I had my spinal cord injury at the age of 25. Being 25 and learning you'll
probably never walk again is one thing, but being 25 and losing control of your
bladder is a whole other matter. It's pretty mortifying to know that you could
be out and about in public and you could wee yourself at any point and it
really knocks your confidence go out and about.
The good news is with a bit of practice and trial and error it's very possible
to learn how to manage your bladder so that things like this don't happen
often anymore. Your bladder is controlled by your S2 to
S4 nerves in your spinal cord. These are at the very base of your spinal cord
which means that pretty much every single person with a spinal cord injury,
even those with a very low level spinal cord injury who can actually walk, will
have problems with bladder control. When you have a spinal cord injury your lack
of bladder control will lead to one of two problems: either your bladder will
keep filling up and when it's full it will then backflow up to your kidneys
and cause infections and all sorts of other problems or it will just release
uncontrollably because you can't control it and you can't stop it from weeing so
you'll end up having accidents and wetting yourself which is obviously not
ideal. Either way you can gain control of your bladder by using a catheter. A catheter
is a tube which you pass up your urethra
through your sphincter and into your bladder and once there it allows the urine to drain
out through the tube. There are a few different types of catheters, most of
you will be familiar with indwelling catheters or Foley catheters, because
you'll likely need this if you ever go into hospital for any kind of surgery
and therefore will most likely end up on one of these if you ever have a spinal
cord injury. Indwelling catheters are catheters that are inserted into your
bladder for a long period of time and the urine will just continuously drain
from your bladder into a urine bag which will then need to be emptied
periodically. Now in the long term these catheters are not really used by people
with spinal cord injury and this is for two reasons: first of all because they
have a much higher risk of infection compared to other catheters, but also
because they're highly impractical for most people's daily lives because you
have to carry a bag full of wee around with you at all times.
The other main type of catheter are intermittent catheters. Now unlike
indwelling catheters which stay in place for a long time and drained the wee
constantly an intermittent catheter is more like going to the toilet
normally. You just insert the catheter when you need to go
let the wee drain and then once the way is finished, you take the catheter out.
There are two ways to use this type of catheter depending on your level of
injury and if you've had any complications. The least common way is a
supra pubic catheter this means that you insert the catheter through an incision
which has surgically been made in your abdomen which goes directly into your
bladder. The most common way and the way that
most people with a spinal cord injury and the way that Craig uses is to insert
the catheter directly up through his urethra into his bladder. Intermittent
catheters come in a variety of shapes and sizes and it took me quite a lot of
experimentation to find one which works well for me. If you've recently had a
spinal cord injury we recommend you take some time to experiment with
different catheters and find out what works well for you. If you're still in a rehab
hospital they should have lots of different varieties that you can try out
but if not you can order free samples from lots of different catheter companies
such as Coloplast. We've ordered a few samples from Coloplast which is where Craig
gets his regular order of catheters from so that we can show you the difference
between some different catheters. So this is the a catheter which Craig normally
uses and these two are some samples which we've ordered. So the nice thing about
all three of these catheters is that they all come in a nice small packaging which
makes them very easy to take with you when you go out and about. Now you can
also get catheters which are much longer and much more bulky but we don't have
any samples because Craig doesn't get on with them and they're very inconvenient
to take around with you. So let's open these up and show you what the
differences are between them. You can do that one.
Opens nice and easily by ripping down the side. You take
out. So this one, the first thing you'll notice is quite wet but it's also quite
flexible its coiled up in the bag. I can't open this one.
Yeah and this is another flexible one as well
but this one is different. This one is very rigid. This one is much
more rigid compared to the other two. Some people like using these rigid ones
because they find you can put more force on them to get them through your
sphincter but when I tried them I find that they got caught in my urethra
and they could cause trauma. So I get on a lot better with these flexible ones. One
big difference between these three catheters is that these two are just a
tube but this one comes with a bag on the end. So Craig likes to use this one
because it's very handy to have that bag to catch the urine in. If you use one of
these two which don't have a bag, you'll either have to sit on the toilet and
direct the wee into the toilet or you'll have to use a urine bottle to collect
the wee and then empty it into the toilet. The handy thing about having the bag is
that you can wee in a variety of places, you don't have to transfer onto the
toilet and then you just empty the bag into the toilet when you finish with it.
The other thing which I really like about this type of catheter is it has a
plastic sheath around the catheter itself so you never have to touch it
with your hands. Now this is much better from a bacterial point of view as UTIs
are very common when you're using catheters. So if you use one like this which doesn't
have a plastic sheath around it you're likely to touch the catheter which
means you have to be very careful about how clean your hands are before you use
them. So you should always wash your hands anyway before you do a catheter
but you have to be extra careful with ones like this whereas these ones give
you a little bit more peace of mind because you don't actually have to touch
them, so the chance of passing the bacteria from your hands into your
bladder is much less likely. When you're at home this isn't so much of an issue
because you can get to your sink you can wash your hands and practice good
hygiene, it's when you're out and about and you might be in a really dirty bathroom
where washing your hands at the sink maybe doesn't even feel that hygienic
if the sink doesn't feel very clean. So it's really nice to have these
closed ones for circumstances like that. So all three of these ones come
pre-lubricated they already have lube on the catheter themselves so they're ready
to use straight away, but there are some catheters which either don't have any
lube with them and you have to apply the lube yourself or they have a little
packet inside the packaging which you have to squeeze and apply first before
you can use the catheter. Now obviously it's much more convenient if you can
just take the catheter and use it straight away so that's what I prefer. And much
less mess. Right so now let's show you how I catheterize when I need to go to
the toilet. Right so let's do a catheter.
First things first, hygiene is important, you don't want to give you
self any extra bacteria, so wash your hands. So next I'm going to grab my
catheter. I keep my catheters in the box on the windowsill here because they're easy
to grab and it's a box of 30 so I don't have to refill them too often. So grab my
catheter, put it on my lap. Next I want to get close to the toilet so that I can
empty the urine bag once I've finished and also so that I'm close to the bin
and I can dispose of the catheter once I'm finished, brakes on. Because of the
shape of your urethra it's easier to insert the catheter if you're leaning
back slightly so, I slide forward in my chair slightly. Like so. Next thing open
the catheter up, take it out and unfold the bag and dispose of this part. So the
next stage, which I'm obviously not going to show you on camera, is I get my penis
out, I take the tip off the end of the catheter, pull back the foreskin and push
the catheter through the end into the opening of your urethra. You then keep
feeding it through until you get to your sphincter. At this point I sometimes
encounter a little bit of resistance and I find if I just do a big cough that can
help get it through the sphincter and into the bladder. At this point the urine
starts draining into the bag. So I'll just go for a wee and I'll see you in a
second. Right so I've finished, got the urine in the bag. The nice thing about this bag
is it's very easy to open, it has a little tear bit here. So tear it open
hold the top, hold the bottom and empty into the toilet.
Then, screw it up put it in the bin, hit the flush, sit up straight and wash up.
It's not always easy to find a disabled toilet when you're out and about so
instead of cutting our day short and heading home just to go for a wee, quite
often I'll just go in the car.
I keep a supply of everything I need to go to the
toilet right here in the car. So under the seat here
I have rubbish bags and catheters and in the glove box here I have hand sanitizer
and wipes to keep everything hygienic. Now the nice thing about the catheters I
use is because they have a bag on the end there's no mess no fuss and if
there's nowhere to empty the wee straight away after I've been, that's not a problem
at all, I keep it in the bag put it in one of these rubbish bags and then I can
take it home and empty into the toilet once I get home. When Craig is doing a
catheter in the car, you can't see anything at all unless you go right up
to the window. But if there are loads of people around what you're trying to do a
catheter you can just put a coat or something over your lap so that you don't
have to worry about flashing anyone while you're doing it.
Similarly I don't have to worry about going to someone's house if they don't
have an accessible downstairs bathroom. As long as they have a room I can shut
myself off in I can go into that room do my business and then all I have to do is
ask someone to enter the urine bag into the toilet for me once I'm finished.
So, don't mind me.
So, using a catheter is how you can go for a wee
when you don't have any control of your bladder, but the key to not having any
accidents and not wetting yourself is routine. Now we really cannot stress
enough how important routine is for this, it really is the key to not having any
accidents when you can't control your bladder. So Craig's routine is that he
will do an intermittent catheter every four hours without fail
and originally this was throughout the day and also throughout the night, so that
meant that he had to wake up in the middle of the night to do another
catheter. Now we've changed this a little bit and actually Craig will stop
drinking a few hours before we go to bed and that means that he does not have to
get up in the middle of the night to go and do a catheter but we're confident
that there's not gonna be any issues with wetting the bed. When transitioning
from an indwelling catheter to an intermittent catheter, there's going to be a
period of time where you have to retrain your bladder. When you use an indwelling
catheter, your bladder gets used to just being in to release whenever it wants, so
when you swap to intermittent catheters it's gonna do the same thing.
So you need to start off with a short time scale. When I did my bladder
training I started off with roughly half an hour gaps between catheters and then
slowly built it up to 1 hour, hour and a half, two hours until I got to the
routine I'm at today. So there are going to be accidents at this time, it's
completely normal and happens to everyone as you push what your bladder
can do. Yup, there were quite a few times during this period where I ended
up getting wee'd on but there's this one notable time that I don't think we're
gonna forget. So back in the day when Craig first started using a wheelchair he
used to keep his phone in between his legs.
So this was before we got the man bag that he now uses to keep his phone in. So
this one time we're just sitting around the table eating dinner and when
we just look on the floor and notice that there was some water on the floor
so we're like "why is that why is the floor wet?" and then we look up at Craig
and we see that his whole lap is soaked and the phone that was between his legs
it was completely drenched and that was the last time that that phone ever
worked. So now we've learned from that, Craig does not keep his phone between
his legs and he uses his man-bag to keep his phone in most of the time and the phone
is also waterproof as well just in case. So even with the bladder training it
might not be enough you might need some medications to help you out. Now your
bladder is a muscle and like all muscles below your point of injury it's
susceptible to muscle spasms and when your bladder spasms then you may have an
accident. Now you might want to take some
medications to help you out of this. There are whole host of medications
which can help and there are two medications which I take: Mirabegron and Solifenacin.
Now these are both muscle relaxers which target my bladder so they
help relax my bladder and reduce the number of spasms I have and therefore
reduce the number of accidents I have. This really was the turning point for us
in terms of being able to go out and about confident that Craig would not wet
himself, before this with the routine he'd sometimes be able to go for four
hours but sometimes he wouldn't so sometimes it would be three and a half
hours and then they'd be an accident or even sometimes we'd just be about to go
to the toilet and there could be an accident but as soon as Craig started
taking this medication this really was the turning point with getting on that
for our routine and being confident with being able to go anywhere without weeing
himself. Unfortunately when you have a spinal cord injury and you have no
sensation in your bladder and you can't tell when you need to go there's always
going to be that chance that you may wet yourself even when you have the
perfect routine. Luckily once you've got your routine
established these instances are going to be very few and far between but there
are a couple of things that can cause this.
The first one is drinking a lot more than you're used to. So you do have to be
very careful about how much you drink and if you do drink more than usual be
very wary that you might need to go and do catheters more than you normally do.
And but the second reason which is very notorious for causing you to have
accidents if you have a spinal cord injury is a urinary tract infection.
Now UTIs are very common when you use catheters and we did touch on this earlier
in the video but if you want to see more information and want us to make a video
all about urinary tract infections and how to avoid them then let us know down
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