Bladder and Bowel Care

(This 3 minute video summarizes bladder and bowel control after a spinal cord injury.)

Overview of Bladder Care

The bladder is a collapsable, hollow organ in the lower abdomen that collects urine from the kidneys.  Urine leaves the bladder via the urethra which stretches from the bladder to the outside of the body.  The urethra of a male is approximately 8-10 inches long, while that of a female is 1-2 inches long.  An internal and external sphincter squeeze the urethra in order to keep urine from leaking out.

Bladder care can involve the manipulation of the bladder from the lower abdomen; the administration of medications; the application of a condom catheter; periodic or regular insertion of a straight catheter; care, removal and reinsertion of a foley catheter or care of a suprapubic catheter.

In many cases of SCI, there is a loss of bladder control.  This can mean that the bladder is flacid and lacks muscle tone or that the bladder is hyperactive and spastic.  A flacid bladder usually results in an inability to drain urine and may require physical manipulation or indwelling catheterization.  A hyperactive bladder may require medication to decrease the spasms and may result in either the free flow of  urine or urinary retention.  If urine flows freely, a condom catheter may be used. Some people opt to have their urethral sphincters surgically removed in order to facilitate this method. 

Catheterization

Catheterization is the insertion of a rubber or latex tube into the bladder.  They are usually made of latex, silicone or polyurethane.  Intermittent catheterizations may be done when there is a sensation or sign of fullness, or at regularly scheduled intervals.  These catheters are inserted through the urethra to the bladder and they are removed as soon as the bladder is empty.  If a person with SCI is unable to perform their own intermittent catheterizations, this method of bladder management can result in a greater loss of independence.

Foley catheterizations (or indwelling catheters) may be used for convenience and/or more reliable bladder emptying.  These catheters have a balloon on the tip, which holds it in place inside the bladder.  They are usually changed on a monthly basis.  Because they are invasive and remain in the body, Foleys and suprapubic catheters  increase the risk of infection to the urinary tract. 







Suprapubic catheterizations may be used if there is a trauma to the urinary tract or if there are frequent urinary tract infections.  These catheters are inserted through a surgical opening on the lower abdomen and into the bladder.  They are typically similar to Foley catheters and have a balloon on the tip.

Condom catheters are an external device that is applied like a prophylactic condom and is secured with tape or a temporary adhesive.  They have a tube at the tip that allows urine to flow out of the condom and into a drainage tube.







All forms of catheters need to be attached to a drainage system. A tube carries the urine from the catheter tip to a bag attached to the leg or a larger bag attached to the bed for overnight use.

Please view the following videos on foley catheterization - male and  foley catheterization - female.  

    

Stimulated Voiding

Stimulated voiding involves physical manipulation to assist emptying of the bladder.  There are four types of stimulated voiding:  anal or rectal stretching is done manually to help relax the  urinary sphincters; bearing down as if having a bowel movement assists the contraction of the bladder; manually pressing on the lower abdomen helps to compress and empty the bladder and tapping the lower abdomen helps to stimulate the bladder to contract.

Module 3 Bladder Care Assignment

In your assigned group of four, you will construct a wiki or a blog related to bladder care.  Please see the link for this assignment in the "pages" column on the right of this screen.