How Spinal Cord Injuries Cause Bladder Problems & Care Tips

Our body functions as one large connected system that works together to perform basic tasks, such as emptying the bladder. However, when someone suffers a spinal cord injury (SCI), the system may no longer function properly, leading to urinary incontinence.

But patients and loved ones don’t have to fight their symptoms on their own. There are a variety of care tips to simplify caring for incontinence and SCI.

In this post, we’ll explain the ins and outs of SCI and how it affects the bladder, and we’ll also give you tips on bladder management to improve your quality of life.

Signals to and from the spinal cord travel up and down a neural superhighway to your brain. The brain also sends signals to your spinal cord using this same pathway. The different spinal cord levels that make up your neural pathway control different bladder functions. Your bladder reflexes are similar to the reflexes in your knee. Here’s how they function.

S1 - S4: These spinal cord levels and their accompanying peripheral nerves are responsible for:

• Sensation
• Voluntary motor control (muscle activation).
• Voluntary motor control of pelvic floor muscles, such as the urinary sphincter relaxation, bladder muscle contraction, and elimination of urine. 

Bladder function depends on the level of the SCI and whether it’s complete or incomplete. To keep it simple, we’ll focus on complete SCI presentations, which occur when the nerves below the injury no longer communicate with the brain.

An SCI occurs when you experience damage to any area of your spinal cord or the nerves at the end of your spinal canal. This damage can cause lifelong alterations in different sensations and functions below the area of injury. Let’s look at what happens to your bladder control with each level of injury. Usually, the higher up the damage occurs, the more severe the injury is.

Over time, the bladder muscle contractions or spasms might intensify because your brain can’t send signals to stop the bladder’s reflex. This makes it hard for your bladder to fill up because it’s contracting faster and more often, preventing it from stretching. When this happens, the bladder walls thicken, making the bladder work harder than it needs to, causing the muscles to become stiff.

When the bladder muscle gets too stiff, it’s no longer easy for the bladder to hold urine and empty it efficiently, resulting in a high-pressure situation in the bladder. Your body always looks for the path of least resistance, which means that you’ll likely experience bladder leakage, or the urine will back up into the kidneys to accommodate this bladder pressure issue.

If the sphincter muscles are spastic, it’s difficult for urine to leave your bladder when the bladder muscle contracts. It also makes fully emptying your bladder challenging. Typically, the bladder muscle and urinary sphincter muscles around the bladder coordinate to help with the bladder filling and emptying. Still, with an SCI, these muscles work out of sync. This can lead to frequent urinary tract infections (UTIs), kidney hydronephrosis (urine backflow to the kidneys), and urinary incontinence.

When these injuries occur, your bladder function is impacted slightly differently, where the bladder muscle becomes flaccid or weak. The bladder reflex is impacted and results in diminished:

Over time, your bladder, prostate, rectum, uterus, and pelvic ligaments become strained and stressed. Sometimes, pelvic organ prolapses can occur if there’s too much strain on the organs. People with SCIs at the level of the sacral spinal nerves commonly experience stress urinary incontinence, which involves leaking when coughing, laughing, sneezing, or other exertional activities.

Every person’s incontinence situation is unique and should be supported individually to determine the best treatment approach for you. Here are some ways you can manage your bladder leaks. Be sure to speak to your healthcare provider before deciding which strategy is best for you.

• Catheters. Depending on your level of SCI and the type of bladder condition you have, your provider may recommend using catheters. Intermittent catheters, indwelling catheters, suprapubic catheters, or external catheters are all great options for management. Intermittent catheterization can assist in easy bladder emptying in the comfort of your home. See if you qualify for low-cost intermittent catheters through your insurance plan with Aeroflow Urology. Speak to your healthcare professional before choosing the catheter you want to use.
• Adult or pediatric briefs. Briefs (diapers) are excellent for bladder control because they are absorbent and open easily with tabs on the sides. This allows you to change your brief easily if you use a wheelchair or have less mobility. Briefs are best for those with heavier leakage.
• Adult or pediatric pull-ons. Designed to look and feel like real underwear for both males and females, pull-ons (pull-ups) are absorbent and discreet. You should use protective underwear if you have moderate leakage.

If a loved one or patient has spinal cord injury symptoms that include incontinence issues, they might be a bit withdrawn or depressed, as incontinence is linked to anxiety, depression, and the loss of independence.

But they don’t have to stress about having accidents. With the proper care, you can help your loved one confidently participate in their favorite activities while remaining comfortable and sanitary.

3. Avoid bladder irritants. There are foods and beverages that can irritate your bladder, including:

• Spicy foods.
• Chocolate
• Fried foods.
• Greasy items.
• Coffee
• Sugary juices.

Avoid these items or only indulge in moderation to reduce incontinence symptoms. It’s much better to stick to organic juices, water, whole grains, fruits, and veggies to keep your system healthy and happy. Hydration will keep your juices flowing as fruits and veggies provide enough fiber to prevent constipation.

4. Prepare for accidents. Have a backpack with all the items you may need in the event of an accident. Have a change of clothes, wet wipes, disposal bag to mask smells and odors, as well as enough briefs or catheter supplies to last for the entire day.

5. Be supportive. Your loved one may have a difficult time facing incontinence, so offer them support and reassurance. Let them know that you’re there to help and confidently assist with managing their symptoms. Participate in their daily routines by making sure they’re prepared with their incontinence supplies and regularly go with them to the doctor to see about new incontinence procedures. While some patients with spinal cord injuries may have incontinence for the rest of their lives, others may be able to retrain their bladder over time.

Continence care products, such as intermittent catheters, adult briefs, and protective underwear, can successfully manage incontinence if you have SCI. The products that are best suited for you will be based on your level of mobility and your specific injury, and you may be eligible to get them covered through your Medicaid or Medicare plan with Aeroflow Urology!

To see if you qualify for coverage, fill out our secure, 2-step Eligibility Form. Once you are eligible, we’ll reach out to your healthcare provider for a prescription on your behalf, and if you’d like to get your products even quicker, you can contact your provider’s office and let them know we’ll be requesting a prescription!

We’ll then ship your order in discreet boxes right to your doorstep for free. You can also refill your supplies monthly with our easy-to-use refill process.

Parittotokkaporn, S., et al. (2021). Transcutaneous Electrical Stimulation for Neurogenic Bladder Dysfunction Following Spinal Cord Injury: Meta-Analysis of Randomized Controlled Trials, Journal of the International Neuromodulation Society, 24(7), 1237-1246. DOI: 10.1111/ner.13459  

The Neurogenic Bladder Research Group.(2015, December 31). Neurogenic bladder. Patient Information library. Retrieved from https://www.nbrg.org/articles?s=neurogenic-bladder 

Spinal injury and Incontinence: What is the Link? (2018, August 28). Incontinence UK. https://www.incontinence.co.uk/spinal-injury-and-incontinence 

Al Taweel, W., & Seyam, R. (2015). Neurogenic bladder in spinal cord injury patients. Research and Reports in Urology, 85. https://doi.org/10.2147/rru.s29644 

Edited by Marlee Septak

Information provided on the Aeroflow Urology website is not intended as a substitute for medical advice or care from a healthcare professional. Aeroflow recommends consulting your healthcare provider if you are experiencing medical issues relating to incontinence.