View Poll Results: How frequently do you get urinary tract infections (more than a year after injury)?

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  • Rarely (once every couple of years or more)

    45 29.03%
  • Occasionally (once every year or two)

    37 23.87%
  • Regularly (2-3 times a year)

    31 20.00%
  • Often (more than 3 times year)

    42 27.10%
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Thread: How often do you get UTI's and what is the meaning of no gas

  1. #1

    How often do you get UTI's and what is the meaning of no gas

    Quote Originally Posted by spidergirl
    I just can't deal with the UTI's anymore. They have substantially taken a toll on me. I work everyday and it's very uncomfortable to have to wear some sort of serentity pad or whatever so I don't pee all over people's couch's in the studio. And not to mention I have to wear clothes that go over my jeans or pants somewhat. ( actually this is a fad right now so that's a plus) It's just so ridiculous. Maybe we can get BBS back again at the very least. Is it weird that I haven't passed gas since my injury? Is that bad? Someone told me my cord was severed because of that and I have clearly seen my MRI's several times to know I have a contusion.
    Spidergirl,

    I thought that this subject would be better dealt with in the Care Forum.

    In my opinion, urinary tract infections should not be occurring with the proper technique and care. I know that for many people with spinal cord injury, one or even more urinary tract infections is common and they accept it as part of their life in spinal cord injury. However, I would like find out how true this is and how many people with spinal cord injury get UTI's yearly or even more often.

    Yes, it is true many women now wear dresses over jeans. I guess that it was heading that way when jeans became so tight that they were just like tights. Actually, I think that most women look surprisingly good with a dress over a pair of jeans. In any case, I think that you would look great.

    Regarding not being able to pass gas, do you really want to know? I have learned to ask because my kids were reluctant to ask me questions when they were younger. I always explained more to them than they really wanted to know. So, do you really want to know why people with spinal cord injury cannot pass gas? It is very interesting but then I don't know how many people would agree with me.

    Wise.
    Last edited by Wise Young; 05-25-2007 at 03:08 AM.

  2. #2
    Quote Originally Posted by Wise Young
    So, do you really want to know why people with spinal cord injury cannot pass gas? It is very interesting but then I don't know how many people would agree with me.
    Let me take a wild stab and say it is correlated to me burping more.
    No one ever became unsuccessful by helping others out

  3. #3
    Senior Member spidergirl's Avatar
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    Quote Originally Posted by Wise Young
    Spidergirl,

    I thought that this subject would be better dealt with in the Care Forum. .
    Ty. Of Course. I agree.

    Quote Originally Posted by Wise Young
    In my opinion, urinary tract infections should not be occurring with the proper technique and care. I know that for many people with spinal cord injury, one or even more urinary tract infections is common and they accept it as part of their life in spinal cord injury. However, I would like find out how true this is and how many people with spinal cord injury get UTI's yearly or even more often. .
    My sheets are cleaned on a daily basis. I take a bath/shower everyday. I don't know what is going on. I did not get 1 for the first 8 months of my injury and now I get them once a month. My doctor recommenced a nutritionist bc I have been getting a little skinny. I am seeing a new urologist next week actually. I know there has got to be some sort of remedy and I just haven't figured it out yet. I don't have sex.

    Quote Originally Posted by Wise Young
    Yes, it is true many women now wear dresses over jeans. I guess that it was heading that way when jeans became so tight that they were just like tights. Actually, I think that most women look surprisingly good with a dress over a pair of jeans. In any case, I think that you would look great. .
    They are not necessarily dresses but you know long shirt that cover at least the top part so you cant really see any type of whatever I may have down there. Cute nonetheless. I know you gotta see me. Maybe I will put a new pic up.


    Quote Originally Posted by Wise Young
    Regarding not being able to pass gas, do you really want to know? I have learned to ask because my kids were reluctant to ask me questions when they were younger. I always explained more to them than they really wanted to know. So, do you really want to know why people with spinal cord injury cannot pass gas? It is very interesting but then I don't know how many people would agree with me.

    Wise.
    Of course I wanna know. It's happening to me.
    Last edited by spidergirl; 05-25-2007 at 04:16 AM.

  4. #4
    Senior Member spidergirl's Avatar
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    Here's more of a long shirt over pants...pic wise. don't know how long I will leave it.....but I know u like this one.

  5. #5
    Senior Member Tom's Avatar
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    One of the things that makes this message board so informative and useful is that there's always a golden nugget among the vast numbers of threads and posts, and you end up learning something you never knew before.

    And yet on the other hand, there are enough patterns that show up to realize that many aspects of care are sometimes sheer trial and error. Bladder management appears to be one of those. There are so many posts about cleaning, storage, etc, that it clearly boils down to 'whatever works for you'. And when you find THAT 'whatever works', your incidences of UTI's decreases.

    In my case (diabetic cystopathy, history of prostate abscess) I started out using a 16F Bard coude tipped red rubber cath - very soft and flexible. despite increasing to CIC 4 to 6 times a day, I still got freqent spasms and urges, sometimes even within an hour of cathing, despite my urodynamics not showing any sensation or urgency even up to 1400cc's. Anyway, i had posted last year, and among the advice I got was to chance catheters to avoid the possibility of latex allergy. Well, last November I changed from the Bard to a Mentor brand 816, much stiffer, clear PVC. The first time I cathed, I noticed that the catheter 'popped' into my bladder, and the volume I drained was WAY more than usual. Before I had usually been draining 700-900cc's, all of a sudden it was now 1000-1400cc's. I have DSD - detrusor/sphincter dysenergia as well (sphincter contracts at the same time the bladder does). My theory is that I was not getting the catheter fully into the bladder and therefore only PARTIALLY draining it, therefore the frequent urges, spasms, blowouts and constant low-level infection that culminated in getting a full blown case of sepsis last August (search post).

    Since switching to the Mentor, I've had only 2 UTI's and probably one of those was probably just colonization. So I picked "regular" since I've improved from 'constant infection' to one every few months. It's still not perfect but its a damned sight better than what it used to be. I feel much better, at least. Still have a lot of frustrating symptoms at times, but its something I'm working on, instead if it working on me. Hopefully, next time a poll like this rolls around I'll be able to click on "rarely" or "never."

    I also discovered early on that storing a cath in a vinegar and water mix in a ziploc bag (as printed on a handout I got from the urologist's office) did NOT work for me, and that washing with soap and hot water, then air drying was much better.

    As for not passing gas, I can't speak to that except to say that while we all often joke at each other's expense about 'breaking wind', I know from experience that its awfully uncomfortable to be bloated/constipated and if you can't relieve it by farting once in a while, no matter the embarrassment, it must be a very unhappy situation. Better to be embarrassed than miserable!


    Tom

  6. #6
    Quote Originally Posted by spidergirl
    Here's more of a long shirt over pants...pic wise. don't know how long I will leave it.....but I know u like this one.
    Are you coming on to Wise?

    Quote Originally Posted by spidergirl
    Is it weird that I haven't passed gas since my injury?
    Here's to blowing up your long shirt.
    "Be kind, for everyone you meet is fighting a great battle." - Philo of Alexandria

  7. #7

    The Physiology of the Flatus

    Quote Originally Posted by spidergirl
    Ty. Of Course. I agree.
    Of course I wanna know. It's happening to me.
    Okay, here goes. The passage of flatus through the anal canal is a remarkably sophisticated reflex. Flatus is of course intestinal gas that contains a variety of odiferous skatoles, indoles, and sulfurous compounds It also contain sufficient methane (from bacteria) that flatuses are frequently flammable.

    The question that have intrigued some physiologists for a long time is how the anal sphincter knows that gas is coming and not feces, or worse, liquid stools. As we all know, by the time the latter two hit the anal canal, the battle is lost. The external sphincter is not able to hold it.

    So, let me describe the anatomy of the anal canal. The canal is 4 cm long in adults. Its upper (proximal half) consists of anal columns or vertical folds of tissues. The lower half is comprised of the anal valves, folds of tisue that connect the bottom of the anal columns together.



    The amazing things is that the upper end of the anal canal is able to distinguish between solid, fluid, and gas. If it is gas, it allows the gas through. However, it clamps down when it is solid or fluid. Sometimes, it has difficult distinguishing between a little bit of fluid mixed with air.

    After spinal cord injury, the anal sphincter miuscle may be quite spastic, i.e. hyperactive. If so, it is not able to relax partially, which is what is necessary to pass a flatus. A spastic anal sphincter either relaxes completely or not at all and hence your inability to pass a flatus.

    Not much is known about the neurotransmitters of neurons that control the anal sphincter. In 1988, Neri, et al. discovered that the canal pressure fell dramatically (30%) when they gave a anti-serotonergic drug called Ketanserin. This was one of the first inkling that what neurotransmitter might be involved in neurons responsible for controlling anal activity.

    For obvious reason, closed is the natural state of the sphincter. Apparently, this tonic activity of at least the internal sphincter is due to neurons that are activated by serotonin. Blockade of serotonergic receptors cause the sphincter to relax.

    The internal sphincter is an involuntary smooth muscle. It receives sympathetic innervation via the hypogastic and pelvic plexus nerves from S1, S2, and S3. The latter carry parasympathetic cholinergic while the former carried excitatory sympathetic signals (adrenergic). There is an unknown component that is probably mediated by serotonin.

    According to Susan Congilosi of the American Society of Colon and Rectal Surgeons (Source), the internal anal sphincter contributes 55% of the anal resting pressure. Most of internal sphincter tone is from the sympathetic innervation. The remainder of the tone comes from the external sphincter (30%) and hemorrhoidal plexus (15%). The internal has repeated slow waves that occur 6-20 times per minute.

    The anal canal is sensitive to touch, pinprick, heat, and cold from the anal verge to about 1.5 cm above the anal verge. Initially, scientists thought that this sensation was what allowed people to distinguish between flatus and stools but local anesthetic blockade of the sensory nerves to this part of the anal canal does not abolish the ability to pass a flatus while preventing passage of stools.

    Rectum distension causes the anal canal to relax. The rectal sensations are mediated by parasympathetic fibers that carry sensory information to S2, S3, and S4. The canal sensations are carried out by the inferior retal branch of the pundendal nerve. This is the first branch of the pudendal nerve. The third of the pundendal nerve forms the dorsal nerve of the penis of clitoris. By the way, these are very important nerves that colorectal surgeons pay a lot of attention to, because any damage to these nerves would make a person very very uncomfortable and lose some very important functions and spectacular lawsuits. It is the reason why proctology is not as easy a profession as people think. The anatomy becomes very complicated when there are rectal abscesses, prolapses, and hemorrhoids.

    So, what are the consequences of not being able to pass gas? There may be bloating and rectal distension from the retained gas, which would be relieved with a bowel movement allowing both stool and gas to pass through the anal canal. Thus, when a suppository is used, i.e. bisacodyl in hydrogenated vegetable oil, the first thing that usually occurs is flatus, followed by stool flow. If the rectum is passively distended by more than 15 cm, this generally causes feelings of discomfort and reflexive relaxation of the internal anal sphinter. Canal opening occurs This of course can be unplanned and is called fecal incontinence.

    In a person with a spinal cord injury above T12 (injuries at or below T12 may results in flaccid anal sphincters and bladder), generally defecation occurs when the rectum is full. This is called an upper motor neuron or bowel reflex. Manual stimulation of the defecation reflex is of course the main means by which people with spinal cord injury initiate defecation at socially appropriate times and places. In a person with spinal cord injury below T12, the neurons mediating the defecation reflex may be damaged. This is called a lower motor neuron or flaccid bowel. Because the anal canal is flaccid, incontinence is prevalent and people engage in more frequent attempts to empty the bowel and bearing or or manual removal of stool.

    The "bowel programs" taught at most rehabilitation centers (Source) usually begin with the insertion of a suppository or a mini enema, waiting 15-20 minutes, and then digital stimulation every 10-15 minutes until the rectum is empty. To avoid injury to the rectum, no more than 4 such stimulation should be done in any given session. Those with flaccid bowels typically do not use enemas or suppositories. Regular use of stimulant laxatives (such as dulcolax, ex-lax, full-sized Fleet's enema etc.) should be limited to no more than several times a month, in order to avoid development of stimulus-dependent or "lazy" bowel.

    A 1996 study by the Aarhus Hospital in Denmark (Source) suggested that only 19% of 424 people with spinal cord injury felt the urge to defecate and that the remainder experienced abdomenal discomfort, headaches and other signs of autonomic dysautonomia, when they needed to go. About 75% of the people report having fecal incontinence; 15% had a few episode each month while 56% had a few episodes a year. Overall, 39% said that colorectal dsyfunction caused major restriction on social activities and quality of life and 30% regarded it as being worse than both bladder and sexual dysfunction.

    Summarizing an overlong post, inability to pass gas suggests anal sphincter spasticity. It does not imply "transected spinal cord". Your spinal cord that controls the anal canal is definitely alive and kicking. The system is influenced by many factors including your bowel program and what drugs you may be taking. Antidepressants that increase serotonin, for example, may increase the sphinncter activity whereas serotonin blockers relaxes the sphincter. Likewise, cholinergic and adrenergic receptor drugs may affect the system. Alpha adrenergic receptor agonist may increase sphincter tone; for example, the commonly used anti-spasticity drug tizanidine may increase sphincter tone (Source).
    Last edited by Wise Young; 05-26-2007 at 12:31 AM.

  8. #8

    Thumbs up

    Very good discussion, Dr. Young. I've tried to discuss the sympathetic/parasympathetic systems' effect on the bowel and bladder and "the dorsal nerve of the penis of clitoris". This area of the nervous system seems overlooked and discounted, either as a source of pain, or something that can be controlled. It is much more than a matter of flatulence. Thank you for putting this into words.

    ETA: Somebody needs to get Tim C. to read that.

  9. #9
    Senior Member McDuff's Avatar
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    I voted rarely. I have only had 2 uti's since sci, almost 4 yrs. One of them was a MRSA uti I came home with from Rehab(thanks folks ). I am confused as to why such a variation in occurences between people. I do use a new cath every time, but I definitely do not worry about cleanliness. I use 1 non-sterile glove for ease of cleanup, do not clean the head of my penis, and a lot of times do not wash hands beforehand. So, if anyone should get one, I would think I would be high on the list.

    I definitely fart. I'm a T10 inc. Not too much while sitting usually, but when I transition from sitting to laying down, lots of times I will get a long drawn out fart. Almost get that "aahhhh" feeling when it happens. And I will continue to fart, little bloop-bloops for a time, I call them my subsonic communication.

    Reminds me of the old joke where body parts vote as to who should run the body; the asshole says, "it should be me, I can tell the difference between liquids, solids and gas". guess it was right.

    I guess once again, it shows how unique we all are in this club.
    "a T10, who'd Rather be ridin'; than rollin'"

  10. #10
    Banned adi chicago's Avatar
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    monthly uti`s [the past 3 years] and rarely gas [i avoid to eat beans].
    • Dum spiro, spero.
      • Translation: "As long as I breathe, I hope."

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