The spinal cord helps in sending and receiving signals to and from the brain and the other parts of the body. Hence, any injury to it can lead to the loss of movement and sensation, thereby affecting the normal life of an individual. Moreover, a spinal cord injury can affect bladder function and cause the loss of bladder control.
Dr Abhilash Bansal, senior consultant, neurosurgeon and spine surgeon, SPARSH Hospital, Bangalore, explains that the bladder function is controlled by neural connections passing through the spinal cord. Mild to severe injuries to the spinal cord can lead to the disruption of neural pathways, leading to different degrees of loss of bladder control.
According to a review article published in Indian Journal of Physical Medicine & Rehabilitation, about 70–84% of individuals with spinal cord injuries have neurogenic bladder dysfunction at some point in their lives. The article also highlighted that conditions like urinary tract infections (UTIs), bladder stones and renal damage, when not managed properly, can lead to neurogenic bladder dysfunction.
Types of spinal cord injuries
Common spinal cord injuries include those involving the cervical spinal cord or thoracic spinal cord. Dr Bansal says, “Owing to their intense physical activities, younger people are more vulnerable to spinal cord injuries, which can lead to bladder dysfunction, paralysis of the limbs and loss of sensation. Severe cervical spinal cord injuries can also cause breathing difficulties in an individual.”
Kinds of spinal cord injury causing urinary incontinence
Bladder function can be affected due to injuries to the spinal cord or spinal nerve, say experts. Dr Umesh Srikantha, senior consultant, neurosurgery, head of spine services, Aster CMI Hospital, Bangalore, explains, “Wounds to the neck or upper back result in spinal cord injury, whereas injuries or fractures to the lower back, which affect the bladder due to neural involvement, are called spinal nerve injury.” Factors compromising spinal cord functioning, like infections, tumors and age-related problems, can also affect the bladder function in an individual. Common issues include injuries involving the cervical or thoracic spine.
Dr Srikantha adds, “Neurogenic bladder [bladder function is affected due to the damage to the spinal cord] or urological issues like urinary tract infections can also affect bladder function.” In people with neurogenic bladder dysfunction, the bladder cannot receive signals from the brain to empty or store urine. The condition can be of two types — upper motor neuron and lower motor neuron. Dr Srikantha explains, “Upper motor neuron neurogenic bladder dysfunction affecting the cervical spine can cause one to have an overactive bladder or hesitancy, in which a person finds it difficult to start urinating.” Apart from this, people with spinal cord injuries that affect bladder function can have difficulties in urinating, or need to deal with urinary leakage or urinary incontinence.
In the case of acute spinal cord injury, severe consequences such as urine retention may be seen.
Can bladder control be regained after spinal cord injury?
In certain cases, it may be possible to regain bladder control after an injury to the spinal cord — it depends on the extent and severity of the injuries. While those with mild injuries have better chances of regaining bladder control, people with moderate to severe ones are likely to have long-term issues with bladder functioning.
Dr Bansal reminds, “Individuals with spinal cord injuries require emergency neurosurgical care to prevent further damage, such as swelling in the spinal cord.” Long-term rehabilitation for achieving mobility and self-care are also needed in individuals with spinal cord injuries, he adds.
How does catheterization help?
Dr Bansal says that individuals likely to be dealing with bladder issues for a long time are taught to artificially empty their urinary bladder at regular intervals using catheters. Dr Amar Kumar Jayaram, urologist, Apollo Hospitals, Bangalore, shares, “After a spinal cord injury, catheterization is one of the most common bladder management techniques adopted. Here, a narrow tube is inserted into the person’s body to empty urine from the bladder.”
Catheterization is of two types — indwelling and intermittent. Dr Jayaram says, “Indwelling catheterization is where the catheter is constantly connected to the individual for six to eight weeks. When people with indwelling catheterization regain upper limb control, they can do intermittent clean catheterization once in four to six hours a day, without the risk of infection and thus the kidney function is protected.”
Takeaways
- Loss of bladder control is common after a spinal cord injury.
- People with mild injuries have better chances of regaining bladder control while those with moderate to severe injuries are likely to have long-term issues with bladder functioning.
- Catheterization is one of the typical bladder management techniques used after spinal cord injury.
