Using bladder reflex?

[etexley]

Hi

Recently I've read some literature that indicates that the bladder can me made to empty by pulling on pubic hair, touching...etc. Also, I've read that Dr. Kao teaches people to "train" their bladders to hold like 400CC.

Would it be possible to to train one's bladder to empty in this manner, and eliminate the dependency on cathing? This was never mentioned to me in rehab, but it is spoken about in the literature that they gave me. It would make a world of difference in my life to not have to cath anymore.

Eric Texley

[SCI-Nurse]

Eric - The answer to your question is related to your injury and the way in which your bladder works. A bladder can be spastic or reflex, i.e. it is automatically triggered to empty when it fills although this individual can also be at risk for sphincter dyssynergia, i.e. sphincter does not open when bladder contracts. The spastic bladder usually occurs when the injury is at T12 and above. A flaccid or non-reflex bladder generally is present in the person with a T12/L1 or lower injury. In this person, the reflexes are either sluggish or absent; the bladder can become full without the person knowing this. This bladder can easily become stretched or over-distended and is at risk for back-up of urine through the ureters to the kidneys.

I am not familiar with the "training" method about which you inquire, however, again your ability to respond to such stimuli will depend upon your sensory responsiveness. I will also ask the SCI-Nurse team for their familiarity with this technique.

For a helpful explanation about bladder management go to: POINTIS at http://calder.med.miami.edu/pointis or University of Alabama at www.spinalcord.uab.edu (http://www.spinalcord.uab.edu) CRF

[SCI-Nurse]

I have been in SCI care long enough to remember when the old goal for bladder management was to have a "balanced bladder", which meant vigorously triggering (usually by suprapubic tapping or anal stimulation or pulling pubic hairs) the bladder to contract and empty.

Those with areflexive bladders were encourage to "crede" (push urine out with their hand or fist pushing on the lower abdomen just above the pubic bone).

A "balance bladder" was considered to be achieved (or "trained") when the person emptied on their own with a residual of either less than 100 cc. or less than 1/3 of the original urine amount. Rarely did anyone do long term intermittent cath, and most men used externals. Women did a lot of transfers to the toilet to trigger and used padding.

Unfortunately we discovered in the mid-1980's that we were often actually setting people up for ultimate failure and perhaps kidney damage by doing this, as this is when the importance of keeping bladder pressures low was discovered. Using the "balanced bladder" model, we were inadvertenty making people have higher pressure bladders and encouraging them to try to get their bladders to contract with high pressures against sphincters that often (more often than not) were not coordinated, and got tighter when the bladder contracted. This is the condition called DSD (detrusor-sphincter dysynergia).

For those with areflexive bladders, it was discovered that crede more often than not just caused urine to reflux up the ureters, increasing the risk of infection and/or kidney damage.

Unless something is done to release the sphincter pressure (occasionally meds work, more often a sphincterotomy is done), this method of bladder management is now considered nearly always dangerous and outmoded. (KLD)

[Scorpion]

I've used externals since 1991 (injured in late 90) and I tap on my abdomen over the bladder to trigger urination if I feel I need to void and it hasn't started on its own. I was told in rehab that a crede could cause urine to reflux into the kidneys, and it wasn't encouraged anymore, so I don't try to push the urine out. I just tap until I feel myself starting to void. Now, I have sensation, but most quads I've known don't cath and only use external catheters, sensation or not. Early on, I was told that a PVR (Post void residual) of under 150cc was a target. After frustration with my urologist (who was familiar with SCI & worked thru the rehab center) giving me antibiotics EVERY time I had a culture done, even after finishing a course of antibiotics, I started talking to other people with SCI more and did some research on drug-resistent bacteria. I found that giving antibiotics every time any bacteria were detected was setting me up for a super-infection down the road (not to mention the fact that doctors have overprescribed antibiotics across the board, putting everyone at risk of drug-resistent bacteria). I also realized my new uroligist had his own ideas as to how I should manage my bladder, some in direct opposition to ideas of the previous doctor, and this new guy was experienced with SCI too.

KLD, are you saying that we should all be on an intermittent cath schedule? Because, if you are, it'd take a helluva lot to convince me to go back to that. I've only had one symptomatic infection in the last 5 years or so, and cathing itself is almost guaranteed to cause UTIs. I did the intermittent cath thing in rehab before my bladder started voiding on its own. Screw that. Not only is it hell trying to cath as a quad, but I can't imagine trying to do it in my chair. And those of us with sensation who have been cathed or have cathed ourselves know that no matter how much you lube up that tube, it's going to hurt. And if A/Bs are often chronically dehydrated as I've been reading/hearing, I can only assume that people with SCI forced to limit their fluid intake (due to intermittent cathing) cannot be as healthy as they need to be.

Is it any wonder we gimps get frustrated and resentful of the medical community when we get all kinds of mixed messages, much of it biased (in my opinion)? I respect you nurses more than doctors in many ways, but sometimes I need to listen to my own body and listen to my fellow gimps first. Does that make any sense? This post may sound inflammatory or curt, but it seems like Eric isn't getting much of an answer here. I often read posts by the SCI-Nurses and learn things, but sometimes, not often, I shake my head and wonder if they've ever met anybody with SCI. (That's an exaggeration, I know.)

I apologize in advance if this offends anyone, because that's not my intention. I'm just tired & cranky tonight, and I'm frustrated with the mixed messages we get, not so much here, but from the medical establishment in general.

~Rus

"Because you're not promised tomorrow." ~ Stuck Mojo

[This message was edited by Scorpion on September 19, 2001 at 12:52 AM.]

[Rick1]

[QUOTE]Originally posted by Eric Texley:

"Recently I've read some literature that indicates that the bladder can me made to empty by pulling on pubic hair..."

So, what do you do when you run out of pubic hair?

[SCI-Nurse]

Scorpion - You have obviously learned to listen to your body, know what works for you and have also taken a pro-active approach to educate yourself. I believe those are important health behaviors. And yes, you are correct in that sometimes there are mixed messages from the medical/health community. This latter, I believe, is related to philosophical approach, research understanding and experience/expertise.

A comment and a caution: 1)there was a concensus statement, 1999 (I think), re: use of antibiotics and UTI's. The recommended approach is a reduction in the use of antibiotics, reserving these primarily for full blown UTI's....for the very reason that you have stated re: resistance and 2)Do you have a periodic urologic evaluation that includes urodynamics to assess bladder pressures and rule out any potential risk for reflux? If not, such an assessment would validate that your method of bladder management is safe, effective and appropriate for you....or not. I think this approach is important for long term bladder and kidney health for you, and all, as a SCI person(s). CRF