Bladder Management Techniques
After a spinal cord injury, different techniques may be used to assist in emptying the bladder. Here are some common techniques:
Clean Intermittent Catheterisation (CIC)
Catheterization is the insertion of a hollow flexible tube, called a catheter, to drain the urine from the bladder. Clean Intermittent Catheterization (CIC) is usually performed at regular intervals throughout the day.
The injured party’s ability to perform the catheterization and to stick to a strict schedule is essential to the success of any CIC program. Most people will require catheterization every four to six hours. (Clar, 2006)
Recent studies have shown that clean intermittent catheterization of the bladder does not increase the risk of urinary tract infections.
Possible downsides to consider: the intake of all liquid must be closely monitored and controlled. Individuals with quadriplegia have limited hand function and will find it difficult to insert a catheter alone.
A condom catheter is a rubber sheath that is put over the penis. The condom is attached to a tube that feeds urine into a drainage bag.
Possible downsides to consider: If the bladder is not completely emptied, the chance of a bladder stone forming may increase. Additionally, bladder sphincter dyssynergia — also known as detrusor sphincter dyssynergia (DSD) and neurogenic detrusor overactivity (NDO) — may occur in a reflex bladder when the sphincter muscle fails to open and release urine, causing the urine to flow back to the kidneys and potentially cause them harm. (Corcos, 2004)
A catheter is inserted into the bladder with a urine bag already attached. The catheter stays inside the bladder for a couple of days before being changed. These catheters are made of silicone or rubber. If made of silicone, the catheter will need to be changed once per month. If made of rubber, it will need to be changed every two weeks.
One type of indwelling catheter, a urethral catheter passes through the urethra and into the bladder.
Another type of indwelling catheter, a suprapubic catheter is inserted into the bladder during a small operation. It is relatively simple to change and to clean, and there is less chance of infection since a portion of the catheter is inside the body.
Clar, D et al., 2006. Clinical Practice Guidelines – Adult Clean Intermittent Catheterization. Society of Urologic Nurses and Associates. Available at: https://www.suna.org/resources/adultCICGuide.pdf [Accessed September 10, 2018]
Corcos, J. & Schick, E., 2004. Textbook of the neurogenic bladder: adults and children, London: Martin Dunitz, Taylor & Francis Group.