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Thread: Bowel & Bladder Control for High-Level SCI

  1. #1
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    Bowel & Bladder Control for High-Level SCI

    My Dad is c3-c4, incomplete (sensory). When we've been able to provide regular exercise to him, he has had sensations in the buttocks and under-the-thigh area and bowel&bladder.

    1) Difficult to Change Catheter

    My Dad has had to go the ER twice since Home Health couldn't insert the foley (he's had problems in the past, one time it took 5 attempts by nurses). I finally got "consent" to take him to a urologist because the ER Urologist had difficulties inserting the foley cath (he used a guide wire, made a bit of a bloody mess, and my Dad was prescribed Cipro). The ER Urologist told us that my Dad had a lot of scar tissue, would not be able to have a foley cath (or at least, would need the help of a urologist) next time, and he recommended a suprapubic.

    However, the nurses interjected "he can pee!" without the foley. The ER urologist was surprised and then, recommended a urodynamics test.

    2) Urodynamics Test

    My Dad just did a urodynamics test.

    After the recent urodynamics test, the tester informed me that my Dad's sphincter is closing when it should be opening -- they took 2 minutes to insert the foley and not a drop of blood.

    When I informed the urologist that my Dad does pee on his own -- the urologist asked why we were using the foley. My response (guilt felt!) was that not using the foley has been suggested by the home health nurses but since my Dad pees a lot and we were concerned about frequent changes (we didn't know that he could pee on his own until about 8 months after his injury) -- but just recently I learned that if his bladder didn't empty entirely, this would be a problem. The urologist nodded and made the suggestion that we try to have my Dad not have the foley and to check if his bladder empties (my Dad would have to come back the next day to get a scan)... but said that he doubted that my Dad's bladder would empty entirely.

    The urologist said that he's never known of a high-level SCI individual who has regained b&b control.


    I was thinking -- why would the home health nurses rec that my Dad not use the foley if there is some "danger" in his not emptying out his bladder? A ER nurse had recommended having "break months" when we would not have the foley for a month to give my Dad a break -- has anyone done this?

    Also, I've also heard that accupuncture has helped with the restoration of bowel and bladder control -- I contacted the lead accupuncturist who worked on this at the major SCI rehab ctr in SF and who was referred by his former PHd grad student who mentioned success with one patient (much lower-level injury) but mentioned that it took a long time.

    Has anyone known of a high-level SCI person who regained b&b control? Any experiences which you can share?
    Last edited by Joey_SF; 05-18-2013 at 09:37 PM.

  2. #2
    Senior Member lynnifer's Avatar
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    Definitely not. I would be on that like white on rice if true.
    Roses are red. Tacos are enjoyable. Don't blame immigrants, because you're unemployable.

    T-11 Flaccid Paraplegic due to TM July 1985 @ age 12

  3. #3
    c5-6 inc, was told by the rehab uro "100% certainty" I'd never regain normal bladder function. He was 100% incorrect.

    Never had urodynamics again. IVP looks fine. I have peed the bed once since-when I passed a stohe and peed blood. I doubt my funxn is 100% but I don't get uti's.

  4. #4
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    Hi Lynnifer - which part is a "definitely not?"

    Hi Betheny - thank you so much. Sorry, dumb question - what is IVP? Did you do any exercises or something "healing" to help to regain b&b control?
    Last edited by Joey_SF; 05-19-2013 at 06:10 PM.

  5. #5
    You do not say how long ago your Dad's injury was. That would be helpful in answering your questions.

    While it is not likely that your Dad would gain b&b control, I never say "never". However, it is scary to not empty completely and can lead to major problems. So please proceed with caution.

    CKF

  6. #6
    When you say your father urinated, you mean he had voluntary control over urination??? He could hold it or go when he wanted? Or is he reflex voiding?? The latter is common in SCI, and since his urodynamics showed that he had DSD (detrussor sphincter dysynergia) where the sphincter gets tighter when his bladder (detrussor) muscle contracts, it is likely that any reflex voiding he does is with high bladder pressures. Over time this puts his kidneys significantly at risk, and the high residual urine he holds also increases his risks for UTI.

    The nurse and physician you reference above clearly have no concept of proper bladder management for a person with a neurogenic bladder from SCI. It could be very dangerous to leave your father's indwelling catheter out unless you plan to do intermittent catheterization 5-6X daily and put him on medications to lower his pressure and keep him dry between caths. It is outmoded to just let him reflex void and contain the urine with diapers or a condom catheter...and potentially dangerous.

    (KLD)

  7. #7
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    My Dad does not have voluntary control and cannot hold it or go when he wants to -- but, he can at times feel when he has to go and when he does go.

    Yikes -- more dumb questions, what is "reflex voiding with high bladder pressures" and the meaning of "high residual urine?"

    They actually had to stop doing more with the urodynamics test cuz my Dad's blood pressure started to rise.

    What can be done to lessen the risk to his kidneys?

    He is now getting plenty of water. Some of the nurses showed me how to detect a UTI by looking at his urine, spot of blood, cloudy, chunky bits, ... are these good tell-tale signs?

    The urologist also said okay to cranberry pills -- I tried to ask a specific measurement (1,000 vs 4200) but he just said to follow the directions on the bottle. I asked cuz I read your post which said that this may cause kidney stones.

  8. #8
    He may be "peeing" but he is isn't emptying and it isn't normal. What did th eurodynamic test show his voiding pressure to be?. He has NDO-neurogenic detrusor overactivity- which means he holds a small eramount than normal then the bladder will have a contraction and he will "pee" but can't empty because of the DSD- detrussor sphincter dysynergy- AKA spasms of the sphincter. He can take an anticholinergic to hold more in the bladder. Has he tried a Coude' catheter? But if a wire was needed it is a temporary fix and the indwelling catheter will help keep it open. Scar tissure - did he offer a DVIU to remove. However with NDPO with DSD- he would need to catheterize himself if he had hand function or someone would need to do it for him every 4 hours.
    We try Tamsulosin also to decrease the prostate size and relax muscles but nothing help the DSD.
    To keep the bladder and to void at high pressures puts the kidney function at risk. What did the urologist say about the urodynamics? He needs to explain the whole picture of SCi and the urodynamics findings with you.

    CWO

  9. #9
    Signs of UTI- the others jus tindicate more water and not necessarily UTI- need symptoms of :
    Fatigue, lethargy, low grade fever, increased stiffness or increased spasms.
    We only treat urine where there is some type of symptom, not just the urine.
    Cranberry pills okay but have to drink alot of water and may not help.
    Chronic Infections of urine is the most common cause of kidney stones in SCI .
    CWO

  10. #10
    High voiding pressure-He needs to take an anticholinergic- relaxes the bladder and will help it hold more. Tamsulosin may also help.
    He is having Autonomic Dysrerflexia due to urine in the bladder and this can lead to a stroke if it continues. The indwelling catheter will prevent this and it will keep the bladder pressure low and prevent high voiding pressure- he should not be voiding but should use catheter to drain his bladder to keep the kidneys safe- and use anticholinergic such as Oxybutynin, Vesicare- even with indwelling we put on a low dose.
    CWO

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