Spinal Cord Injury Info Sheet
An information series produced by the Spinal Cord Program at GF Strong Rehab Centre.
The Urinary System
- filter wastes and excess water from the blood
- produce urine
- monitor and maintain the body’s water balance so the body works properly
- tubes that carry urine from the kidneys to the bladder
- stretchable sac that stores urine
- muscles in the bladder wall contract to push urine out of the bladder into the
Sphincter (SFINK-ter) Muscles
- form a ring around the area where the bladder joins the urethra
- relax to let urine flow out of the bladder into the urethra
- small tube that carries urine from the bladder to outside of the body
When the bladder becomes full (1-2 cups of urine), nerve endings in the bladder send a
message to the brain along the spinal cord. The brain then sends a message back to
contract the bladder and relax the sphincter muscles. The brain will delay this message
until you are ready to void.
After a spinal cord injury (SCI), messages between your brain and bladder can no
longer travel up or down your spinal cord. Depending on your type of SCI, your bladder
will become either FLACCID (floppy) or SPASTIC (hyperactive).
- bladder muscle strength is weakened or lost and so your bladder cannot contract
to empty urine
- bladder can easily become overstretched, which can lead to damage and
increased risk of infection – don’t let your bladder get too full!
- methods for emptying your bladder include intermittent catheterization, Valsalva,
- bladder muscle strength is increased
- bladder muscles and sphincter muscles may not coordinate properly to allow
urine to flow out of bladder
- bladder may contract inconsistently causing incontinence
Foley or Suprapubic Catheter
- a tube is inserted through the urethra or abdomen and into the bladder where an
inflated balloon holds it in place
- it remains in the bladder and drains constantly into a legbag
- you drain your bladder several times a day by inserting a small rubber or plastic
- the tube does not stay in your bladder between catheterizations
- worn by men for incontinence or after a sphincterotomy (see below)
- a latex rubber or silicone condom covers the penis and attaches to a tube that
drains into a legbag
- increasing the pressure in your abdomen by bearing down as if you were having
a bowel movement
- manually pressing down on your bladder for force urine into your urethra
- the area over the bladder is tapped lightly and repeatedly to stimulate the bladder
muscles to contract
- a passageway is created sing the appendix so that catheterization can be done
through the abdomen to the bladder instead of through the urethra
- the bladder is surgically enlarged to allow it to hold more urine at a lower
pressure, decreasing leakage
- the sphincter muscles are surgically weakened to allow urine to flow out more
- after this surgery, you will urinate involuntarily, so must wear a collection device
Urinary Tract Infections (UTI’s)
UTI’s occur when bacteria get into your bladder and/or kidneys causing an infection and
symptoms. With a SCI, it is important to know the difference between a UTI and
Bacteriuria. A UTI is having bacteria in your urine WITH symptoms. Bacteriuria is
having bacteria in your urine WITHOUT symptoms.
UTI’s and Foley/Suprapubic Catheters
- if you have a SCI and use an indwelling catheter, you will ALWAYS have bacteria
in your urine
- the catheter provides a direct pathway for the bacteria to enter your bladder
- the bacteria can develop into a UTI if:
o your catheter becomes blocked
o your general resistance to infection decreases
o you don’t drink enough fluids and your urine becomes concentrated
UTI’s and Intermittent Catheters
- if you have a SCI and use intermittent catheters, you will MOST LIKELY have
bacteria in your urine
- when the catheter is passed through your urethra, it can pick up bacteria that are
normally on your skin and pass them into your bladder
- bacteria can grow and multiply in the urine if the urine remains in your bladder for
prolonged periods of time 9more than 4-6 hours)
Signs of a UTI – things you may notice
- sediment (gritty particles) or mucous in your urine
- cloudy urine
- bad smelling urine
- blood in urine (pink or red urine)
Remember that the appearance and smell of your urine may change because of
changes is your diet and/or fluid intake. For example: if your urine is dark yellow you
should drink more fluids; if your urine is bright yellow you are probably taking a vitamin
B supplement; asparagus can cause your urine to smell strange.
Symptoms of a UTI – things you may feel
- fever - headaches
- chills - nausea
- leakage - mild low back pain or other aches
- feeling tired or lousy - increased spasms of legs, abdomen, bladder
- burning sensation - increased frequency
Treatment of a UTI – what YOU can do
- FLUIDS, FLUIDS, FLUIDS
- If using intermittent catheters
o Empty bladder at least every 6 hours
o Keep urine volumes between 300-500cc
o Wash hands before and after
- Prevent foley catheter from getting blocked by changing it regularly
- Vitamin C and Cranberry Juice
UTI’s and Antibiotics
When you have a SCI, antibiotics for a UTI should only be used if you are having
symptoms. Remember that if you use a foley or suprapubic catheter, you will always
have bacteria in your urine. If you use intermittent catheters, you most likely will have
bacteria in your urine.
UTI’s which come back after antibiotic treatment could be the result of bladder stones.
Questions to ask yourself if you think you have a UTI
- Do I have any symptoms of a UTI?
- Do I feel sick?
- When was the last time I saw my urologist?
Bladder stones are hard buildups of mineral that form in the bladder. They are usually
the result of another problem such as a UTI or inadequate emptying of the bladder.
Bladder stones can be excreted or removed without permanent damage to the bladder.
If the stones are left untreated, they may cause permanent damage to your bladder and
kidneys. They may recur if the underlying cause is not corrected.
For more information, Spinal Cord Program Tel: 604-734-1313
please contact: GF Strong Rehab Centre Toll-Free: 1-866-906-1888
4255 Laurel St Fax: 604-714-4121
Vancouver, BC V5Z 2G9