Finally, in some patients, the only practical method of bladder drainage is using an indwelling catheter either via the urethra or in the suprapubic area. Bladder complications such as stones, infections, and possible bladder cancer are more common with this method of management. Whatever the method of management used, urinary tract infections are a risk but are most common with an indwelling catheter and least with sacral root stimulation. Management of these is controversial but generally treatment is not recommended unless there are significant symptoms. These would obviously include fever, flank pain, malaise, increased frequency of bladder contractions with incontinence, blood in the urine, and very cloudy urine with a strong odor.
Some patients have more non-specific symptoms such as increased spasticity.
Mild cloudiness and odor may clear on increased fluid intake and more frequent catheterization. Treatment with antibiotics should be short term otherwise organisms resistant to oral antibiotics may start to appear. Long term or prophylactic antibiotics are not recommended for the same reason. The presence of bacteria in the urine without symptoms is not a reason to treat with antibiotics. The risk of kidney and bladder stones is increased in any acutely paralyzed individual if recovery does not occur within two to three months.