HomeIntroduction To Spinal Cord InjuryUrinary System After Spinal Cord InjuryUnderstanding the urinary system

4.1. Understanding the urinary system

The Urinary System is made up of five major parts (Kidneys, Ureters, Bladder, Urethra, and Sphincters) and has three major functions.

1- It makes urine in the kidneys
2- Stores urine in the bladder
3- Removes urine from the body through the urethra.

Urine is made when the kidneys filter out waste products and water from the blood. The urine moves from the kidneys through tubes, called ureters, to the bladder. The bladder temporarily stores the urine. Voiding, or urinating normally occurs when the bladder muscles contract, and the small sphincter muscles, acting as a valve, relax and allow urine to flow from the bladder through the urethra and out of the body. When the process is finished, the bladder is empty.

After Spinal Cord Injury
The bladder, along with the rest of the body, undergoes dramatic changes. Since messages between the bladder and the brain cannot travel up and down the spinal cord, the voiding pattern described above is not possible. Depending on your type of spinal cord injury, your bladder may become either "floppy" (flaccid) or "hyperactive" (spastic or reflex).

The Flaccid (Non-reflex) Bladder
A floppy bladder loses detrusor muscle tone (strength) and does not contract for emptying. This type of bladder can be easily overstretched with too much urine, which can damage the bladder wall and increase the risk of infection. Emptying the flaccid bladder can be done with techniques such as Crede, Valsalva, or intermittent catheterization. It is very important that you do not let your bladder get overfull, even if it means waking up at night to catheterize yourself more frequently.

The Spastic (Reflex) Bladder
The detrusor muscles in a hyperactive bladder may have increased tone, and may contract automatically, causing incontinence (accidental voiding). Sometimes the bladder sphincters do not coordinate properly with the detrusor muscles, and medication or surgery may be helpful.

Dyssynergia
Dyssynergia occurs when the sphincter muscles do not relax when the bladder contracts. The urine cannot flow through the urethra. This can result in the urine backing up into the kidneys. This is called "reflux" action. The bladder may also not empty completely. Treatments include medications or surgery to open the sphincter.

Bladder Management
A bladder management program will help you effectively prevent infections and avoid bladder accidents. It will also allow you to empty your bladder in an acceptable manner when it is convenient for you. Level of injury, lifestyle, susceptibility to infection, and loss of normal urinary system function must be taken into consideration when deciding which bladder management program works best for you.

Foley (or Suprapubic) Catheter: A tube is inserted through the urethra or abdomen and into the bladder, where a balloon on the end holds it in place. It remains in the bladder and drains constantly, so the bladder is never full.

External Catheterization or Condom Catheters: This method is made of latex rubber or silicone that covers the penis and attaches to a tube that drains into a collection bag. This method attaches only to the tip of the penis using hydrocolloid, a hypoallergenic adhesive commonly used in wound and ostomy care. Urine is directed into a collection bag and does not come in contact with skin.

Intermittent Catheterization: You drain your bladder several times a day by inserting a small rubber or plastic tube. The tube does not stay in the bladder between catheterizations.

Stimulated Voiding:
Voiding is encouraged in one of several ways:

Surgical Alternatives
Mitrofanoff: A passageway is constructed using the appendix so that catheterization can be done through the abdomen to the bladder.

Spincterotomy: This surgical process weakens the bladder neck and sphincter muscle to allow urine to flow out more easily. After this surgery, you will urinate involuntarily, and must wear a collection device.

Bladder Augmentation: Surgical enlargement of the bladder.

Surgery is a serious matter. Consulting a variety of people with a range of expertise and experience will help give you the information you need to make an informed decision.

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