Initial Bladder Management after SCI

The immediate and early effects of SCI on bladder function are quite different from those that follow recovery from the initial injury. During the initial phase of spinal cord injury, the patient is experiencing "spinal shock." Basically, spinal shock is the result of swelling of the spinal cord. This swelling causes the inhibition of all reflexes below the level of the injury, making the bladder "atonic" or "flaccid." All reflexes are depressed, and the bladder cannot contract and empty.

For this reason, the best plan for bladder management at this stage is use of a urinary catheter. During this time, in response to IV fluids and posttraumatic changes in fluid balance, there are generally large fluctuations in urine output.

Catheterization is achieved by insertion of a small-diameter latex or silicone tube into the bladder through the urethra. It prevents overdistention of the bladder, and consequently prevents injury to urinary structures. During initial stages, the catheter is either left "indwelling" (a "retention" or "foley" catheter) or is inserted intermittently ("ICs") with aseptic technique. Other methods of management may be adopted based on results of further patient assessment, such as frequency of UTIs and client compliance


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Bladder management for a patient in spinal shock is frequently urinary catheterization.
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Spinal shock, or depression of the reflexes, generally lasts from 1 to 2 months, when the spinal reflexes return. Reflexes may even become hyperactive.

Suggested guidelines, and practical tips, for initial bladder management after SCI include:


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It's important that the amount of urine in the bladder not exceed about 300 cc.
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