Spinal cord injuries

Spinal cord injury means damage to the spinal cord itself, sometimes in combination with damage to the nerve roots in the lowest section of the spinal cord. Each year, at least 7,500 Europeans suffer such serious damage to their spinal cords that they get permanent complications. In the US, the figure is around 10,000.

The spinal cord is about as thick as a finger and is very delicate. It lies in a fluid-filled canal in your vertebral column, the spine itself. The spinal cord contains cells that send and receive signals from your entire body. Thanks to these signals, we can, among other things, move our arms, legs and other muscles in the body. These signals also control the body’s ability to empty the bladder and bowels.

How spinal cord injuries affect your bladder

Male urinary systemWoman urinary systemIf your spinal cord is damaged, the ability for the signals to travel back and forth is impaired, resulting in bladder emptying problems.

There are different types of damage to the spinal cord. The higher up in the spinal cord an injury occurs, the more muscles are affected. In the case of paraplegia, the spinal cord is so damaged that the legs are affected. In the case of tetraplegia, both arms and legs are affected.

Complete spinal cord damage means that the spinal cord has been completely cut off. No signals can travel along it, which means that all feeling and ability to move is gone below the point of injury.

If the damage is incomplete, you experience a certain loss of the ability to control your muscles. But some signals will still go through. If you have some motor control in your hands and arms, you will most likely be able to choose self-catheterisation as a bladder emptying option.

The anatomical location and severity of your injury will determine the type of bladder condition you will have. Simply put, the higher the injury is located, the more serious it may be for your health. This is due to loss of steering and control of urination from the brain, and its centres. An injury above anatomical level of vertebra TH12/L1 may cause something called detrusor-sphincter dyssenergia. This means when no central steering of nerves is present, a reflex centre takes over, leaving a chaos of impulses going through to the bladder and sphincter. The result is that the bladder and sphincter are working against each other which is dangerous since a high pressure is built up in the bladder, causing urine to back up to the kidneys which potentially can destroy them. This is also associated with an increased risk of infection and incontinence. First line treatment is to reduce bladder pressure with pharmaceuticals and emptying the bladder with Clean Intermittent Catheterisation (CIC). 

If you have an injury lower in your spinal cord at or below anatomic level of TH12/L1 you lose muscle tonus in the bladder and sphincter. Due to the fact that this region is responsible for reflex bladder emptying. A complete injury results in areflexia of the detrusor (missing contraction of the bladder muscle).

Damage below this reflex centre affects some or all of the nerves in this region, depending on the type of lesion. If all nerve roots are affected, the condition of acontractile detrusor and sphincter occurs. However incomplete lesions are most common. And then only some nerve fibres are affected, so it may partly function. For example, filling of the bladder may be registered, but activation of the detrusor and/or sphincter is not possible.

A low spinal cord injury results in retention or incomplete emptying, urinary tract infections and (overflow) incontinence. First line treatment is CIC.

It is also worth mentioning that recent studies indicate that up to 30% of those who lose control of their bladder, regain function again some time after injury.

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