Paralysis Resource Guide - (Page 63) HEALTH MANAGEMENT BLADDER MANAGEMENT Paralysis at any level almost always affects control over bladder and bowel function. This is because the nerves controlling these organs attach to the very base of the spinal cord (levels S2–S4) and are therefore cut off from brain input by all but the very lowest of sacral dysfunction. Although it may not be possible to regain the same control one had before paralysis, a wide range of techniques and tools are available to manage bladder and bowel function. (See page 67 for information on bowel management.) Here’s how the bladder works: Urine consists of excess water and salts that are extracted from the bloodstream by the kidneys. From the kidneys, the urine is pumped down thin tubes called ureters, which normally allow urine to flow only in one direction. The ureters connect to the bladder, a storage bag. When the bag is full, nerves send a message via the spinal cord to the brain. When one is ready to empty the bladder, the brain sends a message back down the spinal cord to the bladder, telling the detrusor muscle (the bladder wall) to contract and the sphincter muscle (a valve around the top of the urethra) to relax and open. Urine then passes down the urethra to exit the body. It takes a rather elegant process of muscle coordination just to go pee. After paralysis, however, the body’s normal system of bladder control goes haywire; messages can no longer pass between the bladder muscles and the brain. The bladder is usually affected in one of two ways: 1. Spastic (reflex) bladder is when your bladder fills with urine and a reflex automatically triggers the bladder to empty; this usually occurs when the injury is above the T12 level. With a spastic bladder you do not know when, or if, the bladder will empty. 2. Flaccid (non-reflex) bladder is when the reflexes of the bladder muscles are sluggish or absent. If you do not feel when the bladder is full, it can become over-distended, or stretched. The urine can back up through the ureters into the kidneys (called reflux). Stretching also affects the muscle tone of the bladder. Dyssynergia occurs when the sphincter muscles do not relax as when the bladder contracts. The urine cannot flow through the 63
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