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Regaining Bladder Control After Spinal Cord Injury

Portrait of African businessman with disability sitting in wheelchair and smiling at camera during his work at office

In the United States, there are nearly 18,000 new cases of spinal cord injury (SCI) each year, and roughly 250,000 patients living with SCI.[1] [2] In addition to impairing motor functions like walking, sitting and standing, SCI can also cause problems with the nerves that control your organs and those that communicate sensation.

Depending on the location of your injury, bladder control may be among the challenges after your injury. When the nerves that control your bladder don’t work the way they should, the condition is called neurogenic bladder.

About 80 percent of patients with SCI experience some form of neurogenic bladder and regaining bladder control consistently ranks as their top quality of life priority. [2][3]. Aside from incontinence, a lack of bladder control can also lead to kidney problems, urinary tract infections, bladder and kidney stones, and a poor quality of life.[2]

Why does an SCI affect bladder control?

The nerves that control your bladder originate from an area at the base of your spinal cord called the sacral micturition. These nerves signal the brain when the bladder needs to be emptied. They also control the sphincter, a muscle at the base of your bladder that acts like a valve – it tightens to keep urine from leaving your bladder when you don’t want it to. When you urinate, your brain signals the sphincter to relax and for muscles to squeeze your bladder, helping to vacate your urine.

If you have a spinal cord injury, communication between your brain and this area of your spine (sacral spine) is totally or partially blocked, since in most cases your injury site will be above this point. With a SCI, only areas above the injury site function as they did prior to the injury.

What is neurogenic bladder?

When your bladder and brain are communicating correctly, the muscles and nerves of the bladder work together to hold and release urine on command. When this communication is blocked by an SCI, the bladder muscles may remain permanently relaxed. You will have no sensation that your bladder needs to be emptied, and incontinence – an inability to control urination – is the result. Conversely, the muscles may be tight, and you may not be able to empty your bladder without the help of a catheter. Both of these are symptoms of neurogenic bladder.

Symptoms of neurogenic bladder

  • Frequent urinary tract infections (UTI)
  • Kidney stones
  • Inability to control urination (incontinence)
  • Small volume when urinating
  • Frequent feeling of needing to urinate immediately
  • Loss of sensation that your bladder is full
  • Dribbling urine

These symptoms may be indicators of other conditions as well. Please consult with your health-care provider.

How to regain bladder control after SCI

There is no single solution that will work for each patient, but there are a variety of approaches your healthcare team can suggest to help you regain bladder control.

  • Exercises and therapy to strengthen bladder control
  • Medications to improve bladder function
  • Antibiotics to reduce the risk of infection
  • Botox ® injections into the bladder muscle to reduce the frequency of contractions
  • Emptying the bladder at regular times with a catheter
  • Nerve stimulation therapy to stimulate or slow down bladder activity (Percutaneous tibial nerve stimulation and sacral neuromodulation, also known as PTNS and SNS.
  • Surgery to remove stones or blockages
  • A procedure that places a cuff round the neck of the bladder, which can be inflated to hold urine or deflated to release it

To learn more about the spinal cord injury rehabilitation program at Good Shepherd Penn Partners, please call 877-969-7342 or visit our spinal cord injury rehabilitation page.

[1] Spinal cord stimulation for the restoration of bladder function after spinal cord injury, Healthcare Technology etters, May 2020.

[2] Neurogenic bladder in spinal cord injury patients, National LIbrary Of Medicine, June 2015

[3] A Proof-of-Concept Study of Transcutaneous Magnetic Spinal Cord Stimulation for Neurogenic Bladder, Nature, August 2018