Choosing the method of bladder management
Many factors will determine whether a person with spinal cord injury (SCI) will be able to self-manage their bladder function or whether assistance will be necessary.
Bladder management considerations include:
- Does the person have enough grip strength to hold and pass a catheter?
- Can the person open catheter wrappers?
- Can the person open the tap on the leg bag? Is there a style or modification(s) available to make it easier?
- Is the person able to dress and undress independently, and in a timely manner?
- Can the person move clothing, to access a drainage bag?
- Can the person roll, sit themselves up, and manage bedding and clothing to perform intermittent catheterisation?
- Is the person able to reach outside their base of support to set up an intermittent catheter?
- Can the person balance on the front of the cushion in the wheelchair to set up an intermittent catheter?
- Can the person lean forward to access the tap on the urine bag and/or reach to empty the bag into a toilet?
- Can the person transfer onto a toilet?
- Is the person able to adapt the transfer technique to varied bathroom environments?
- Does spasticity and tone challenge the person’s ability to perform any tasks related to the selected bladder management?
- Does spasticity affect the person’s ability to maintain a position while setting up a catheter?
- Does a full bladder increase spasticity or tone, or impact the ability to pass a catheter?
- What is the person’s potential bladder capacity? Is it limited by detrusor spasticity?
- Does the person experience detrusor sphincter dyssynergia (DSD)?
- Does the person have adequate bladder sensation to recognise when to void and/or whether the bladder has been completely emptied?
- Does the person experience urinary urgency? (This may increase the risk of falls, unsafe transfers, or incontinence, prior to voluntary bladder emptying).
- Is there any evidence of cognitive impairment?
- What is the person’s ability to remember routines and timing of tasks? Have alternative methods been trialled to help with reminders?
- Is the person ready or able to undertake change related to their bladder management, such as incidents or becoming increasingly independent with their day-today care?
- Can the person see and reach the urethral meatus, to pass a catheter? Reduced flexibility of the spine from orthopaedic fixations or body shape can result in an inability to visualise the urethral meatus. Postural changes such as lordosis can change the position of the surface anatomy.
- Would a mirror assist with this task?
- Can the person independently access a toilet in the community, at home or work? This includes opening a door and ensuring adequate circulation space in the toilet/bathroom.
- Is the person able to maintain a clean area/space/environment to perform intermittent catheters?
- Would modifications be helpful?
- What is the set-up of the person’s wheelchair? This includes footplates, balance of the wheelchair when setting up a catheter, or the option to connect an assisted drainage system.
- Does the person require care support to assist with bladder management and are there sufficient hours to accommodate this?
- Have you considered the ability to access the urethra for people with a vulva?
- What are the individual’s goals and preferences regarding intimacy and sexual activity?
- Does the person have any medical conditions or take medication that may impact renal function, for example: diabetes mellitus, obstructive sleep apnoea or diuretic use?
- Does the person have a prostatomegaly that may cause lower urinary tract symptoms or result in difficulty inserting urethral catheters?
- Has the person had previous surgical interventions that might impact on their kidney or bladder function, for example: nephrectomy or trans-urethral resection of the prostate (TURP)?