The topics posted this far have been fairly light. Nothing has been too terribly serious, deep or personal. This week begins a journey deeper into the realities of life with a spinal cord injury.
Most of the time when you hear someone who is not disabled talking about disability you will hear them use phrases such as, "They will never walk again." Or, when interviewing a person who is disabled that uses a wheelchair, will ask them something like, "What is the first thing you would do if you could walk again?" Seldom do they understand that the mobility is one of the lesser difficulties of a disability.
Hand function, normal urination, normal bowel function, normal sexual function – most of the disabled people I interact with place these far higher on the list than worrying about climbing a flight of stairs.
That said, I begin with bladder management.
The first step in the process is to access and drain the urine. Intermittent catheterization is just that, periodic insertion of a catheter to drain the bladder. Typically this is only available to persons with spastic paralysis. That is, people whose sphincter will remain tight without interference from a source such as a catheter. This is the type of catheter I use and it was a good day when I was informed about hydrophilic catheters. Prior to that I was using a standard rubber catheters that require lubrication applied to them externally. With hydrophilic catheters there is a coating on the outside of them that holds water making them very slippery right out of the package. They were a great help in reducing my issue with inserting the catheter, reducing infections and avoiding causing strictures. If the person develops incontinence over time, does not have spastic paralysis, or is recovering from bladder surgery a catheter such as an indwelling catheter or a condom catheter may be used.
An indwelling catheter is one that remains inserted for a period of time, with the help of a balloon that is inflated with saline solution once the catheter is inserted. These need to be changed on a regular basis, often accompany persistence urinary tract infections and some research shows that they may be a cause of cancer with long term use. One additional note about both types of inserted catheters, there are styles that have a special curved tip designed for easy insertion should a standard catheter be too difficult because of a narrow urethra or other restriction. These are called Tiemann catheters.
For males, an alternative to a catheter that is inserted is a condom catheter. Exactly as it sounds, it is a condom that is glued to the skin and has an opening at the tip with the appropriate fitting to attach to a urine collection device. These may be used by someone who does not have spastic paralysis or who has excessive leakage throughout the day. In the second case the sphincter may actually need to be cut so that the remaining spasticity does not cause the bladder to overfill and so that the bladder can drain entirely, which is best for preventing infection.
Next week we will look at
accessing the area needed to catheterize.
Source: Medical supply companies.
On a side note, today's post marks the 16th anniversary of my injury. My, how time flies!
