Outlet obstruction from urethral compression
Outlet obstruction can be caused by urethral compression when sitting. This can occur after a spinal cord injury where there is significant muscle wasting of the pelvic floor muscles, secondary to the paralysis. This is usually an issue for people who manage their bladder with external drainage (sheaths) and have possibly had a sphincterotomy in the past. The secondary issues that can arise are urinary retention, recurrent urinary tract infections, bladder distention, renal impairment, and episodes of autonomic dysreflexia. The bladder will drain in positions when there is reduced or no pressure over the urethra or perineum such as side lying in bed, on the shower commode or when being hoisted.
Management Options
Management options for preventing outlet obstruction may be limited to providing interim relief rather than eliminating pressure. These measures are:
- tilting the power chair to remove pressure in sitting
- hoisting to remove all pressure
- changing to an air cushion which provides better pressure relief.
These options are generally not sustainable and don’t address the issue. The long-term plan is to discuss with a Urologist an alternate bladder management plan which may result in changing to a supra-pubic catheter option.