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Thread: Methods to augment bladder Control?

  1. #1

    Methods to augment bladder Control?

    I was just wondering about the best methods to increase a paraplegic's control over his bladder, and measures to decrease or prevent nocturnal enuresis.
    Please we want a full review of this subject, concerning each non-drug method then a brief comment on the safest drugs to use in such case.

  2. #2
    The clinical practice guideline on urologic management following spinal cord injury will be out later this year from the Consortium of Spinal Cord Medicine (www.scicpg.org), and I would refer you to this publication (which will be announced on this forum) for a complete discussion of all bladder management methods, medications and other interventions such as surgery. This forum is not intended for the provision of doing full literature reviews or writing scholarly papers.

    Methods include intermittent catheterization, reflex voiding (using external condom catheters or padding), indwelling catheters (both urethral and suprapubic), urinary diversions (continent and incontinent urinary ostomies), and for a very few, implanted electrical devices such as the Vocare (Brindley).

    Other than the last one, none of these give persons with SCI volitional control over their bladder, and the former requires extensive surgery with few being candidates. For some who have fairly incomplete injuries, if indicated by their urodynamics studies, biofeedback may be used to gain further control when the person already has some volitional control.

    For those using intermittent catheterization or indwelliing catheters, the use of anticholenergic drugs is commonly needed to maintain capacity, decrease bladder pressures (increasing compliance), and to prevent reflux or leakage.

    Night-time diureses is common because of 3rd spacing during the day (most have significant leg edema if they do not use elastic compression hose) and the lower blood pressures most have when sitting vs. laying down. This can result in a large diuresis when the person lays down and mobilizes this fluid. For those using indwelling catheters or reflex voiding, this rarely causes problems other than being sure they have a large enough urinary drainage bag for use at night. For those doing intermittent cath, to avoid having to cath more often than every 6 hours at night, measures include taking most fluids early in the day (I recommend about half prior to noon), the remainer prior to about 7PM and then no fluids after that time other than sips to take medications. Use of compression hose when out of bed will reduce 3rd spacing and edema as will periodic leg elevation above the heart during the day (but the use of elevating leg rests routinely is discouraged due to the excessive pressures this places on the ischiums leading to pressure ulcers).

    For a few people with SCI, esp. tetraplegia, they may have inadaquate excretion of ADH during the night. In a study I participated in, we found this in nearly 30% of our subject with tetraplegia. Instead of their ADH level increasing during sleep, it decreased. For those patients the cautious use of DDAVP at bedtime can help with some of the nighttime diuresis.

    (KLD)

  3. #3
    Thanks for ur help but I still want to know if there are mechanical excercises that a paraplegic can carry out to increase his bladder volume and decrease urinary urgency?

  4. #4
    None that I know of or that have any research base. The detrusor is innervated primarily by parasympathetic nerves, the internal sphincter by sympathetic nerves, and the external sphincter is somatic. It is rarely a case of urinary muscles that are too weak, but instead lack of brain-mediated muscle coordination and inhibition that causes the urinary dysfunction in people with SCI.

    (KLD)

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