Spinal cord injury leading to bladder problem

By Noimot Olayiwola/Staff ReporterA good number of people in Qatar are increasingly suffering from dysfunctional urinary bladder (neurogenic bladder) due to spinal cord injury sustained in road traffic accidents and fall from heights, a senior Urology consultant at the Hamad Medical Corporation stated yesterday.Yearly, the HMC Urology’s Voiding Dysfunction unit receives an average of up to 70 patients including males, females and children with neurogenic bladder.Neurogenic bladder refers to dysfunction of the urinary bladder due to the disease of the central nervous system or peripheral nerves involved in the control of micturition (urination).Neurogenic bladder usually causes difficulty or full inability to pass urine without use of a catheter or other method. “If the spinal cord is damaged, the ability for the signals to travel back and forth is impaired, resulting in bladder emptying problems. There are different types of damage to the spinal cord. The higher up in the spinal cord an injury occurs, the more muscles are affected. In the case of paraplegia, the spinal cord is so damaged that the legs are affected. In the case of tetraplegia, both arms and legs are affected,” Urology senior consultant Dr Ardalan Abdolghafor Ghafouri stated.The anatomical location and severity of the injury will determine the type of bladder condition the patient will have, he said.Catheterisation methods range from intermittent catheterisation, which involves no surgery or permanently attached appliances, to the creation of a stoma, which bypasses the urethra to empty the bladder directly.Intermittent catheterisation is the use, several times a day, of straight catheters (which are usually disposable or single-use products) to empty the bladder. “Due to increase in awareness level among the population, the high incidence of road crashes, resulting from over-speed and abandoning of seat belt, as well as accidents on work sites, because of the proliferation of construction projects, we are receiving more cases of dysfunctional urinary bladder at the Voiding unit”, Dr Ghafouri said.He mentioned that there are few cases involving children, who were born with the deformity in their spinal cord.“There are two categories of spinal cord injury such as lower and upper of injury. If it happens in the upper part, the symptoms of the bladder dysfunction could include urge incontinence where the patient leak urine and could not control their bladder,” he explained.The doctor added that the patient can also suffer from spinal shock, that is paralysis below the injury level and this can continue for six week post sustaining the injuries.In this situation, the first line of treatment is to reduce bladder pressure with pharmaceuticals and emptying the bladder with Clean Intermittent Catheterisation (CIC).  “Paralysis at any level almost always affects bladder and bowel function. This is because the nerves controlling these internal organs are attached to the very base of the spinal cord (levels S2-4) and are therefore cut off from brain input,” he explained.“In Urology, we have the complete care for our patients who are usually referred to us from the  Rehabilitation Unit for evaluation including urine culture, kidney test, urodynamic test such as electrocardiography (ECG) of the bladder with an X-ray to see how the bladder is functioning,” he explained.Although, he said it may not be possible to regain the same control one had before paralysis, a wide range of techniques and tools are available to manage bladder and bowel function.“We give medication as a first line of treatment to patients and once that is not working, we then give botox into the bladder in order to relax it and decrease the pressure,” he mentioned.He stated that intermittent catheterisation can lead to infections of the bladder and could later cause cancer later on.“Intermittent catheterisation can cause bacteria to be present in the urine and the patient may require antibiotics, but caution should be exercised while taking antibiotics except the patient is having fever and severe pain in the lower abdomen,” he suggested.Complications of bladder problems resulting from spinal cord injury include urinary tract infections, sepsis, dyssynergia, kidney stones or bladder stones and bladder cancer in those who use indwelling catheters for a long period of time.“To avoid complications from bladder control problems, patients should empty their bladder on a regular basis, and make sure it empties completely. Keep your catheter and supplies clean, and always clean the area around the catheter with soap and water prior to catheterisation. Wash your hands before and after self- catheterisation. Keep the skin around the catheter clean and dry to prevent skin breakdown and infection. Keep hydrated and drink the amount of fluid recommended for the type of catheter you use. Try to drink mostly water and limit the amount of alcohol and caffeine you drink,” he suggested.