This article focuses on common conditions plaguing the GU system following SCI/D—and available treatments.

— Autonomic Dysreflexia. Any GU problem can lead to, or be associated with, autonomic dysreflexia (AD). This condition can induce any or all of the following symptoms: sweating, facial flushing, rapid heart rate, anxiety, and an elevated blood pressure that can sometimes become dangerously high. People with SCI above T6 are susceptible to AD. Depending on your familiarity with AD and its probable causes, you may be able to identify and remedy the cause of an AD episode. If not, treat it as an emergency and seek immediate medical intervention at a local emergency room.

— Urinary Tract Infection. The most common post-SCI/D problem to plague the GU system is urinary tract infection (UTI). This may be coupled with any or all of these symptoms: chills, fever, flank pain, hematuria (blood in urine), increased urination, cloudy/thick or smelly urine, sediment in the urine, burning with urination, and increased spasticity.

Two of the most important protections against UTIs are consistent fluid intake to "wash out" bacteria and routine bladder emptying. Any evidence of an existing UTI should prompt you to make an immediate visit to your physician or hospital emergency room. UTI treatment usually consists of increasing fluids (an IV may be started), antibiotics, and the possible insertion of an indwelling catheter.

— Urinary Retention. Men are more prone to urinary retention because the prostate gland may enlarge and block the urethra, making it difficult to empty the bladder. Other conditions that may cause urinary retention in men and women are infections, bladder stones, and some medicines.



How do you detect a urinary-retention problem? People who spontaneously void should be alert to frequent strong urges to urinate accompanied by an inability to pass much urine. They may have dribbling or leakage during the day or during sleep. Those who do not feel the urge to urinate may have dribbling, leakage, or AD as their first sign of urinary retention. Chronic infections can also indicate a problem for all levels of SCI/D.

The best ways to avoid urinary retention are to maintain good fluid intake and schedule regular urination times during the day. When you suspect a problem, immediately seek medical advice. Often the solution is simple.

— Urinary/Bladder/Kidney Stones. Collections of mineral deposits can develop because of infection, high calcium levels, or other chemicals. They are usually small enough to pass through the urinary system and may look like sediment or sand. If they are large, they can block the urinary system, possibly damaging the kidneys.



Bladder stones are common and may be caused by catheters and bladder infections. The stones originate in the kidneys and then migrate down the ureters (tube from kidney to bladder) and into the bladder. Persistent stones in the bladder and kidneys can cause ongoing damage to the kidneys.

The presence of stones is usually painful. Common symptoms are lower-back or abdominal pain radiating to the groin, increased bladder spasms, nausea/vomiting, anxiety, frequent and persistent infections, fever and chills, and bloody urine. Any of these symptoms should prompt an immediate visit to your physician or local hospital for an evaluation of blood and urine specimens.

— Bladder Spasms. Uncontrolled bladder contractions (spasms) may be painful and damaging to the bladder and kidneys. They occur when the bladder's smooth muscle contracts and does not allow the bladder to expand as it fills with urine. Symptoms include a sudden urge to void associated with incontinence (leakage of urine). This may be painful, particularly if a catheter is in the bladder.



Drugs that reduce spasms may be used to inhibit bladder contractions. A surgical treatment being performed more frequently is bladder augmentation.

— Implantable Electric Stimulator. A high-tech surgical procedure now available implants a small device that stimulates nerves in the spinal cord. Targeted nerves are those that control urinating, bowel movements, and erections.



This "miracle" has a downside. During surgery, nerves affected by this computer must be cut in order for the computer to work. Severing the nerves is permanent, and the procedure is not reversible.

Regular medical screening is the key to maintaining good urologic health and detecting problems early in their course. People with SCI/D should schedule an annual examination that includes x-rays of the kidneys, ureters, and bladder (KUB) and a urodynamic evaluation. The annual exam should also include a microscopic assessment of the blood and urine.

Throughout the year, it is imperative that you report to your physician any changes in bladder function, urine appearance, or symptoms. You may need routine urine or blood monitoring throughout the year. If your urine must be screened with a dipstick—a strip of paper that is dipped into the urine—this can be done at home and reported to your physician on a regular basis. People who have pus or blood in the urine may need microscopic examinations of the urine or blood done on a routine basis.