204 chapter 25
‘Types’ of bladder —in persons whose feeling and control have been
partly or completely lost.
AUTOMATIC BLADDER: A person
with paralysis whose legs have ‘reflex
spasms’ (uncontrolled stiffening or
jerking) usually also has reflex spasms
in his bladder. As the bladder fills
with urine, the walls of the bladder
stretch and cause a reflex spasm. As
the bladder squeezes, the muscles
that hold back the urine relax, letting
the urine flow out. This is called an
‘automatic bladder’ because it empties
automatically when it gets full.
LIMP BLADDER (flaccid bladder):
When a person’s paralyzed legs are
limp and do not have spasms, usually
the bladder is also limp, or flaccid.
No matter how much urine fills the
bladder, it will not squeeze to empty.
The bladder stretches until it cannot
hold any more and the urine begins
to drip out. The bladder does not
completely empty this way. Some
urine stays in the bladder, increasing
the chance of infection.
The most simple methods of bladder management work well with an automatic
bladder but do not work with a limp bladder. So try to figure out which type of
bladder a child has.
For the first few days or weeks after the spinal cord has been injured, the bladder
is almost always limp. Urine either drips out or does not come out at all. Then, as
the ‘spinal shock’ wears off, persons with higher back injuries (above the 2nd lumbar
vertebra, see p. 176) usually develop automatic bladders. In persons with lower back
injuries, the bladder usually stays limp.
During the first weeks, usually a ‘Foley catheter’ is kept in the bladder all the time.
However, after about 2 weeks, it is a good idea to test how the bladder works by
removing the catheter and trying one of the methods described in this chapter. If the
person is often wet, try another method for that type of bladder.
A catheter is a flexible rubber tube used for draining urine out of the bladder.
Standard catheter
Foley catheter
A ‘Foley’ catheter has a small
balloon near the tip. This balloon is
filled with water when it is inside
the bladder, so that it can be left
inside and will not slip out.
Water is injected into the balloon
here.
Urine drains out here.
For instructions on how to use a catheter, see p. 206.
Disabled village Children