Most complications can be avoided with proper urinary system care. However, individuals with SCI are likely to develop a urinary tract infection (UTI) even with the best bladder care. Not only are individuals with SCI at high risk for UTI, but complications due to UTI are also the #1 medical concern and more likely to affect their overall health and health care costs.

Bacteria are tiny, microscopic single-celled life forms that group together and form colonies. Different bacteria can live in various systems of the body. Those bacteria living in the urinary system can quickly multiply and lead to infection or disease.

Individuals with SCI should watch for early signs of an infection such as sediment (gritty particles) or mucus in the urine; cloudy urine; bad smelling urine (foul odor); and blood in the urine (pink or red urine). Attempt to avoid the onset of an infection by drinking more water; avoiding beverages with sugar, caffeine and alcohol; and emptying the bladder more often.

Antibiotics are used if an individual suffers an infection. Antibiotics are prescribed by a doctor and essentially kill the “bad” bacteria causing the infection. Always follow the doctor’s advice on treatment of UTIs. On the other hand, many doctors do not know that individuals with SCI have special considerations when it comes to the use of antibiotics for UTIs. In order to properly treat an individual with an SCI for urinary complications the treating doctor needs to have experience and familiarity treating those with SCIs.  The doctor should know that most (80%) individuals with SCI have bacteria in the urinary system at any given time. The presence of bacteria is common because bacteria from the skin and urethra are easily brought into the bladder with ICP, Foley, and Suprapubic methods of bladder management.

Also, many individuals with SCI are not able to completely empty their bladder, leaving some bacteria in the urine remaining in the bladder. Whereas bacteria identified in a urine culture is commonly cause for treatment by doctors, you do not necessarily need treatment for an infection. Antibiotics are only recommended for treatment of UTIs if you actually develop one or more symptoms of infection that include: fever; chills; nausea; headache; change in muscle spasms; and autonomic dysreflexia (AD). Depending on your level of injury, you may also feel burning while urinating or discomfort in the lower pelvic area, abdomen, or lower back.

When you show symptoms of illness, it is highly recommended that you get immediate advice on treatment from your doctors. Your doctor should also get a urine sample prior to prescribing a treatment. These two actions are recommended so that your doctor can first rule out any other health problems. Second, your doctor can prescribe the most effective antibiotic to treat your specific infection (bacteria type). Finally, antibiotics should be taken exactly as prescribed and for a sufficient duration to fully kill the bacteria.

Use of antibiotics as a preventative measure for UTIs is not recommended unless there is an overriding medical need to prevent an infection. Although there are some circumstances such as pregnancy, when prevention of infection is needed to avoid unwanted medical complications, antibiotic resistance is a major concern for individuals with SCI. Each time you take an antibiotic, the bacteria have the opportunity to change in some way that reduces or eliminates the effectiveness of that antibiotic to kill the bacteria in the future. So it becomes harder and harder to get an effective antibiotic when you actually get sick from a bacterial infection. Whereas bacteria found in the urinary system can cause illness, there are also “good” bacteria found in your digestive system. These bacteria are actually beneficial for maintaining the natural balance of organisms (microflora) in the intestines. Maintaining this proper bacterial balance can help individuals with SCI in their bowel management.

Anytime antibiotics are taken, these medications kill both the good and bad bacteria. Therefore, probiotics are sometimes recommended by doctors during and/or after a course of antibiotics to replenish and restore the numbers of beneficial bacteria lost to antibiotic use. Probiotics are dietary supplements containing potentially beneficial bacteria or yeast. The most common sources for probiotics are yogurt, but other dairy products such as cheese, milk, sour cream and kefir are also probiotics. Although it is likely that a UTI is present when symptoms of illness have been observed, it is possible that the individual may have another health problem. Therefore, it is highly recommended that individuals who show signs of UTI call their doctor immediately for advice on treatment if you develop any symptoms. It is recommended that you provide your doctor with a urine. These two actions are recommended so that the doctor can rule out any other health problems and prescribe the most effective antibiotic to treat the individual’s specific infection (bacteria type).

If an individual becomes ill with two or more UTIs per year, it can be an early sign of other problems with the urinary system. A complete urologic examination may be necessary to find out if a more serious problem is present. Individuals may want to consult with a urologist, a doctor specializing in the treatment of the urinary system.

Remember, any doctor who treats an individual with SCI should be familiar with the medical issues of individuals with SCI. Kidney (Renal) failure was once the leading cause of death for individuals with SCI. Today, improved methods of bladder management have resulted in fewer and less severe complications with the kidneys. A more common cause of death related to the urinary tract is now sepsis (a blood stream infection resulting from a symptomatic infection in the urinary tract). Kidney and bladder stones can form in the urinary system. Such stones usually hinder the kidney/bladder functions and can cause infection. Most individuals with lower levels of injury will notice pain associated with a stone. Those with higher levels are not likely to feel the pain. Blood in the urine is also a common sign that a stone has developed. If an individual experiences reoccurring or prolonged symptoms of AD that seem to be without cause, it may also be a sign of a kidney stone.

Urine leakage or incontinence is a problem for some individuals. Treatment can include both drugs and surgery. Medications are often used to control bladder spasms and tighten the sphincter muscles. Several surgical options are available for treating urine leakage. A new urinary reservoir (“pouch”) is made from bowel tissue. The ureters are implanted into the new bladder “pouch.” The urine is drained with a catheter through an opening (stoma) in either the navel or stomach wall. Another surgical method is bladder augmentation cystoplasty. Here the bladder is enlarged using bowel tissue. Since surgery involves both the urinary and gastrointestinal systems, recovery time is longer.

Bladder cancer is another concern for some individuals with spinal cord injury. Research in aging with SCI shows a small increase in the risk of bladder cancer among individuals with SCI who have been using indwelling catheters for a long period of time. Smoking further increases this risk. If you have used an indwelling catheter for at least 10 years, it is strongly recommended that you have regular cystoscopic evaluations. Treating other problems of the urinary system is important. Many times these problems do not have any symptoms. This means they can go undetected until the problem becomes serious. The annual physical exam and laboratory studies are the best ways to find problems early and treat them before they become serious.

The keys to a healthy urinary system are taking all the proper steps to prevent complications and identifying any complications as early as possible for treatment. This includes learning proper bladder management techniques as well as proper bladder care. Learning these skills will allow an individual to improve the chances for lasting long-term health.