Methods of retraining bladder function after spinal cord injury
● Treatment of bladder dysfunction after SC I.
△Catheterization
◇Continuous catheterization with an indwelling urinary catheter
◇Intermittent open catheterization
◇Intermittent catheterization
◇Patients in spinal shock or with large amount of residual urine or urinary retention
The patient’s general condition is good
◇Promoting urination
◇Method of inducing urinary reflex
△Bladder function training
△Neuromuscular electrical stimulation
△Magnetic stimulation
△Surgery
Advantages of intermittent catheterization
△Habituate the bladder to rhythmic filling and emptying
◇Preventing spasm
△Avoiding small bladder volume
◇Favorable to the development of reflex bladder
◇Injury to upper motor neurons
After the development of reflex bladder, pay attention to the symptoms of sympathetic hyperactivity, which are the precursors of bladder filling, and look for the “point of the board”.
△Lower motor neuron injury
◇Train the patient to hold his or her breath with force at regular intervals so that the abdomen can be pressurized to facilitate urination.
Intermittent catheterization method
Intermittent aseptic catheterization
◇Strictly aseptic operation
◇Interval time 4-8 hours
◇Drink 1650-2000ml/day, 125ml/hr
△Intermittent clean catheterization
◇Required items: catheter, saline, cotton ball, wet tissue, measuring cup, dirt bag and mirror (for female patients)
◇Operating procedure: Hand washing with soap→Appropriate body position→Wet tissue wipe→Urethral orifice cleaning→Urethral tube removal and gel application→Insertion→Drainage of urine→Recording of urine volume
●The number of catheterizations and precautions
△Teach patients or family members about catheterization and determine the frequency of catheterization before discharge
◇Start with 6 times/day and gradually decrease
◇Try to self-expel urine before catheterization to understand the ability to self-expel
During urinary catheterization
A small amount of bleeding is usually not a big problem.
Seek medical attention in case of heavy bleeding
Record the volume of urine catheterization
Shorten the interval between catheterizations if the volume is >500ml; extend the interval if the volume is <300ml
◇If there is sudden fever, lower abdominal pain or urinary incontinence, there may be a urinary tract infection, so seek further treatment.
●Promote urination
◇The method of inducing urinary reflexes of the forced urinary muscles to urinate
◇Search for trigger points in the patient’s body
Lower abdomen, inner thighs, and pubic bone
Use tapping or ice or ask the patient to pull the pubic hair by himself.
◇Crede method
After touching the bottom of the bladder by placing the palm of the hand on top of the bladder area
◇Press down slowly and squeeze the middle without pausing or relaxing
Not recommended for patients with spastic bladder or vesicoureteral reflux
Bladder function training
◇Give the patient the necessary explanation and psychological support before training
◇Design a drinking plan
Drinking volume: 1650~2000ml/day, 200ml/2hr
Make a drinking schedule
Drinking water on time and opening the catheter intermittently
200ml/time during the day
Open the catheter once every 4h
Continuous drainage after sleep
●Physical factor treatment
△Ultra short wave
△DC electrical stimulation
△Computerized medium frequency
Rectal (pelvic floor) electrical stimulation
△Acupuncture
● Rectal (pelvic floor) electrical stimulation.
△A non-invasive treatment
◇The electrode head is inserted into the vagina or anus to stimulate the muscles of the pelvic floor.
It can strengthen the contraction of the muscles around the urethra.
It also has the effect of inhibiting the contraction of the detrusor muscle.