210 chapter 25
URINARY INFECTIONS
Persons with spinal cord injury or spina bifida have a high risk of urinary (bladder)
infections, for the reasons we have discussed. Long-term or untreated infections and
kidney problems are a common cause of early death. Preventive measures are essential
(see the bottom of the next page); but even when precautions are taken, some urinary
infections are still likely to happen. Therefore, it is very important to recognize the signs
and provide effective treatment.
Signs
When a person who has normal feeling has a urine infection, it burns when he pees.
The person with spinal cord damage may not feel this burning and therefore has to
use other signs to know when he has an infection. He may learn to recognize certain
unpleasant feelings, or may only know that he does not feel as healthy as usual. Parents
and health workers should learn to listen to the child and be aware of changes in
behavior or other signs that might mean that he has an infection.
Possible urinary signs
• cloudy urine, possibly with pieces of
mucus, pus, or blood specks
• dark or red urine
• strong or bad smelling urine
• increased bladder spasms (cramps)
• increased wetting or changes in bladder
function
• pain in the mid-back (kidneys) or side
(urine tubes)
Possible other signs
• body aches
• general discomfort
• increased muscle spasms
• fever
• dysreflexia (headache,
goosebumps when sweating, high
blood pressure, see p. 187.)
Treatment
At the first signs of infection, drink even more water than usual. Antibiotics
(medicines that fight bacteria) may also be necessary. But avoid frequent use of
antibiotics because they may become less effective (bacteria may become resistant).
If a person has had many urinary infections before, take the person to a medical
laboratory for a ‘culture’ and ‘sensitivity test’ of the urine. If possible, consult a
specialist in urinary problems. If this is not possible, start with the last medicine that was
effective.
In patients with a first infection:
• Start with one of the medicines in Group 1 on the next page. After 2 days, if the
person does not begin to improve, try another medicine in Group 1.
• If none of the medicines of Group 1 help, try the medicine in Group 2.
• If a medicine seems to help, continue taking it for at least a week, or for 3 days after
the last signs have disappeared. Do not change from one medicine to another unless
the medicine is not working or causes serious side effects.
Disabled village Children