Overactive bladder, also known as a spastic or reflex bladder, is one of the most common challenges of living with a neurogenic bladder, characterized by a lack of control due to nerve damage. Bladder spasms occur with spinal cord injuries of T12 or higher. It is vital to treat spasms with your urologist, because “accidents” are the least of your concerns: spasms also create high pressures in the bladder that can lead to permanent damage to the kidneys and bladder.
Fortunately, there are a variety of options to help you control your bladder. Two options that address all urinary accidents do so by allowing urine to flow freely from the bladder if intermittent catheterization does not work. One is an indwelling Foley catheter, which passes through the urethra, and the other is a suprapubic catheter, which passes through a surgically created hole near the belly button. Unfortunately, neither option addresses the spasms. Leading urologists say it is important to control bladder spasms and suspect that prolonged use of indwelling Foley or suprapubic catheters without also addressing spasms may lead to permanent bladder contraction.
The first and easiest option to calm the bladder is oral medications. These medications were known for their annoying side effects, but newer medications have many fewer. “I take Myrbetriq, which doesn’t give me any side effects,” says Matt Fritsch, 41, who has been on T6 for 20 years. “Myrbetriq is very expensive and my last insurance didn’t pay for it, so I was taking Ditropan, which gave me huge cottonmouth and horrible constipation.”
When oral medications are ineffective or the side effects are not tolerable, urologists turn to Botox injections to calm the bladder. Yes, the same trendy injections to make facial wrinkles disappear can also help you stay continent. “I’ve been getting Botox for eight years and it calms my bladder enough to allow me to catheterize every five hours or so and not have any problems,” says Bruce Hammer, 72, an inventor and entrepreneur turning 43 as a C6 ATV. -7. He says each Botox treatment lasts about six months. Like Fritsch, Hammer experienced unwanted side effects with Ditropan. “It made me feel dizzy and gave me a lot of brain fog,” he says.
One option that permanently calms the bladder and increases its capacity is to surgically enlarge it, known as bladder augmentation. Augmentation also facilitates intermittent catheterization using a surgically created tube in the abdomen to empty the bladder. The bad thing is that it is a major surgery. “I spent three weeks in the hospital recovering,” says Tami Ridley, 64, a C6 incomplete quadriceps. “I had bladder augmentation 26 years ago when I was going to law school and partying with my friends. [and] having a great life but being hard on my bladder and having constant urinary tract infections,” says Ridley. “My surgeon said bladder augmentation will be healthier for me. It was and is [and] It still works very well. It is easy to empty and has capacity for about 1,000 cubic centimeters.”
Member Advice
“Before Botox, I was on Ditropan, but it really ruined my mindset. A urologist taught me an old school trick: crush a Ditropan pill and put it in a 50 cc syringe, add tap water and put it into the bladder through a catheter, and leave it until the next time you do a catheterization . It calms the bladder, but does not cause any side effects.”
—Bruce Hammer, Sonoma, California
United Spinal Resource Center’s MOST frequently asked question
My bladder was quiet until about a year after my SCI, but now I urinate even when I do regular caths. That I have to do?
SCI nurse Amy Dannels-McClure responds:
Before the injury, the bladder muscle and sphincters worked in unison. When the bladder squeezed to urinate, the sphincters opened and you could urinate. After the injury, they both try to contract at the same time, a very ineffective way to try to urinate as the bladder tries to release urine against a closed door. This lack of communication occurs with spinal cord injuries above S1 and is known as “upper motor neuron neurogenic bladder.”
A challenge with bladder management after SCI is that it changes. You need to review how you are effectively managing your bladder at least once a year or whenever something changes. For example, when you first start seeing episodes of incontinence, it’s time to see your urologist. Even if you think your bladder is empty, urine leakage is often the result of incomplete emptying of the bladder, with the bladder being unable to store urine and/or the bladder’s inability to release it, creating a involuntary overflow of urine. or incontinence. You may notice this increase over time as your body begins to respond to the constant incomplete emptying of the bladder. The bladder wall can begin to weaken from being overstretched with large volumes of urine, plus the sphincter contracts randomly.
Help your urologist create the best bladder control program to fit your lifestyle with these preparatory steps:
- Keep a bladder diary. Track intake, fluid output and incidents.
- Ask about a urodynamics test to get a clear idea of how your bladder is working.
- Develop a fluid schedule that works for you.
- Keep track of how often you defecate and the consistency of your stool. There is a proven connection between constipation and the inability of the bladder to fill and empty successfully.
- Keep track of your medications and how often you take them. When you talk to the doctor, listen and ask questions. Ultimately, this is YOUR journey and it should work for you while supporting a healthy bladder.
Member Tip:
“My bladder is so spastic that I receive the maximum dose of Botox and still need to take Myrbetriq capsules. The combination keeps my bladder calm for about four months, then I start leaking and add Ditropan XL, which will keep the spasms at bay for a few more months. “Then I will schedule another round of Botox and start the cycle again.”
—Matt Fritsch, Orangevale, California
The best new articles on mobility
Options to control bladder spasms:
Why it is vital to calm the bladder and the dangers of untreated bladder spasms. Eight options to calm your bladder, from oral medications and topical gels to Botox injections.
The FDA approves Botox:
When to consider Botox and how the procedure works. Wheelers shares his experience with Botox.
Guidelines and options for indwelling catheter users:
Important considerations for users of indwelling suprapubic and Foley catheters, including the importance of controlling spasms to help prevent bladder atrophy.
Suprapubic revised:
Possible long-term complications of a permanent Foley. Reasons to consider a suprapubic catheter, the procedure and long-term management of a suprapubic catheter.
What about bladder augmentation surgery?
Bladder augmentation and surgery criteria explained. A wheelchair user shares his experience.
The best of web resources
United Spinal Resource Center: Types of bladder management after SCI:
A look at the main treatment methods for neurogenic bladder.
Bladder enlargement: what, why and how?
An animated video that explains and shows how bladder augmentation is performed.
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