Renal failure is the major cause of death in people with spinal cord injury (SCI). For those who are living with it, this adds an unwelcome burden to an already strained financial situation. Renal failure will eventually lead to a stage where hemodialysis is needed. Dialysis is a tedious and expensive process that many with SCI can ill afford.
The kidneys filter waste products from blood to form urine which is then stored in the bladder and discharged through the urethra. In some people with SCI, the bladder can go into uncontrolled contractions. These are called spasms. It causes urine to be pushed back into the kidneys. This is called a reflux. Spasms and reflux will eventually lead to irreparable damage to the kidneys and cause them to fail.
The other cause of kidney failure is urinary tract infection (UTI). This can occur in the bladder, kidneys or other parts of the urinary tract. If left untreated, it can also damage the kidneys. Among the factors contributing to UTI are poor hygiene around the genitals, sexual intercourse and diet.
There are several methods to reduce the occurrences of spasms and reflux. One is through medication. There are drugs to relax the bladder. The other is to empty the bladder at regular intervals, usually every four hourly, through intermittent catheterization.
In intermittent catheterization, a catheter, which is essentially a tube made from either PVC or latex, is inserted through the urethra into the bladder to drain the urine completely. The catheter is then removed, cleaned and stored for use later.
Unfortunately, intermittent catheterization is also a major cause of UTI by introducing bacteria into the bladder. Therefore, it is important that the catheter be kept as clean as possible and hands are properly washed prior to the procedure.
The act of drinking sufficient water throughout the day and emptying the bladder regularly reduces the opportunity for bacteria to multiply. A balanced diet is essential. However, the intake of coffee and carbonated drinks should be restricted as they are known to irritate the bladder and promote UTI.
Prevention is certainly better than cure when it comes to renal failure. The damage cannot be reversed. It can only get from bad to worse. The quality of life for people with renal failure is greatly reduced, more so when it occurs in those with severe physical impairments.
Medical and rehabilitation personnel must provide such information to people with SCI who are under their care to allow them to make informed decisions. I have known of cases where doctors were not in favour of good bladder management practices for whatever reasons best known to themselves. Pity those who regarded the doctors’ advice as the Gospel truth only to realise too late that they could have avoided renal failure had they been properly educated in these matters.