Bladder function

My little brother is paralyzed from the waist down. He has a catheter and sits on a bedside comode for his bowel movements. He ordinarily has no control over his bladder/bowel. Yesterday, while wearing a catheter and a diaper, he felt as if he was urinating. He did actually start to leak. He was able to increase the urine flow by flexing his abdominal muscles and then he was able to stop the flow by contracing the muscles again. He tested this several times and for some strange reason he was able to do it over and over. Could you please explain what this means, if anything?

Also, the other night the nurse said when she took off these things that are around his lower legs she thought his legs were sweating. Any advice?

Thank you in advance for your comments.

By the way, he broke his 11th vertebrae and pinched his spinal cord and has been paralyzed since March 20th, the day of his accident.

[Wise Young]

big sister,

I think what you are describing suggests that your brother is getting function back, particularly the return of sweating. It is hard to judge whether he is getting bladder function back based on your description because it is possible to squeeze the bladder and get urine leakage without the bladder actually functioning. On the other hand, if he can feel fullness in his bladder and he can release urine voluntarily, this would suggest that he is getting bladder function back. Note that the part of the spinal cord that innervates the bladder is in the lower sacral part (i.e. S2-4).

Your brother is still very early after spinal cord injury. I believe that he has much recovery ahead of him in the coming year.

Wise.

Thank you very much for your reply, Dr. Wise. This forum has been an excellent source of information for me over the past few weeks.

My family feels very blessed that Tommy is with us today. We do, however, remain hopeful for recovery, no matter what the doctors say. We shall wait and see.

Another question I have for you is whether or not Tommy should be able to receive therapy that consists of attaching braces or something to his legs and trying to help him walk on a treadmill. I've seen people use such machines and I am curious as to why Tommy is not getting that type of therapy. Maybe that is to come in the future.

Finally, my family lives in Arizona and someone suggested to us that we send Tommy to a place in Colorado that specializes in spinal cord injuries. I'm sorry, but I do not know the name of the center. Any advice?

[Wise Young]

I don't know what the policy of the hospital is and they differ tremendously. Some places are very aggressive about getting patients into functional electrical stimulation and walking programs while others are not. You should ask. There may be reasons why he may not be eligible, i.e. urinary tract infection, recent surgery, etc. One possibility is to get him into a swimming pool so that he can stand and walk in the water. This is the least expensive and possibly the easiest way to get him to put some weight on his feet without risk. Wise.

[SCI-Nurse]

Just a couple of questions, as well as a few words of caution.

Is your brother in a CARF accredited spinal cord injury rehab program? Why is he using a foley catheter at this point? He should be on intermittent catheterization. Has he had urodynamics? Urination with a lower level injury may be done with increasing intra-abdominal pressure and straining without return in the sacral nerves. Only a urodynamics study can show the true neurologic picture. Straining to void may not be a good idea for many reasons, one of which is that it can cause significant reflux of urine in some (back flow to the kidneys).

The hospital in Colorado is probably Craig. It has an excellent rehab program, but is not always covered by insurance, esp. Medicaid. Does he have private non-HMO insurance?

Sweating below the level of injury may indeed indicate some return of autonomic function, but it is difficult to tell at this time. Local heat (such as from the TED hose he is wearing) can often cause sweating even with a complete SCI, although environmental heat usually will not. This is more true with injuries above the mid-thoracic level though.

Often walking with braces is delayed with lower thoracic or lumbar injuries until the spine is healed. Walking with significant paralysis, even with FES, can cause a lot of lordorsis or curvature of the spine, which can cause problems with a recent fracture. Use of an FES bike early on is recommended more than walking. The FES bike can maintain the muscle tone and bulk until his back is fully healed, when suspension ambulation should be explored.

(KLD)

Thank you very much, nurse. I will print your comments and take them to the rehab center to ask the appropriate questions and have my mom discuss things with Tommy's doctor. I appreciate your informational reply. I will continually post questions and would love any input you could provide.

SCI-Nurse:

I visited with my brother today and he would like to know if he should be concerned with his physical therapy. As an athlete he pushes himself during his strength training for his upper body. Should he take it easy or is it okay to work out as he would ordinarily do? His injury occurred on March 20th and his surgery took place the next day.

Also, he is on intermittent catheterization not a foley catheter. I gave my mom the information you gave me regarding the urodynamics. I will get back to you with the doctor's response.

Finally, a doctor told my mom that the use of leg braces is out of date. Tommy is eager to get on one of those bikes you mentioned because he is interested in doing anything and everything that is possible at this point. This is something that will need to be discussed with his doctor, I'm sure, but I wanted to hear your position on the comment of the leg brace method being out dated.

Thank you for your information. I look forward to hearing from you.

[SCI-Nurse]

As long as your brother is sticking to any limitations imposed by the healing of his back (the surgeon should have been very specific about this) there is no reason that he should not be able to work out to his maximal effort. Of course this needs to be balanced by other things he needs to do during acute rehabilitation including working on activities of daily living (ADLs) with occupational therapy, getting educated about SCI and maintaining his health (usually by rehabilitation nurses) and dealing with the emotional consequences of this injury (through work with social workers or psychologists).

I am puzzled by the statement that walking with braces is "out of date". Obviously FES ambulation is the ideal, but not everyone is a candidate for this (nor has insurance funding for this very expensive treatment). Many people want to work on brace walking, and if they are committed to this, we certainly will support them in their efforts, although we also do suspended gait therapy for those with incomplete injuries as well as walking without braces in the pool.

He definately should be standing daily, at least an hour, and this can be done in braces, on a tilt table or in a standing frame.

Glad to hear he is on intermittent catheterization. It is the preferred method for long term health of the kidneys as well as for fertility potential in men with SCI.

(KLD)

I am giving my mom this information today so she may discuss things with Tommy's doctor. I can tell you that Tommy has not been standing at all. I do not understand why this is so if it is imperative that he do so at least one hour each day. Could this be due to the "healing process"? Is it too early to start doing stuff like that if he is still healing from his surgery (March 21st)?

By the way, Tommy is at a spinal cord injury rehab center (Good Samaritan in Phoenix, AZ) so he has been undergoing OT as well as PT and has met with a psychologist several times.

Thank you for all of your assistance. You are really helping my family ask questions that will hopefully benefit Tommy in the long run. I'm sure there will be more to come, if you don't mind.

[mom01]

My daughter was at a hospital that had a tilting table, but it was more time consuming to strap her into it, so they didn't want to bother. I regret not switching to a more progressive program sooner. If possible talk to her Dr. and insist that he have more opportunity to use the standing frame. It really is a tremendous help...

[GoBig]

How is your brother doing. Is he standing now. Give us an update.