| THIS MONTH: BLADDER MANAGEMENT BASICS |
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I still remember reading the “how to function with a spinal cord injury” manual in rehab after my C7 injury. There were a lot of things I didn’t love about my new reality, but one thing that hit particularly hard was the section about bladder control. Weirdly, the inability to walk, lack of sensation and poor grip strength were all things I could wrap my head around. But having to stick a tube into my bladder every two hours to pee? That seemed beyond the pale.
Eventually, I came to peace with my neurogenic bladder. But it took years of trial and error. First figuring out systems that worked in my everyday life, then how to adapt when traveling, doing sports or anything else out of the ordinary. I wish I’d had a resource that could’ve shown me what options were available and where I could find out more. That’s why we’re starting this Health & Wellness newsletter. Every month we’ll dive into a specific topic and offer the kind of practical information that can hopefully get you further on the road to a healthier, more functional you. |
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Transfers Benefits — Not Bacteria!
The Cure Dextra Closed System with Cure ProteX Introducer Tip offers enhanced protection against the transfer of UTI-causing bacteria. This benefit may be associated with the unique design of the tip — which is fully enclosed with small, X-shaped slits for the pre-lubricated catheter to pass through. Samples available upon request: https://www.convatec.com/continence-care/forms/consumer-request-sample-form/. |
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CALMING A SPASTIC BLADDER
If you want to lead an active life as a wheelchair user, calming bladder spasms is one of your first orders of business. Reducing spasms helps hold more in your bladder, reduces bladder pressure and its kidney-harming complications, and gives you more time to get to a bathroom when you do need to go.
Fortunately, there are a lot of options for quieting a spastic bladder. Oral medications are the least invasive and least expensive option but have the most side effects. (I still can picture the stringy white spittle that would form in a wheelchair-using friend’s mouth because of the amount of Ditropan he used to take. Gross.)
Modern bladder meds like Myrbetriq do a great job of relieving spasms while reducing side effects, including the dreaded brain fog that anticholinergic medications like Ditropan can produce. The downside to drugs like Myrbetriq has always been cost. So, a bit of good news: As of April 2024, Myrbetriq is now available in generic form. It’s still not cheap (GoodRx has a 30-day supply listed at $117 at pharmacies near me), but it’s a significant reduction for those who aren’t having success with other options.
Other options include something as simple as applying an over-the-counter transdermal Oxybutynin patch. It’s the same medication that’s in Ditropan, but because it’s absorbed through the skin, side effects are reduced. Or you can ask your urologist for a Botox injection. Copays can run you a few hundred dollars, depending on your insurance, but wheelchair users generally swear by the procedure.
If none of that is working for you, the next step could be talking to your urologist about a bladder augmentation, a reconstructive surgery that can increase bladder capacity and reduce spasticity. Many wheelchair users love the results of augmentation as well, but it’s a full surgery with the costs and recovery that entails. |
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HYDRATION TIP
“Some people intentionally dehydrate themselves while they travel because of limited or nonexistent accessible washrooms. If you day-dehydrate during your trip, drink 16 ounces or 2 cups upon waking and do a preventative pee before leaving your accommodation for the day. When you get back, drink another 50 ounces over the course of the evening.”— Joanne Smith, wheelchair user
and certified nutritionist |
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CATHETER OPTIONS
For wheelchair users who don’t have any bladder control, the two most common options for taking a pee are to use either an intermittent or an indwelling catheter.
Intermittent catheter technology has gotten a lot smarter in recent years. Hydrophilic coatings reduce damage to the urethra and eliminate the need to carry a tube of KY everywhere. Flexible sleeves with no-touch hand grippers help you maintain sterility. Closed systems make it easy to take a pee in your van before you head out into the wild world of questionably accessible restrooms. They’re all widely available, and the major companies like Convatec, Wellspect, Coloplast and Hollister all have their versions.
The best place to see what’s available is an event like Abilities Expo, where you can visit all the manufacturers’ booths, see and touch products, and decide which sales pitch strikes you as the most reasonable. You can also check out manufacturers’ websites — they all make it easy to request free samples. Take them up on it. All the products have small variations that can make a big difference in how they work for your particular body. For a product you use as often as a catheter, it’s worth shopping around.
Intermittent cathing doesn’t work for everyone, and many wheelchair users go with either a Foley or a suprapubic — an indwelling catheter inserted into a surgically-constructed hole in your lower abdomen. The pros are that they can be easier to manage for someone with limited hand function, and they can be helpful for travel or other situations where you don’t know when or where you’ll find the next accessible bathroom. High risk of infection is an issue, as well as damage to the bladder lining from always having a foreign object in there. Sediment can also be a major issue with indwelling catheters — just read Ian Ruder’s tale of trying to figure out why his catheter kept getting blocked.
For anyone who needs an indwelling catheter but is concerned about the complications of long-term use, check out Ruder’s review of the TruCath Duo Dual-Balloon Urinary Catheter, which features two balloons designed to reduce irritation and damage to the bladder lining. “As someone who’s dealt with more bladder issues than I care to remember, the TruCath has offered much-needed relief and made it way easier to get through the day without dyreflexia or incontinence issues continually popping up,” Ruder says. |
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FUNCTIONAL FITNESS
Improve Your Balance and Stability
Whether you’re scooting into a slouch to be able to pee, leaning over to pull a shirt off, or reaching to the side to grab something from the fridge, so much of everyday functionality as a wheelchair user requires staying stable as your body moves. Here's a quick stability routine that can be done sitting in your wheelchair and is adaptable to a variety of functional abilities. |
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- Start by sitting upright in your wheelchair. If you have wheel locks, engage them. Put both hands on your knees.
- Using your arms, pull yourself up off your backrest so your spine is straight and your shoulders are stacked on top of your hips. Squeeze your shoulder blades and engage all the back muscles you have control over. Hold for 30 seconds. Rest for 30 seconds to a minute and then either move to step 3 or repeat 2-3 times.
- For added difficulty, lift one hand off your knee, holding yourself upright with the other arm. Hold for 30 seconds, rest, then switch arms and repeat. This variation is great for balance practice and increasing isometric strength on your engaged side.
- If you're feeling spicy, hold yourself upright with one arm and do active flexibility movements with the other. Overhead raises, single-arm clappers and wide arm circles all work — basically any movement in which you’re bringing your shoulder through its full range of motion. Moving an arm while holding yourself in a stacked position makes balance even more difficult. But if you keep things slow and controlled, it’s a great way to build balance and stability even with limited trunk control.
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| The Health & Wellness newsletter is written by Seth McBride. A C7 quad since 2000, McBride is drawing on two and a half decades of personal experience, seven years of disability reporting experience, and a deep archive of New Mobility content to translate complex health and wellness topics into a monthly narrative newsletter with something for everyone. Whether you like the format and want to let us know, see something we missed or want to suggest a topic for us to cover in the future, please reach out or respond to this email. |
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