Spinal Cord Injuries

How is the bladder affected?

The Ranges of Spinal Cord Injury

“The spinal cord is a central bundle of nerves extending from the brain and branching peripherally, and is responsible for transmitting signals between the brain and the rest of the body.  The spinal cord is located within the spinal column.  Any trauma to the spinal column or the vertebrae has potential to affect the spinal cord could and result in temporary or permanent neurologic impairments”.1,7

Traumatic spinal cord injury usually begins with a traumatic injury to the spine that may result in fractures or dislocated vertebrae.3,8

According to the Centers for Disease Control, the spinal column consists of 8 cervical vertebrae (neck), 12 thoracic vertebrae (upper and middle back), 5 lumbar vertebrae (lower back), 5 sacral vertebrae (sacrum), and 2 mostly fused coccygeal vertebrae (coccyx). 1,7

Spinal cord injuries can typically be classified as tetraplegia or paraplegia.  Tetraplegia (also known as quadriplegic) typically results from to an injury between the C1 and T1.  This type of injury is typically associated with a loss of feeling or movement in the upper body such as head, neck shoulder, arms, hands and/or fingers.  Paraplegia may result from an injury between levels T2 and S5.  This type of injury can affect the lower part of the body to include the stomach, hips, legs and feet/toes. 9

The National Spinal Cord Injury (2014) Database states that the most frequent neurological category at discharge from the hospital since 2010 is incomplete tetraplegia (45%) followed by incomplete paraplegia (21%) complete paraplegia (20%) complete tetraplegia (14%).2

An incomplete injury means that the ability of the spinal cord to convey messages to or from the brain is not completely lost.  People with incomplete injuries retain some sensory function and may have voluntary motor activity below the injury site.  A complete injury prevents nerve communications from the brain and spinal cord to parts of the body below the injury site.  There is a total lack of sensory and motor function in the sacral segments S4-5. 3, 9

Common Causes of Spinal Cord Trauma

The National Spinal Cord Injury Statistical Center (2014) reports that motor vehicle crashes account for 38% of reported SCI cases.  The next most common cause of SCI is falls (30%), followed by acts of violence (14%)-primarily gunshot wounds.2

The proportion of injuries that are due to sports has decreased over time while the proportion of injuries due to falls has increased.  Violence caused 14% of spinal cord injuries prior to 1980, and peaked between 1990 and 1999 at 24.8% before declining to only 14% since 2010.2

More than 80% of all spinal cord injuries happen to males, who are primarily young adults.2


Please note that this information provided by Liberator Medical is not intended to be used in place of a visit, consultation, or advice of a medical professional.  


Spinal Cord Injury and Physical Function

Depending on the level where a spinal cord injury occurs effects physical functions, starting from the point where the injury is in the spinal column.

Loss of neurologic function typically occurs below the level of the injury.  So the higher the spinal injury is to the spinal column, the greater the loss of function typically experienced.

  • Cervical spinal nerves (C1 to C8) emerge from the spinal cord in the neck and control signals to the back of the head, the neck and shoulders, the arms and hands, and the diaphragm.3
  • Thoracic spinal nerves (T1 to T12) emerge from the spinal cord in the upper mid-back and control signals to the chest muscles, some muscles of the back, and many organ systems, including parts of the abdomen.3
  • Lumbar spinal nerves (L1 to L5) emerge from the spinal cord in the low back and control signals to the lower parts of the abdomen and the back, the buttocks, some parts of the external genital organs, and parts of the leg.3
  • Sacral spinal nerves (S1 to S5) emerge from the spinal cord in the low back and control signals to the thighs and lower parts of the legs, the feet, most of the external genital organs, and the area around the anus. 3,10

Please note that this information provided by Liberator Medical is not intended to be used in place of a visit, consultation, or advice of a medical professional.  


Neurogenic Bladder

People who have Spinal Cord Injury (SCI) often need to perform intermittent catheterization or take other medical steps to help manage their bladder.

This could include behavior techniques, physiotherapy, transurethral and suprapubic catheters as well as appliances such a condom catheters and penile clamps.  This is because the spinal trauma that they experienced may have caused damage to the nerves that control their bladder function.11, 12

According to the National Institute of Neurological Disorders and Stroke, most spinal cord injuries affect bladder functions because the nerves that control the involved organs originate in the segments near the lower end of the spinal cord.  Although the kidneys continue to produce urine, bladder control may be lost and the risk of bladder and urinary tract infections increases.3

If you have been diagnosed with neurogenic bladder, it is important for you to follow your doctor’s orders on your care regimen. 

 


Please note that this information provided by Liberator Medical is not intended to be used in place of a visit, consultation, or advice of a medical professional.  


Intermittent Catherization

Depending on your level of injury and hand dexterity, the method you apply for using intermittent catheters may vary.

Using a clean technique is a key element in hygiene for catheter use regardless of the type of intermittent catheter prescribed.

Remember it is important for you to follow your doctor’s orders on your care regimen to be sure that you are self-cathing according to the prescribed number of times per day.11

Discretion is also a key part of a daily continence care regimen, as most intermittent catheter users don’t want anyone to know about their catheter use.


Please note that this information provided by Liberator Medical is not intended to be used in place of a visit, consultation, or advice of a medical professional.  

Resources and references for the article above

The United Spinal and the National Spinal Cord Injury Association [NSCIA] offer a variety of peer support programs through their national network of chapters and community groups.

Additional organizations like the Christopher and Dana Reeve Foundation also deliver public and professional education, information, and support on a national and local level.

The NSCIA (National Spinal Cord Injury Association) has also complied a wide variety of educational materials designed for active living with spinal cord injury, including health resources related to bladder management.  Following are links to other resources.


References:

  1. Centers for Disease Control Spinal Cord Injury Fact Sheet https://www.cdc.gov/TraumaticBrainInjury/index.html
  2. National Spinal Cord Injury Statistical Center Spinal Cord Injury Facts and Figures at a Glance: https://www.nscisc.uab.edu/PublicDocuments/fact_figures_docs/Facts%202013.pdf , https://www.nscisc.uab.edu/PublicDocuments/fact_figures_docs/Facts%202014.pdf
  3. NIH: National Institute of Neurological Disorders and Stroke – https://www.ninds.nih.gov/disorders/spina_bifida/spina_bifida.htm
  4. Cleveland Clinic, Diseases and Conditions – Neurogenic Bladder, https://my.clevelandclinic.org/disorders/neurogenic_bladder/hic-neurogenic-bladder.aspx
  5. Sauerwein D. Urinary tract infections in patients with Neurogenic bladder dysfunction, Int J Antimicrob Agents. 2002 Jun; 19(6):592-7.
  6. ASIA International Standards for Neurological Classification of Spinal Cord Injury
  7. Clinical Neuroanatomy, 27th Edition, McGraw-Hill Education, 2014, Chapter 5-The Spinal Cord, Chapter 6. The Vertebral Column and Other Structures
  8. Principles and Practice of Hospital Medicine, McGraw-Hill Education, 2012, Chapter 63 – Common Neurosurgical Conditions
  9. Current Diagnosis and Treatment in Orthopedics, 5th Edition, McGraw-Hill Education, 2014
  10. Harrisons™ Principles of Internal Medicine, 18th Edition, McGraw-Hill Education, 2012, Chapter 377, Diseases of Spinal Cord
  11. Smith and Tanagho’s General Urology, 18th Edition. McGraw-Hill Education, 2013
  12. Textbook of Neurogenic Bladder, J.Corus MD and E.Schick MD, Martin Dunite Ltd., United Kingdom, 2004, Chapter 43 –Conservative Treatment

Information is as of 12/2014. Please check references for updated information.

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