causes the kidneys to produce more urine.

I make sure to use the restroom and catheterize immediately before boarding the plane to make sure I’m empty. But avoiding a full bladder, and avoiding dehydration is a balancing act — the dry air in an airline cabin can add to dehydration. I do drink water on the flight to stay hydrated — just not a lot of water.

If you manage your bladder by intermittent catheterization and are worried about the long flight, one option to consider is asking your urologist about getting a prescription for an indwelling Foley catheter and leg bag to use during your time in the air.

Another important part of planning is to call ahead and find out what kind of plane your flying on, in particular how many aisles it has. According to the Air Carrier Access Act of 1986, “Aircraft with more than one aisle must have least one accessible lavatory (with door locks, call buttons, grab bars, and lever faucets) available which will have sufficient room to allow a passenger using an on-board wheelchair to enter, maneuver, and use the facilities with the same degree of privacy as other passengers.” And the aircraft must have an on-board wheelchair (aisle chair).

When calling ahead, if it turns out the plane only has one aisle, ask if it has an accessible bathroom. The Air Carrier Access Act also says any aircraft with more than 60 seats must have an operable on-board wheelchair (aisle chair) if there is an accessible bathroom. Last but not least, if you get stuck on a plane with no accessible bathroom, the act says the airline still needs to provide an on-board wheelchair (aisle chair) if you phone ahead. On long flights I’ve used the isle chair to get to “inaccessible” bathrooms — the transfer into the bathroom was “expert only” to say the least, but doable with good arm strength and transfer skills.

Finally, some wheelers wear pads or Depends when flying — just in case.

Here is hoping you get bumped to First Class, with plenty of free drinks on a plane with an aisle chair and accessible bathroom. Safe travels and happy holidays!

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