Bladder Management after SCI

Suprapubic Catheter: A tube is inserted through the abdomen and into the bladder, where a balloon on the end holds it in place. It remains in the bladder and drains constantly, so the bladder is never full.

Indwelling Catheterisation: The bladder is drained by having a tube inserted which then drains urine into a bag.  Most commonly seen in early hospital stage of rehabilitation and not normally used again unless infection is a problem.  Tube can be clamped to allow bladder muscle to expand.

Intermittent Catheterisation: You drain your bladder several times a day by inserting a small rubber or plastic tube. The tube does not stay in the bladder between catheterisations.  Several different discrete types of intermittent catheter are available and this is one of the common preferred methods of bladder management post hospital stay.

External Bladder Control Methods:

• Condom / Conveen Drainage
  A condom catheter is a way to drain the bladder without putting a catheter (rubber tube) inside your urethra. The urethra is the tube that runs from the outside of your body into your bladder. The bladder is where urine is stored in your body. A condom catheter is a rubber sheath that is put over your penis. It is also called a texas catheter. The catheter allows your bladder to empty without using a urinal, bedpan, or toilet. The condom catheter is hooked to a plastic tube which leads to a bag. The urine stays in the bag until it is emptied into the toilet.
• External Continence Device (ECD)
  An ECD is a method of continence management that attaches only to the tip of the penis using hydrocolloid, a hypoallergenic adhesive commonly used in wound and ostomy care. Urine is directed into a collection bag and does not come in contact with skin.

Spontaneous Voiding
The bladder muscles contract to start the bladder-emptying process. This may be under your control (voluntary) or not (involuntary):

• Normal Voiding
  This is done under your control. When the bladder gets full, messages are sent to the sacral level of the spinal cord and carried to the brain. The brain sends messages back to the bladder to contract, and to the sphincter muscle to open, so you can void.
• Spincterotomy
  This surgical process weakens the bladder neck and sphincter muscle to allow urine to flow out more easily. After this surgery, you will urinate involuntarily, and must wear a collection device.
• Condom/Conveen Drainage
  These collection devices are worn by men for incontinence problems or after sphincterotomy (see above). They are made of latex rubber or silicone that covers the penis and attaches to a tube that drains into a collection bag.

Stimulated Voiding
Voiding is encouraged in one of several ways, such as:

• Anal or Rectal Stretch
  This method for relaxing the urinary sphincter is usually used along with an abdominal corset and valsalva (see below).
• Crede
  This method involves manually pressing down on the bladder.
• Tapping
  The area over the bladder is tapped with the fingertips or the side of the hand, lightly and repeatedly, to stimulate detrusor muscle contractions and voiding.
• Valsalva
  This method involves increasing pressure inside the abdomen by bearing down as if you were going to have a bowel movement.

Surgical Alternatives

• Mitrofanoff
  A passageway is constructed using the appendix so that catheterization can be done through the abdomen to the bladder.
• Bladder Augmentation
  Surgical enlargement of the bladder.
• Spincterotomy
  See the description of this procedure in the "Spontaneous Voiding" section.

Bladder Management - Urinary Tract Infections - Spinal Injury