How does a spinal cord injury affect your body? Part 2 of 4.
Second of a series. Find part one (mobility, spasms, skin) here.
Unlike the loss of movement, losing control of bodily functions like bowel movements, urination and sex are less obvious clinical complications of spinal cord injury (SCI). Stuff you take for granted, which are noticed when they’re not working.
Bowel Movements
Think about it: you know when you have to have a bowel movement, and you walk on over to the toilet, sit a while, and then you’re done. Ideally this happens every day (or multiple times per day in some people… that’s “normal” for them) to every 2-3 days. It’s pretty much scheduled and predictable. Unfortunately this inherent “scheduled and predictable” gets disrupted in an SCI. This disruption is called the “neurogenic bowel”; “neurogenic” = caused by an injury to the nervous system (in this case, the spinal cord, but other parts of the nervous system like the brain or nerves can be involved and it would still be called a neurogenic bowel).
Depending on the level and extent of the SCI, the neurogenic bowel may manifest as a loss of sensation (“can’t feel the poop in the rectum”), or loss of muscle tone (a “loose” or “flaccid” set of muscles that keep the poop in), or too much muscle tone (“spastic” and difficult to relax). Other people can have slow gut motility – the muscular waves that propel food down the digestive tract, from the esophagus to the stomach and the small and large intestines may not be contracting well enough or strong enough.
The goal of managing the neurogenic bowel is to make the bowel movements scheduled and predictable, so the bowel movement doesn’t get in the way of the rest of your day (causing “accidents”). Once a day, every day. Or once a day, every other day. And so on. This can be done with diet (regulating the amount of fiber), medications (oral or suppository, or both) with or without physical maneuvers. If conservative measures fail, patients can resort to a colostomy or other surgical means of evacuating poop.
The University of Washington has a comprehensive guide for more information.
Urination
As with bowel control, controlling urination can be similarly affected: loss of sensation (“can’t feel the need to urinate”), or loss of muscle tone (a “loose” or “flaccid” bladder that can’t squeeze the urine out), or too much muscle tone (“spastic” and small, unable to store urine). Another problem would be dyssynergia – simply put, the lack of coordination: the bladder wall muscles might be squeezing like crazy to get rid of urine, but the muscles controlling the bladder outlet (the “sphincter”) might be tight and clamped shut. In this case, the urine can’t exit the body and instead refluxes (back flows) into the kidneys. That can put you in danger of kidney damage.
Before physicians figured out how to manage the neurogenic bladder, kidney failure was the leading cause of death in SCI patients. Times have changed and patients live longer and more productive lives due to advances in medicine. The urinary bladder has two functions: to store urine, and have urine exit the body at convenient times (at least 2-3 hours between urination, maybe up to 6 or even 8 hours if overnight). You don’t want to be urinating too frequently, or not urinating at all. One must find a balance that works well with their day-to-day schedule.
As with bowel movements, bladder management can consist of regulating the amount of water you drink and the timing of fluid intake (for example: stop drinking fluids 2 hours before bedtime, so you don’t have to urinate overnight). A warning here: don’t limit the water intake so much that you’d get dehydrated! There are multiple oral or topical (patch) medications that act on the urinary bladder, and finding the correct single medication (or combination of medications) is something you can work on with your doctor. Some people are also candidates for botulinum toxin (botox – like for wrinkles) injected into the bladder’s muscular wall to help it relax.
Read it from the experts: the American Urological Association and the Urology Care Foundation webpage details the causes, symptoms and possible treatments for neurogenic bladder.
Sex
For women: not much change here. Menstrual periods may pause for up to 6 months, due to the injury’s stress on your body, but should resume if there are no other reproductive system issues. Yes you can still get pregnant and have babies, although having an SCI puts you in a “high risk pregnancy” category. Women with SCI may or may not feel the labor pains.
For men: much more complicated. The ability to have an erection and ejaculation will differ based on the level of injury and extent of injury. Fertility can be impaired in many ways – for example, changes in sperm quality, low sperm count, inability to perform spontaneous ejaculation. However, it can also be aided in many ways – I don’t want to reinvent the wheel, so I’ll just direct the reader to existing websites with good information below.
Craig Hospital in Colorado has an excellent resource for information about sexual function in men and also for women (which also addresses birth control). Facingdisability.com has videos and other media by patients, caregivers and healthcare experts on all three topics above, plus more.
Next up: part 3 – all about blood pressure, breathing, and other stuff you don’t usually think about but keep you alive.
