Related Outcome Tools

Bladder Dysfunction

Neuropathic dysfunction of the urinary bladder (also known as neurogenic bladder) in persons with suprasacral spinal lesions of traumatic etiology results in the bladder not functioning as an effective organ for storing urine, and may require various treatments to enable proper voiding.  This may include the use of an indwelling urethral catheter, abdominal urinary stoma, augmentation cystoplasty, radio-frequency stimulation of sacral interior nerve roots with surgically implanted electrodes and receiver block, or intravesical capsaicin therapy. 

Despite the considerable advances made in urological rehabilitation, persons with bladder dysfunction often develop urinary tract infections (UTIs), and stones of the upper and lower urinary tract, and deterioration of the bladder [1].  Although bladder problems such as UTIs have been declining as a cause of death over the past 25 years, and account for only 2.3% of deaths as reported in the last 5-year analysis of the Model Systems data [2], they still remain one of the most prevalent secondary health conditions reported after spinal cord injury (SCI) [3, 4].  

Bladder dysfunction in persons with SCI can be disabling medically, physically, and socially [5]. Issues of incontinence have been reported to be one of the most bothersome or life-limiting conditions after SCI [6, 7].  For instance, implementation of an individualized bowel and bladder management program may be time consuming for both the persons with SCI and caregivers, which results in interpersonal stress in some marital or familial relationships and less time for pleasurable activities [8].  Further, embarrassment about and/or fear of accidents may negatively reinforce avoidance learning, which may decrease the likelihood of an individual engaging in social activities [8].  Bladder and bowel incontinence has been shown to be a significant issue that impacts negatively on sexual function [9, 10].  In addition, UTIs have been shown to be associated with poorer social adjustment [11]. 

It is not surprising that regaining bladder function is one of the top priorities for persons with SCI [12].



Spinal Cord Essentials - is a patient education initiative which aims help people through rehabilitation following SCI.  Below are downloable PDFs of the bladder care handouts.  




1. Vastenholt JM, Snoek GJ, Buschman HPJ, van der Aa HE, Alleman ERJ, Ijzerman MJ. A 7-year follow-up of sacral interior root stimulation for bladder control in patients with a spinal cord injury: quality of life and users' experiences. Spinal Cord 2003;41:397-402.

2. DeVivo MJ, Krause JS, Lammertse DP. Recent trends in mortality and causes of death among persons with spinal cord injury. Arch Phys Med Rehabil 1999;80:1411-9.

3. Noreau L, Proulx P, Gagnon L, Drolet M, Laramee MT. Secondary impairments after spinal cord injury: a population-based study. Am J Phys Med Rehabil, 2000;79:526-35.

4. Hitzig SL, Tonack M, Campbell KA, McGillivray CF, Boschen KA, Richards K et al. Secondary health complications in an aging Canadian spinal cord injury sample. Am J Phys Med Rehabil 2008;87:545-55.

5. Wolfe DL, Ethans K, Hill D, Hsieh JTC, Mehta S, Teasell RW, Askes H (2010). Bladder Health and Function Following Spinal Cord Injury. In Eng JJ, Teasell RW, Miller WC, Wolfe DL, Townson AF, Hsieh JTC, Connolly SJ, Mehta S, Sakakibara BM, editors. Spinal Cord Injury Rehabilitation Evidence. Version 3.0. Vancouver: p 1-19

6. Lin KH, Chuang CC, Kao MJ, Lien In, Tsauo JY. Quality of life of spinal cord injured patients in Taiwan: A subgroup study. Spinal Cord 1997;35:841-9.

7. Stiens SA, Bergman SB, Formal CS. Spinal cord injury rehabilitation: 4. Individual experience, personal adaptation, and social perspectives. Arch Phys Med Rehab 1997;78:S65-S72.

8. Hicken BL, Putzke JD, Richards JS. Bladder management and quality of life after spinal cord injury. Am J Phys Med Rehabil 2001;80:916-22.

9. Anderson KD, Borisoff JF, Johnson RD, Stiens SA, Elliot SL. The impact of spinal cord injury on sexual function: concerns of the general population. Spinal Cord 2007;45:328-37.

10. White MJ, Rintala DH, Hart KA, Fuhrer MJ. Sexual activities, concerns and interests of women with spinal cord injury living in the community. Am J Phys Med Rehabil 1993;72:372-8.

11. Anson CA, Stanwyck DJ, Krause JS. Social support and health status in spinal cord injury. Int J Paraplegia 1993;31:632-8.

12. Anderson KD. Targeting recovery: priorities of the spinal cord-injured population. J Neurotrauma 2004;21:1371-83.

Page last updated May 25, 2013

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