Spinal Cord Injury And Incontinence
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SPINAL CORD INJURY
A spinal cord injury may interrupt communication between the nerves in the spinal cord that control bladder and bowel function and the brain, causing incontinence. This results in bladder or bowel dysfunction that is termed “neurogenic bladder” or “neurogenic bowel.”
If you have a spinal cord injury, look for these signs of a neurogenic bladder:
Loss of bladder control (urinary incontinence)
Inability to empty the bladder
Urinary frequency
Urinary tract infections.
Signs of neurogenic bowel include:
Loss of bowel control (bowel incontinence)
Constipation
Bowel frequency
Lack of bowel movements.
Before delving into causes and treatments, an understanding of spinal cord terms and injuries will be helpful.
The Basics
The spinal cord has four areas. Going from top to bottom, the first and highest part of the spinal cord is known as the cervical spinal cord. The cervical region controls hand and arm sensation and function. Next is the thoracic spinal cord. The thoracic spinal cord controls the sensation and function of the muscles of the chest, back and abdomen. Next is the lumbar spinal cord. Lower back and leg activity is controlled here. The lowest part of the spinal cord is the sacral spinal cord. Bladder function, bladder and bowel external sphincters, sexual functions (including erections and ejaculation in men and responsiveness in women), and some leg muscles are the domain of the sacral spinal cord.
A very important part of voiding involves the sacral spinal cord. There is a part of the sacral spinal cord known as the sacral voiding, or micturition, center. This center receives and sends signals directly to and from the bladder. When the bladder becomes filled with urine, it sends signals to the sacral spinal cord. If this communication is disrupted, through disease or injury, the message is delayed or not received. The result is incontinence.
Causes
The position of the spinal cord injury has a lot to say in terms of what sort of incontinence may manifest. Above the sacral spinal cord (supra—sacral spinal cord injury) or at or below the sacral spinal cord.
Supra-Sacral Spinal Cord Injuries
Immediately after SCI, the bladder usually undergoes spinal shock. During spinal shock, the bladder does not contract. Spinal shock frequently lasts at least 2 to 3 months. However, it may last 6 months, and there are a few cases of it lasting up to 2 years. What happens after spinal shock depends in large part on the level and completeness of the spinal cord injury.
A spinal cord injury above the sacral center may prevent signals from going from the sacral voiding center up to the brain. The spinal cord injury may also block signals going from the brain back down the cord to the sacral voiding center. Since the brain is unable to have any control of the sacral center, the sacral center works on its own. A bladder that has involuntary or uninhibited contractions is known as an overactive bladder, or overactive detrusor (the bladder is also known as the detrusor). Since voiding occurs as a reflex, with signals coming in and out of the sacral voiding center, this is type of voiding is known as reflex voiding.
Between the brain and spinal cord is an area called the brainstem. Within the brainstem is the brain micturition, or “voiding”, center. This center is responsible for sending signals down the spinal cord to the sphincter to tell it to relax when a person’s bladder contracts. The spinal cord injury blocks signals from the brain micturition center to the sphincters. When the bladder, or detrusor, has an uninhibited (involuntary) contraction, the sphincters may not relax. This is known as detrusor sphincter dyssynergia (DSD).
DSD can cause high pressures to develop in the bladder. High bladder pressure over time can cause kidney damage.
Another problem that can occur in those with spinal cord injury at or above thoracic level 6 (T-6) is autonomic dysreflexia. The most dramatic effect is a sudden severe rise in blood pressure. One or more common symptoms that often occur with the high blood pressure are a severe headache, sweating, flushing, goose bumps, chills, a feeling of anxiety, and a slower pulse rate. However, about 30 to 40% of people have elevated blood pressures with few, if any, other symptoms (silent dysreflexia). Therefore, it is important to check your blood pressure when you have a full bladder or are voiding.
In addition to bladder issues, there are also two main types of neurogenic bowel, depending on level of injury: an injury above the conus medullaris (at L1) results in upper motor neuron (UMN) bowel syndrome; a lower motor neuron (LMN) bowel syndrome occurs in injuries below L1. The position and effect of the spinal cord injury are similar to those causing neurogenic bladder.
Treatment Options
Bowel accidents happen. The best way to prevent them is to follow a schedule, to teach the bowel when to have a movement. Most people perform their bowel program at a time of day that fits with their lifestyle. The program usually begins with insertion of either a suppository or a mini-enema, followed by a waiting period of approximately 15–20 minutes to allow the stimulant to work. After the waiting period, digital stimulation is performed every 10–15 minutes until the rectum is empty. Those with a flaccid bowel frequently start their programs with digital stimulation or manual removal. Bowel programs typically require 30–60 minutes to complete. Preferably, a bowel program can be done on the commode. Two hours of sitting tolerance is usually sufficient. But those at high risk for skin breakdown need to weigh the value of bowel care in a seated position, versus a side-lying position in bed.
Talk to your doctor!! Incontinence is a normal part of life after a spinal cord injury but there are ways to manage it that can let you be comfortable and independent. Your doctor can discuss the details of your particular injury and its impact on your bladder as well as suggesting potential management options.
Non-Invasive Treatment
Anal irrigation. Anal irrigation is a new, conservative bowel management therapy to reduce constipation and assist in effective bowel movement and management.
Clean technique intermittent catheterization. In clean technique intermittent catheterization (CIC), you or a healthcare professional inserts a thin tube (catheter) through the urethra and into your bladder several times during the day to empty your bladder.
Continuous catheter drainage. A healthcare professional may insert a catheter through your urethra or abdominal wall and into your bladder to continuously empty your bladder.
Surgical Treatment
Doctors trained in bladder management (urologists) may perform bladder reconstructive surgery that may resolve or improve bladder symptoms and management.
Pharmaceutical Treatment
Your doctor may prescribe medications to improve bladder function, such as reduce bladder contractions, lower urinary frequency, improve loss of bladder control (incontinence), increase bladder storage, or empty the bladder. Your doctor may also prescribe medications to manage timing and consistency of bowel movements.
There are many medications that can help treat incontinence issues that arise with spinal cord injuries. Click here to learn about them.
RELATED ARTICLES
Showing incontinence who’s the boss in the workplace
Managing urinary incontinence is challenging enough, but bladder leaks, sudden urgency and frequent trips to the restroom can be especially stressful when you’re trying to get through a busy workday.
In this episode, we share practical strategies for managing bladder symptoms on the job, whether you’re commuting to an office, sitting through a long meeting, working from home or navigating a packed schedule. We’ll talk about bladder training and bathroom planning, hydration and potential bladder triggers, keeping a bladder diary, preparing for unexpected leaks, choosing incontinence products, staying active and more.
Why Bladder Health Matters More as We Age
Aging and the Bladder: What Changes?
As we grow older, the urinary system naturally undergoes changes that can affect bladder function.
Common age-related changes include:
Reduced bladder capacity
Increased bladder sensitivity
Changes in pelvic floor muscle strength
Hormonal changes, particularly after menopause
Enlarged prostate in men
Increased prevalence of chronic conditions such as diabetes, stroke, and neurological disorders
These changes can contribute to symptoms such as:
Urinary urgency
Frequent urination
Overactive bladder (OAB)
Urinary incontinence
Nocturia (waking at night to urinate)
While these symptoms become more common with age, they should never be viewed as something people simply have to live with.
The Hidden Connection Between Bladder Problems and Falls
One of the most overlooked consequences of bladder symptoms in older adults is an increased risk of falling.
Many falls occur during urgent trips to the bathroom, particularly at night. An individual may wake suddenly with a strong urge to urinate, rush through a dark room, become dizzy when standing, or trip over furniture, rugs, or other obstacles.
Research has shown that urinary urgency, frequency, and nocturia are associated with a higher risk of falls and fractures in older adults.
For seniors, a fall can have life-changing consequences, including:
Broken bones
Head injuries
Hospitalization
Loss of independence
Reduced mobility
Increased risk of future falls
In many cases, addressing bladder symptoms can be an important part of a comprehensive fall-prevention strategy.
How Nocturia Impacts Healthy Aging
Waking multiple times each night to urinate is more than a sleep disturbance.
Nocturia can contribute to:
Daytime fatigue
Reduced concentration
Memory difficulties
Mood changes
Increased fall risk
Lower overall quality of life
Older adults who experience frequent nighttime bathroom trips often report feeling less energetic and less able to participate in activities they enjoy.
Protecting sleep is an important part of protecting overall health.
The Emotional Impact of Bladder Leaks
Many older adults quietly manage bladder leakage without discussing it with family members or healthcare providers.
Unfortunately, untreated bladder symptoms can lead to:
Social withdrawal
Anxiety
Depression
Reduced physical activity
Fear of leaving home
Loss of confidence
Some people stop exercising, traveling, attending social events, or spending time with friends because they worry about finding a bathroom or experiencing leakage in public.
The result can be a cycle of isolation that negatively affects both physical and mental health.
Healthy Aging Includes Bladder Health
The good news is that many bladder conditions can be improved or successfully managed.
Treatment options may include:
Pelvic Floor Muscle Training
Strengthening the pelvic floor muscles can help improve bladder control and reduce leakage.
Bladder Training
Scheduled voiding and urge-suppression techniques may help reduce urgency and frequency.
Lifestyle Modifications
Small changes can make a meaningful difference, including:
Managing constipation
Maintaining a healthy weight
Limiting bladder irritants when appropriate
Staying physically active
Monitoring fluid intake patterns
Medical Treatments
Depending on the cause of symptoms, treatment options may include:
Medications
Neuromodulation therapies
Vaginal estrogen for postmenopausal women
Prostate treatments for men
Surgical interventions in select cases
Fall Prevention Tips for Older Adults with Bladder Symptoms
If urgency or nighttime bathroom trips are a concern, consider these safety measures:
Keep pathways clear of clutter
Use nightlights between the bedroom and bathroom
Wear supportive, non-slip footwear
Install grab bars when appropriate
Rise slowly from bed to avoid dizziness
Discuss medications with your healthcare provider
Seek evaluation for persistent bladder symptoms
Addressing both bladder health and home safety can significantly reduce fall risk.
A Conversation Worth Having
Too often, people assume bladder leakage is simply the price of getting older. The reality is that while bladder problems become more common with age, they are not an inevitable part of aging.
National Senior Citizens Day reminds us that healthy aging means more than managing chronic diseases—it means preserving independence, confidence, mobility, and quality of life.
If bladder symptoms are interfering with sleep, daily activities, or peace of mind, don’t ignore them. Talk with a healthcare provider and explore your options. Effective treatments and management strategies are available.
Because aging well isn’t just about adding years to life—it’s about adding life to those years.
UTI and Your Period: What You Need to Know
If you menstruate, experiencing a UTI while on your period can be an uncomfortable experience.
While a menstrual period may bring pain, pelvic pressure, and make you feel like you need to urinate more, a UTI can tack on additional symptoms.
Feeling a sudden, strong urge to use the restroom, burning when you pee, noticing cloudy urine, or pain that feels different than your usual cramps shouldn’t be ignored.
Keep reading to find out the relationship between UTIs and your period. Plus, learn what to do if you suspect you may have a urinary tract infection during your cycle.
Showing incontinence who’s the boss in the workplace
Managing urinary incontinence is challenging enough, but bladder leaks, sudden urgency and frequent trips to the restroom can be especially stressful when you’re trying to get through a busy workday.
In this episode, we share practical strategies for managing bladder symptoms on the job, whether you’re commuting to an office, sitting through a long meeting, working from home or navigating a packed schedule. We’ll talk about bladder training and bathroom planning, hydration and potential bladder triggers, keeping a bladder diary, preparing for unexpected leaks, choosing incontinence products, staying active and more.
