The Best Bladder Management Options for People with Paralysis
The bladder is perhaps the trickiest thing to manage after a spinal cord injury (SCI). It causes the most grief compared to other bodily issues, causing issues like bladder infections, bladder stones — not to mention spinal cord injury urinary incontinence (click to tweet). Simply put, the bladder does not like being paralyzed.
Thank goodness for modern day medicine! The invention of catheters has completely changed the lives of people who live with paralysis and made normal lifespans a possibility through bladder management. However, trying to figure out the right catheterization (“cathing”) method isn’t easy. Depending on your level of injury and the sensitivity of your bladder, there are different options to consider.
From the newly injured to those who've been living with paralysis for years, read on for a rundown of your best post-injury bladder management options. It's always good to know all of your options before sticking with something for too long that may not be the best option for you.
Suprapubic Catheter (Surgery Required)
One of the most common ways male and female quadriplegics manage their spinal cord injury bladder problems is with a suprapubic catheter. This method of catheterization involves a minor surgery that puts an incision on the side of the abdomen for the catheter to be inserted into (with the other end attached to a drainage bag). The location of the incision is quite low on the abdomen near the bladder.
From this incision, surgeons put another incision into the bladder for the catheter to then enter. These incisions heal quickly if removed, but many quadriplegics will keep this style of catheter in for 24/7 use for years. Also, a suprapubic catheter needs to be changed every four to 12 weeks depending on your bladder health.
Another popular option for quadriplegics, an indwelling catheter, offers a very similar bladder-management setup to the suprapubic catheter method described above. The only difference is that surgery is not required because the catheter is inserted through the urethra. To keep the catheter in the bladder without coming out, a tiny inflatable balloon is on the end of the catheter (that is filled with saline).
For years, men and women both commonly used a Foley indwelling catheter, but a new style of indwelling catheter, called a Duette, offers less bladder irritation because it has two smaller inflated balloons instead of one large one. An indwelling catheter also is attached to a drainage bag and needs to be changed every four to 12 weeks.
Condom Catheter (for Men Only)
A cathing method reserved for men, a condom catheter, is a silicone or latex condom attached to a catheter that is placed over the penis. This is sometimes favored over an indwelling catheter because no inflated balloon or urethra tube is required, reducing bladder irritation.
A condom catheter also requires careful upkeep. The catheter needs to be removed and the penis washed at least once a day, and a new catheter should be used every day.
Mitrofanoff Catheter (Surgery Required)
For anyone who would rather not have a drainage bag on them, the Mitrofanoff procedure is an option to consider. Most urologists recommend you have decent upper body mobility to cath yourself for this method, but some quadriplegics will still get the procedure and have assistance. Essentially the Mitrofanoff procedure creates a new stoma in a place that is not obvious, such as the belly button. When you are ready to drain your bladder, you put an empty bottle in between your legs and then insert the catheter into its new hole.
Additionally, this procedure does require a surgery that has a three-day recovery time in the hospital, and it takes about 30 days for it to heal before you can use your new stoma.
Clean Intermittent Cathing Method
Intermittent cathing, whether alone or in combination with other methods of bladder emptying, is the most popular style of cathing among men and women, including those with spinal cord injuries. This method is when a new, straight catheter is inserted through the urethra every time you need to drain your bladder throughout the day. This method works great for anyone with full arm and hand movement, especially with men since it is easier to get to their urethra while sitting.
For women with spinal cord injuries, intermittent cathing is only usually reserved for women who can transfer themselves and get to their urethra without any struggle. For those that cannot, the Mitrofanoff method (described above) is usually opted for instead.
If you find over time that you keep getting recurring bladder infections and even bladder stones every four to six months, talk to your urologist about trying a new bladder-management method. You truly do not need to suffer. There are better options available and it’s smart to try them all before settling.
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Spinal Cord Team