The Forgotten Problem After Spinal Cord Injury
By: Gary Stover
Tags: Health, Spinal Cord Injury, Medical, Healthcare, Medicine

The Forgotten Problem After Spinal Cord Injury

How a doctor can help you regain control after injury

Severe pain? No. Impaired sexual function? Nope. Weakness? Not correct. Inability to walk? Also no. While each of these significantly impacts the quality of life, they are not the answer we are looking for. So what is it then?

Photo by Meta Zahren on Unsplash

Pooping and peeing yourself!

As a doctor specializing in rehabilitation medicine, many of my patients have suffered spinal cord injuries. I oversee their medical care after they leave the main hospital and are admitted to the rehabilitation hospital. Depending upon the location and severity of the spinal cord injury, the patients often experience loss of control of bladder and bowel function (a.k.a. incontinence).

Why is incontinence such a big deal?

Incontinence can be embarrassing

Even the most self-confident individual may be embarrassed if another adult has to undress them, wipe off their stool or urine, and help don a fresh diaper and pants. Imagine you are at the mall with your significant other and you look down to realize your shorts have been saturated in urine. Your face immediately flushes red and you scurry off to the restroom to change. Individuals often live in fear of incontinence so they choose to stay home, missing out on events and severely decreasing their quality of life.

Imagine you are out at the mall with your significant other and you look down to realize your shorts have been saturated in urine.

Skin breakdown and infection

Individuals with spinal cord injuries are at high risk of skin breakdown, particularly over bony areas such as the tailbone and heels. Depending on the location of the injury, they may be unable to sense the need to shift their body weight to offload pressure. Constantly increased pressure leads to skin breakdown and moisture from stool or urine breakdown even further. Stool is home to bacteria which, when introduced to a fresh skin wound, may cause an infection requiring oral or even intravenous antibiotics.

Kidney damage and urinary tract infections

Elevated bladder volumes increase pressure in the bladder, pushing urine from the bladder back up to the kidney causing potentially permanent kidney damage. Alternatively, if urine stays in the bladder for too long, bacteria may colonize resulting in the development of a urinary tract infection.

Risk of bowel obstruction

Development of ileus, a condition where the intestine has difficulty moving stool through the gut, can be easily managed in these patients if recognized early. The patient is not allowed to eat or drink and a tube is placed down the nose into the stomach. This tube removes air and any material in the stomach that the patient could vomit. Ileus will typically resolve in a few days without further treatment. If ileus is not recognized, it could progress to a serious bowel obstruction that may require surgery.

Decreased participation in therapies

While admitted to the rehabilitation hospital, patients receive around three hours of therapy a day (physical, occupational, and speech depending on their needs). An incontinent accident during therapy requires leaving the therapy gym, getting cleaned up, and hopefully returning to therapy before the session time runs out. If incontinence occurs on a daily basis, missed therapy time adds up quickly.

Photo by Joyce McCown on Unsplash

How do we prevent incontinence?

Bowel movements are managed with oral medications to soften stool and help the gut move it along the intestines and a rectal suppository to empty the stool. Using a rectal suppository at the same time every day retrains the bowels to empty at the specified time rather than randomly throughout the day. Eventually, this leads to a reduced number of bowel accidents.

Using a rectal suppository at the same time every day retrains the bowels to empty at the specified time once per day

The bladder is initially managed with a catheter to drain the urine. If the catheter is removed and the patient is unable to urinate on their own or if they can urinate but a significant amount of urine remains, a temporary catheter is inserted to drain the bladder then removed. This process repeats every few hours. If the patient never regains control of urination, temporary catheterization may be completed indefinitely. If the patient is unable to catheterize themself and no one else that can perform it for them, a permanent catheter is placed.

Bladder and bowel function is an often overlooked but essential topic after spinal cord injury. Controlling incontinence will greatly decrease medical complications and improve quality of life.