Spinal cord injury and bladder & bowel control

Spinal cord injury

Spinal cord injury is a broad term for damage to the spinal cord. Most spinal cord injuries cause some degree of permanent disability or loss of sensation in parts of the body below the site of injury. The degree of disability depends on the extent of the injury and where along the spinal cord it occurs.

The spinal cord

The spinal cord is part of the central nervous system. Together with the brain it controls bodily functions including movement and behaviour. 
The spinal cord is protected by the bones of the spine and is cushioned by a clear fluid called cerebral spinal fluid. Nerves enter and exit the spinal cord at different points to control the various parts of the body. The spinal cord forms a vital link between the brain and the rest of the body – if damaged, sensation and movement may be impaired or completely lost.

Spinal cord injuries fall into four different categories

The extent to which a spinal cord injury will lead to bladder and bowel problems depends largely on two factors: whether the injury is complete or incomplete and the level of the spinal cord injury (high/low). Spinal cord injuries can be split into four groups:

• Complete injury: no voluntary movement or sensation below the site of injury
• Incomplete injury: some sensation remaining below the site of injury
• Tetraplegia (quadriplegia): paralysis involving most of the internal organs and all four limbs
• Paraplegia: complete or incomplete paralysis, affecting the legs and sometimes the internal organs, but not the arms

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Learn more about spinal cord injury and bladder problems and how to take care of your bladder. 

Learn more about spinal cord injury and bowel problems and how to take care of your bowel.

This FAQ is intended as a guide to commonly asked questions. Please always consult your healthcare professional regarding spinal cord injuries. 

What is meant by spinal cord injury?

Spinal cord injury is the general term used to describe damage to the spinal cord. Typically, the injury is caused by broken bones in the neck or back pressing on the spinal cord. 

What causes spinal cord injury?

Spinal cord injury is most often the result of some sort of trauma, most commonly car accidents, falls, violence or sports injuries. However, it can also result from infection of the spinal cord and certain medical conditions, including multiple sclerosis and spina bifida. 

How can I improve my daily life?

Although most spinal cord injuries are permanent, it is often possible to achieve some degree of improvement through physiotherapy and rehabilitation. Various methods are available to help people with spinal cord injury live as full and active a life as possible by managing complications such as loss of bladder, bowel, or sexual control. 

Why does a spinal cord injury cause bladder issues?

The bladder, which stores urine, is controlled by the nervous system. When you have a spinal cord injury, it is likely that the nerves controlling your bladder are damaged and, as a result, bladder function is affected. Some people find that they need to urinate more frequently or urgently, some experience urine leakage, whereas others experience difficulty emptying the bladder. 

Why does a spinal cord injury cause bowel issues?

The bowel is controlled by the nervous system. When you have a spinal cord injury, it is likely that the nerves controlling your bowel are damaged and, as a result, bowel function is affected. 

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Read more FAQs on bladder issues. Read more FAQs on bowel issues.

The impact of a spinal cord injury on the bladder can result in involuntary messages to contract the bladder being received by the bladder causing leakage, or wetting. When no messages to contract the bladder are received, then the bladder is not emptying and it retains urine. The urine must be emptied to maintain health and prevent damage to the kidneys, this is most often achieved using intermittent catheterisation. 

Most people with a spinal cord injury will experience bladder dysfunction known as neurogenic bladder, which means they have a decreased ability to control their bladder. Learn more about how the bladder works. 

Typical symptoms of urinary problems associated with spinal cord injury

• Small or large amounts of urine leaking without warning or without feeling the urge to go to the toilet
• Inability of the bladder to empty completely 
• Urinary tract infections (UTIs)

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Products that can help to manage bladder problems:

• Catheters for women
• Catheters for men
• Collecting systems for men

Learn more about neurogenic bladder and how to take care of your bladder. 

Many people with an spinal cord injury (SCI) will experience bowel dysfunction known as neurogenic bowel, which means they have a decreased ability to control their bowel.

A neurogenic bowel can lead to bowel leakage, constipation or both. The degree of severity of the bowel symptoms depends on the extent and level of the spinal cord injury.

With a high SCI, the general symptoms are

• Slower movement of stool, potentially leading to constipation
• Many uncontrolled bowel contractions which lead to frequent evacuations
• Low rectal capacity – the nerves react to only a small quantity of stool in the rectum, causing frequent evacuations
• Reduced or no control of the external sphincter muscle  – this is due to communication between the sphincter and the brain becoming disrupted and this may lead to faecal incontinence

With a low SCI, the general symptoms are

• Slower movement of stool, potentially leading to constipation.
• Increased rectal capacity – the nerves react only to a large quantity of stool in the rectum, again leading to constipation
• Relaxed and overstretched lower bowels – an increased rectal capacity may overstretch the lower bowels, resulting in leakage and possibly mega colon
• Reduced rectal contractions, making it difficult to fully empty the bowels
• Reduced or no control of the external sphincter muscle, leading to involuntary leakage of stool

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Products that can help to manage bowel problems include: 

• Bowel irrigation

Read more about how to take care of your bowel.

Most people with spinal cord injury go through a rehabilitation programme with the goal of living as full and independent a life as possible. A variety of products can contribute to an improved quality of life by effectively managing complications such as loss of bladder function.

Dealing with bladder retention

If you have difficulty emptying your bladder, you will typically use an intermittent catheter. Your first step will be to find a catheter that fits you and your lifestyle. It is important that you follow the guidance in terms of technique and how often you catheterise.

Dealing with urinary incontinence

Collecting devices like urisheaths and bags are used effectively by many men dealing with urinary incontinence. Urisheaths are worn over the penis like a condom and connected to a collecting bag. It is important you use the right size urisheath while finding the right collecting bag depends on how much you leak. Read more about how to take care of the bladder. 

Urinary tract infections

The presence of bacteria in the urinary tract is quite common and does not always cause an urinary tract infection. If, however, the bacteria grow and multiply to a certain level, they may cause an infection of the urinary tract that needs treatment.

Symptoms of urinary tract infections

Symptoms of a urinary tract infection vary and may be subtle. They include:

• Dark-coloured and strong-smelling urine
• Cloudy urine
• Blood in the urine
• Fever/sweating
• Bladder spasms
• Increased muscle contractions in your leg

If you experience any of the symptoms listed, you should consult your healthcare professional.

Avoiding urinary tract infections

While there is no definite solution to avoiding urinary tract infections, there are a number of precautions that can help you prevent and sidestep recurrent infections: 

• Generous intake of fluids – at least 1.5 litres a day
• Good personal hygiene – especially when you catheterise
• Catheterisation routines – complete emptying the bladder regularly
• Healthy digestion – a good bowel routine may reduce the risk of urinary tract infections

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Following the right technique and using a hydrophilic coated catheter can also help reduce the number of urinary tract infections you experience. 

• Catheters for women
• Catheters for men

Learn more about neurogenic bladder and how to take care of your bladder. 

As a spinal cord injury affects bowel function, you will need some kind of help to manage your bowels on a regular basis – typically every day or every other day. This is commonly known as a bowel management routine.

Dealing with bowel leakage

A key aim of a bowel management routine is to ensure a convenient time to empty your bowel, thereby minimising the risk of bowel accidents, which can be a particularly distressing aspect of post-injury lives.

Dealing with constipation

Regular emptying of the bowel helps to prevent excessive build up of stools and chronic constipation.

Options available to help manage bowel problems

To manage both bowel leakage and constipation, there are a number of treatment options available in increasing order of invasiveness:

• Conservative treatment
• Digital stimulation
• Trans anal irrigation, also known as bowel irrigation e.g Peristeen®
• Sacral nerve stimulation
• Antegrade colonic irrigation (ACE)
• Sacral anterior root stimulation
• Stoma

It is most likely that you will be offered conservative treatments first, such as moderating diet and fluid intake and/or taking medication, such as bulking agents, laxatives and enemas. 

Bowel irrigation

Bowel irrigation helps you empty your bowels in an effective and predictable manner. Irrigating on a regular basis prevents bowel leakage and eliminates the risk of bowel accidents. By preventing the build-up of stool, it is also an effective method for reducing the risk of constipation.

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Products that can help to manage bowel problems include: 

• Bowel irrigation

Read more about how to take care of your bowel. 

For answers to the most common questions about spinal cord injury and bladder and bowel issues read more in the FAQ.