Maintaining urinary health is essential for individuals with spinal cord injury. Last week, your own catheterization processes and techniques was reviewed. However, you can also enlist the help of healthcare providers to ensure you are doing all you can to protect your urinary health especially when something does not seem right or for what you might not see.
The main complication of the urinary tract for individuals with spinal cord injury is a bladder infection. The concern of difficulty and cost of going to a professional’s office is great for some especially when visits are frequent. Urinary tract infection (UTI) like most health issues, is best treated when caught early. It is much easier to treat an early infection than one that has a good hold on the bladder. In addition, bladder infections can easily migrate to the kidneys which can be more dangerous. Through the kidneys, the infection can spread to other parts of the body, even turning to sepsis, which is a potentially fatal infection affecting all internal organs.
Infections are treated with antibiotics. Different bacteria types are susceptible to different antibiotics. A urinalysis test will indicate if an infection is present. Culture and sensitivity tests are performed on the same urine sample if an infection is present. The culture will indicate the type of bacteria present. Sensitivity will indicate the antibiotic specifically needed to eliminate it.
When an antibiotic is prescribed, it must be taken for the full prescription. Once you start an antibiotic, the bacteria will try to change itself making the antibiotic ineffective. This is how the bacteria survive. If the entire prescription is taken, you will be sure the bacteria are completely eliminated. You do not want a bacteria cell or two to survive and to go through the process again.
Antibiotics come in ‘generations’. This is as they are discovered or developed, first generation, second generation, third generation and fourth generation. Beginning with the lowest generation (first) of antibiotic when you have an infection is helpful to your health as each time you take an antibiotic, the bacteria will become just a bit resistant to it. As you take higher level ‘generations’ of antibiotics, your options for treatment become less to eliminate the bacteria. Some people take so many high level ‘generations’ of antibiotics that they develop allergies or resistance to the prescribed antibiotic. With antibiotic resistance, there are less options. Super infections can evolve for which there is no antibiotic treatment. For these reasons, it is best to treat infections early and with the lowest ‘generation’ of antibiotic.
Symptoms of urinary tract infections (UTI) include: urgency to empty the bladder or burning when toileting. Neither of these most common symptoms are felt by individuals with complete spinal cord injury. You will rely on later symptoms such as cloudiness in the urine, not to be confused with sediment. Over time, you will learn to tell the difference. Blood might be present with a urinary tract infection. You may have a fever. Pain is a general symptom of a UTI. With SCI, you might not feel pain in the bladder, but it could be referred to your left shoulder or left jaw (much like the symptoms of a heart attack are referred to the shoulder or jaw) or to another part of your body where you have sensation.
Recently, there has been a lot of research in the understanding of AD. It is important to note that often individuals have AD without the pounding headache. Being aware of the other symptoms is important. If you suspect AD, check your blood pressure. If it is higher than your average with any one or a combination of symptoms, you probably are having AD. Medical treatment is available for AD. The first effort is to remove the noxious stimulus causing the AD. A bladder infection takes some time to treat, so you might need some medical intervention to treat the AD episode until the antibiotics are able to work.
A great prevention for urinary tract issues is a urodynamic study. Even if you do not feel that you have any urinary issues, a urodynamic study is critical to understand your baseline. We all age. As our bodies age, so do our bladders. If you know your baseline, you will be able to catch issues before they become problems.
In the urodynamic study, a small catheter with pressure sensors is inserted into the bladder. These sensors measure pressure in your bladder and urinary sphincters. A sensor might also be placed in the rectum to measure abdominal pressure. A sterile fluid is then dripped into your bladder. Measurements are assessed to ensure all parts of the urinary system are working in unison.
One issue that could be found in the urodynamic study is a small capacity bladder. This is often connected with individuals who use indwelling catheters or suprapubic catheters because urine is continuously drained which does not allow the bladder muscle to expand and contract. The lack of contraction may cause an issue if you want to convert to an intermittent program or other interventions may need to occur to enlarge your bladder.