Bladder, bowel, and sexual functioning are among the top health concerns that individuals with SCI rank as important priorities in their functional recovery. These are topics that people typically don’t speak openly about, but are an important part of your health, well-being, and quality of life. Don’t be afraid to talk to your healthcare team about your bowel, bladder, and sexual functioning concerns: they are trained to help you manage these issues.
After a SCI, the nerve messages that tell your brain that the bladder is ready to be emptied are no longer being relayed, which can result in an automatic, involuntary release of urine or an inability to urinate. These changes in bladder function are called neurogenic changes. The National Spinal Injury Statistical Center reports that over 80% of individuals with a SCI experience altered bladder function.
Your healthcare team can help. The main goal of bladder management is to protect kidney function. If the kidney is not functioning properly, then it won’t be able to filter blood properly which can result in infection, development of kidney or bladder stones, or autonomic dysreflexia (a medical emergency that is characterized by a dangerous rise in blood pressure and can lead to stroke, heart attack, seizure or death). A secondary goal is to avoid incontinence (lack of voluntary control over urinating or defecating) for social comfort as well as reduce the risk of developing pressure sores caused by damp skin. Common strategies for bladder management include: drinking water consistently (~18oz or 15 cups/day) and intermittent or indwelling catheterization. For more information about different types of catheterization, ask your healthcare team.
Similar to bladders, neurogenic bowel changes can occur after a SCI. These changes can result in an inability to detect the urge to empty your bowels or a loss of the ability to control the evacuation of your bowels. Individuals with a SCI report altered bowel function as one of the top bothersome problems
they experience. One study found that 40% of individuals with a SCI experience constipation. Common strategies for bowel management include: digital stimulation, using stool softeners and laxatives, and dietary changes. Please consult your healthcare team to identify the bowel management strategy that is best for you.
SCI often impacts an individual’s sexuality on both a physical and emotional level. Romantic and intimate relationships can be developed or maintained after SCI. It is important to communicate openly with your partner about your sexual needs and concerns and be open to exploring and experimenting with different ways to be intimate.
Men with SCI may experience erectile dysfunction, in which they may not be able to achieve or maintain an erection. Furthermore, 90% of men with SCI are not able to ejaculate or semen is ejaculated into the bladder. These conditions create considerable challenges for men who wish to father a child, although there are options that can support men with SCI who wish to become parents. It is important to see a doctor, urologist, or fertility specialist or urologist for accurate information on the treatment options available.
Women with SCI can engage in sexual activity, and research suggests that approximately 52% women with SCI were able to achieve orgasm. However, women with SCI may not be able to produce adequate vaginal lubrication. Lubrication can be added by using artificial lubricants which can be purchased over the counter. It is also possible for women with SCI to conceive and have children. Pregnancies must be monitored by a team of healthcare professionals in order to make sure that the pregnancy can be managed and carried to term safely.
Risks of Sexual Activity after SCI
If your SCI is at the level of T6 or above, there is an increased risk of Autonomic Dysreflexia during sexual activity: specifically, during stimulation of the genital area, during use of a vibrator, and during orgasm. If you experience symptoms of autonomic dysreflexia, stop the activity immediately, put yourself into a seated position. Speak with your physician if you are prone to Autonomic Dysreflexia to come up with a plan and discuss treatment options.
Helpful Resources to Read Through: www.spinalcordessentials.ca
Al Taweel, W., & Seyam, R. (2015). Neurogenic bladder in spinal cord injury patients. Research and reports in urology, 7, 85.
Hughes, M. (2014). Bowel management in spinal cord injury patients. Clinics in colon and rectal surgery, 27(3), 113.
Simpson, L. A., Eng, J. J., Hsieh, J. T., & Wolfe and the Spinal Cord Injury Rehabilitation Evidence (SCIRE) Research Team, D. L. (2012). The health and life priorities of individuals with spinal cord injury: a systematic review. Journal of neurotrauma, 29(8), 1548-1555.
University of Pittsburg Schools of the Health Sciences. (n.d.). Bowel, Bladder, and Sexual Function: UPMC. [Webpage]. Retrieved October 6, 2020, from https://www.upmc.com/services/rehab/rehab-institute/conditions/spinal-cord-injury/education-spinal-injury/bowel-bladder-and-sexual-function
Brain Injury Resources in Alabama (n.d). Living with a spinal cord injury. [Webpage]. Retrieved October 6, 2020 from http://www.braininjurysupport.org/living-with-a-spinal-cord-injury/
Craig Hospital. (n.d). Sexual function in women after spinal cord injury. [Webpage]. Retrieved October 6, 2020 from https://craighospital.org/resources/sexual-function-for-women-after-spinal-cord-injury#:~:text=Orgasm%20and%20lubrication&text=Studies%20found%20that%2052%25%20of,This%20is%20called%20lubrication
Craig Hospital. (n.d.) Bowel management with spinal cord injury. [Webpage]. Retrieved October 6, 2020 from https://craighospital.org/resources/bowel-problems#:~:text=bleeding%2C%20and%20pain.-,Constipation,changes%20how%20the%20intestines%20work