Life on Wheels (26 page)

Nausea and vomiting

Increased spasticity

Difficulty urinating

Pain during urination

Cloudy or foul smelling urine

Bloody urine (pink, red, or rusty in color)

Change in volume of urine—either more or less

Sudden onset of leaking between catheterizations

When you have a UTI, you need to drink two to three additional glasses of water each day to help flush out the bacteria and prevent the bacteria from multiplying and the infection from spreading. Visit your urologist, who will culture your urine to determine an appropriate antibiotic, if necessary. People with chronic infections need to be careful; overuse allows the body to build a resistance to antibiotics, rendering them ineffective for treating future infections.

Stones are another risk with a neurogenic bladder. Excessive calcium can collect in the bladder, kidney, or ureters, which are the tubes that connect the kidneys and bladder. The formation of stones is encouraged by residual urine, chronic infections, incorrect catheterization, lack of fluids, or lack of physical activity. The ureters can become blocked by stones, increasing backup of urine into the kidneys. Symptoms include sweating, severe pain, blood in the urine, increased spasticity, or pain in the lower back or abdomen. Stones are usually removed surgically, though there are new techniques being developed such as using sound waves to crush the stones.

As a diagnostic test, a urologist might perform:

A renal scan or ultrasound, in which a dye is injected into the body and then is flushed through the kidneys. An x-ray is then able to reveal the condition of the urinary tract.

A cystoscopy, which is a visual examination inside the urinary tract with a cystoscope, inserted by catheter through the urethra, to inspect for stones.

Many physiatrists recommend that bladder diagnostics be routinely performed every two years for people with neurogenic bladders as a preventive management measure.

The ability to evacuate your bowels and bladder depends on your particular disability. For example, the ability depends on the level of a condition that otherwise affects your nervous system, such as a brain injury, MS, or ALS, the level of a spinal cord disability, or the strength of surrounding muscles of the bladder, such as the urinary sphincter.

Normal, reflexive emptying happens when the bowels or bladder become full and send a message to a particular area of the spinal cord. The message then goes to the brain, which can send back the instruction to relax the sphincter muscle or to hold on until later.

Injury or disease can interfere with this communication process. For example, in an SCI, if the spinal cord is damaged above T12, the message will reach the reflex arc, but not the brain. This is known as a reflex or spastic bladder or bowel; you will not be able to control when your bowel and bladder will empty. If the cord obstruction is below L2, the message will not reach the cord at all, and your body does not know it is time to respond. This is known as a nonreflex or flaccid condition, sometimes referred to as a frozen bladder.

Management of these neurogenic conditions is central to the degree of independence possible in your life. Tremendous amounts of time can be spent dealing with your bowels and bladder—but this depends considerably on how consistent and well-designed your bowel and bladder programs are. A poor bladder program can invite nearly constant infections. Surgeries could become necessary, such as installation of a suprapubic catheter through the abdomen or cutting the sphincter muscle to allow urine to flow.

A poor bowel program can allow constipation, making evacuation very difficult. You might spend hours dealing with evoking a bowel movement, inserting suppositories, stimulating the area, manually cleaning out the stool with a gloved hand, or relying on a personal assistant to do so. For some, bowel management unavoidably takes some time, but you have some control over how much time it takes, depending on your habits and discipline.

A good bowel program starts with maintaining a good consistency in your stool. When your feces becomes too dry and firm, not only will you have more difficulty in emptying your bowels, but you are allowing bacteria to remain in your body for a longer period of time. Bacteria can multiply and become the cause of infections and other problems.

Firm stool is irritating to the colon and can cause hemorrhoids. It might also require you to apply more aggressive manual stimulation in your bowel program, which can further irritate those delicate tissues. Diarrhea can be an indication of constipation, since the runny stool can be from the water lost from the fecal matter farther up the intestines. The more severe the diarrhea becomes, the more likely you are to become impacted. You need to drink more water to replace the fluids lost with diarrhea.

Avoid becoming reliant on laxatives, which dull the nerves of the bowel and compromise whatever reflex activity you might have retained. If you continue to have chronic constipation, there might be another medical issue involved, and you should see your doctor. Enemas are also a poor standard method. They stretch the colon and compromise its tone. Your body can develop a dependency on these measures if they are overused.