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Thread: Anyone out there with lower thoracic injury have bladder return?

  1. #1

    Anyone out there with lower thoracic injury have bladder return?

    Is there anyone out there who has had bladder function return following lower thoracic injury?
    I dislocated my spine in a fall and suffered sci. I lost my bowel and bladder function. I have always felt the need to void, but have needed to rely upon intermittent cathetorization since my injury.
    Surprisingly there is very little information available on this subject. I figured as with just about everything else regarding sci, the best place for info would be here.
    Why is it that locomotor training is attempting to retrain muscles to work and it has been fairly widely accepted that this is a valid treatment for both acute and chronic para and quadrapalegia, yet the accepted course of action with our bladder is to never let it try to work? I have no idea if my sphincter is capable of working. I cath every four hours whether I need to or not.
    I fully understand the health ramificatication of not emptying our bladders. I just wonder if circumventing my sphinchter isn't preventing nerve activity from taking place. I will visit my urologist later this month and breach the subject again with him, but don't expect much information.
    I have a flaccid bladder which will hold it, but cannot void.
    Today, while taking a dump, I pee'd probably 3 cc's an hour after cathing. I know that the standard response would be UTI but I have no other symptoms and have never had a UTI since my injury (I am 81/2 months post).
    I just want to know if anyone has had return following the loss of function and what types of signs may have occurred prior to the return.
    Every function I have had returned has come back slowly and I worked every movement to build strength. Why should my bladder be any different?
    Thanks in advance for any responses.

  2. #2
    Sorry. I meant to say 300 cc's. 3 wouldn't be very much would it? Ha!

  3. #3
    Quote Originally Posted by MFlounlacker View Post
    Today, while taking a dump, I pee'd probably 300 cc's an hour after cathing. I know that the standard response would be UTI but I have no other symptoms and have never had a UTI since my injury (I am 81/2 months post).
    I just want to know if anyone has had return following the loss of function and what types of signs may have occurred prior to the return.
    Every function I have had returned has come back slowly and I worked every movement to build strength. Why should my bladder be any different?
    Thanks in advance for any responses.
    Well first of all, your bladder is a different type of muscle that your arms or legs. The latter is striated muscle, while your bladder is smooth muscle. Your external urethral sphincter is striated muscle too, while your internal bladder sphincter is smooth muscle. They are differently innervated too...the bladder primarily by parasympathetic nerves from S2-4, the internal sphincter by sympathetic nerves from T10-T12, and the external sphincter by somatic nerves through S2-4.

    If you are doing dig stim as part of your bowel management, you are stretching and attempting to fatigue your internal anal sphincter, which is part of your pubococcygeal muscle, which also makes up the external urethral sphincter. If you truly have a flaccid bladder (unusual in thoracic injuries, but not unknown) then you would need to strain or do some valsalva to get your bladder to partially empty, and dig stim has been used to relax the external sphincter and allow urine to flow (by decreasing sphincter resistance to straining).

    There has been some work on surgically transplanting both nerves and muscles to replace flaccid bladder muscle. You may want to do a search for some of these studies and trials on the Cure forum here.

    (KLD)

  4. #4
    KLD- Thanks for the response. I am improving in many ways and am not at a point where I would consider any type of surgical procedure. I have seen some studies with the nuero transplants but it is early yet. I am still hoping nature may take its course.

    I understand that my bladder is controlled by different nuerological pathways. I get that. I also get that there are very few treatments available to us leading one to believe that we know very little about this subject. Believe me I have researched. Being stuck in a hospital for a month and then spending another month or more stuck in the house leaves a little time on one's hands. I dislocated my spine at T-12 and a, fused from T-11-L-1 and have a flaccid bladder.

    Smooth muscle fibers can't atrophe? Our bodies can't become accustomed to not having to worry about emptying? It seems that when I am over full, I leak. What if I tried to squeeze more out when I leaked? Maybe I could initiate leaking somehow and try to urinate on my own? These are valid questions and do not imply that I don't know what I am talking about or am completely ignorant to my anatomy. In fact it was put precisely that way by my urologist when he said that just like my other musles atrophe so too will my sphincter muscles. The problem is; there is no PT for our sphincter. I am paraphrasing but that's the jist. I trust him too as he is associated with Johns Hopkins. So I am really not that far off base.

    That is why I reached out to my fellow CC members for input. I am sure someone out there has had bladder return and can offer some information as to how it transpired. I was told I would never walk again and am now walking doing all my own therapy. Sorry if I don't believe I won't pee ever again just yet either.

  5. #5
    Quote Originally Posted by MFlounlacker View Post
    I dislocated my spine at T-12 and a, fused from T-11-L-1 and have a flaccid bladder.
    Sorry, I misunderstood that you had a thoracic SCI. Most likely if you have a T12 fracture, the damage to your cord is actually in the lumbar/conus area, not thoracic. The fracture is different than the neurologic damage.

    Quote Originally Posted by MFlounlacker View Post
    Smooth muscle fibers can't atrophe?
    Smooth muscle that is denervated tends to atrophy, but also significantly increases it connective tissue (collegen) content, which over time can make it stiffer. This can create higher pressures inside the bladder, even without contraction of the muscle.

    Quote Originally Posted by MFlounlacker View Post
    The problem is; there is no PT for our sphincter.
    Actually there is. If someone is incomplete, and can do Kegel exercises, or biofeedback, there is therapy available for the sphincter. PT and exercises (such as FES) for totally paralyzed other muscles with LMN damage has questionable benefits as well.

    Quote Originally Posted by MFlounlacker View Post
    Sorry if I don't believe I won't pee ever again just yet either.
    No one is asking you to believe that.

    (KLD)

  6. #6
    I'm incomplete (cauda equina) and did Kegal's like crazy. I got to the point where I could empty all but 150-225ccs on my own. I was told by my urologist that I still needed to cath. 6 times a day. Give it your best shot, you never know. Good Luck!

  7. #7
    KLD- I have never been given a diagnosis of my nuero logical level. They were never sure and the doctors told me it could be conus or if my damage was higher. I slammed pretty hard and figure I could be damage in many places.Not just where I am fused I always refer to my injury site since that is really all I know. I am not super convinced that it matters. My symptoms are what they are and that's all they have to go by. I am sorry for the confusion.
    I am sorry that I may have mis understood the tone of your response. Wasn't sure that my original required an anatomy lesson. Maybe it did. I don'y know. Your second post is quite helpful though and seems to support my assessment. I will give research the Kegel exercises and see if it is something that may work for me. Thank you.
    Loancoaster- Thanks for your input. Just figured I need to give something a try. I have started to be able to strain out a pretty steady stream and this is definitely new. I still cath to make sure. Just thinking I may want to take advantage.

  8. #8
    Sorry about the typos. My keypad is acting up.

  9. #9
    Hi my brother had decommpression surgey and had recoved his bladder he was not injured but it was a compression due to classified ligament flamvn between his facet joints which became like bone and was pressing his cord on 3 levels from t6 to t9 w worst on t9 he had surgery 7 months before he was not fussed which was good news for us at that time but right after 3 days of his surgery doc find that my brother doesn't feel his bladder at all ( FYI my brother was walking and having all the functions including bowel and bladder before his surgery but he was having numbness and difficulty in walking) when they did clumping after they opene it and my brother passed al most 1500 cc but no feeling and doc took again for meylography and they find that spinal cord was still pressing coz there was edema and they did his dura plasty to give space to his spinal cord and they open the dura and put patch on it which was 7 cm my brother do feel his bladder right after his surgery but he was on foley for about 4 months and then doc removed his cathedr now my brother h
    Is emptying his bladder by him self and he have also control on his pee and also when he is sleeping and wants to pee he feel his bladder and he pee on his own he had scan and doc said to stay to the same plan but they were happy and surprised that he recoverd his bladder

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