Bladder Program Tips and Techniques

Posted by Nurse Linda in Life After Paralysis on March 03, 2021 # Health

Bladder programs are unique to everyone. Every individual must maintain excellent technique and timing to keep their urinary system healthy. For some individuals, the urinary system stays healthy, and for others, there are challenges. It does seem that some people have more issues than others. This can be from poor technique, but more likely, it is due to the autonomic nervous system (ANS).

After spinal cord injury, the nervous system is affected. The ANS is a part of the nervous system that controls the body in automatic functions. One of the functions of the ANS is to coordinate contractions of the bladder with the internal sphincter opening. These messages can be miscommunicated, leading to higher pressures in the bladder.

A lesser-known issue is the ANS’s control of the immune response in the body. After SCI, the ANS may not identify bacteria entering the urinary system, may not react quickly with the immune response, or may not respond at all. The ANS response is different for everyone. This could be one reason some individuals have more urinary tract infections than others. The immune system also tends to slow down as a part of the aging process. Combined with a pokey ANS, some people have no urinary tract infections at a younger age but do as they become older.

No one can control aging or the ANS. However, an extensive amount of successful and quickly progressing research is being conducted to try to circumvent issues with the ANS after SCI. However, you can control your technique for bladder management. Developing excellent techniques will help reduce your risk of bacteria from entering your bladder, reducing urinary tract infections. You do have power over your health.

Here are tips and techniques that you might find helpful. You will find that you are already taking most of these actions, but there might be a prompt to think about something you are not doing or not doing as well as you can. Small changes can make big differences in urinary health.


Keep supplies together in a location where you can easily access them repeatedly. This might be a designated drawer or shelf. You will need to restock it if you buy in bulk.

Have a ‘go bag’ ready. Include your supplies for 1, 2, or 3 catheterizations. If you get delayed when out at work, school, or a social event, you will not be short of bladder management equipment.

Store all urinary supplies in a dry space. If you get a large box of catheters or other supplies, do not store them in the garage where it is too hot or too cold or in a damp basement.


Be consistent with drinking. Drink freely if you are able. If you do intermittent catheterization, monitor your intake.

Water is best.

Minimize alcohol and caffeine which leads to a quick bladder fill.

Avoid sugary drinks that enhance bacteria growth.

Bowel Care

Keep your rectal area clean. During the day, gas is passed. This leakage might not be seen but can ooze to the urethra, in both genders but especially in women.

Diarrhea or even a normal bowel movement can spread to the urethra of men and women. Try doing a bowel program on the commode or toilet to take advantage of gravity for bowel evacuation and clean up thoroughly.

If your stool is too hard or dry, it can block the urethra from within the body, preventing urine from flowing out.


Review your technique with a critical eye.

Do you wash your hands at the sink and then roll to somewhere nearby to cath? If you do, you have contaminated your hands from your rims.

Urine left in the bladder can become stagnant, increasing the risk of UTI. Be sure your bladder is empty by withdrawing the catheter slowly. Newer developed catheters are stiffer, which allows easier insertion. However, they do not drag along the dependent side of the bladder, especially if lying down. A significant amount of urine can be left behind. Sitting up with slow catheter removal ensures the bladder is empty.

Clean the urethra by wiping one way, front to back, both men and women. Change the location of the washcloth or wipe and clean again, front to back. Repeat. Using a scrubbing motion of back and forth brings bacteria from the skin to the urethral opening.

Catheterize on time to avoid overstretching your bladder.

If you use an indwelling catheter, be sure you have the correct size and balloon to avoid overstretching the urethra and bladder.

The catheter cannot touch anything prior to entering your urethra. It can’t even swipe your thigh or clothes quickly.

Rinse the urethra with water when the catheterization is complete. Cleaners (soap or ureteral cleaners) are very drying, which can crack the tender urethral tissue.

Signs of Infection

Know what your urine typically looks like, if you are doing reflex voiding, intermittent catheterization, if someone else is performing it or if you have an indwelling catheter.

Signs of a bladder infection are burning, urgency, and small frequent toileting, which might not be sensed with spinal cord injury. Other signs will be smelly or cloudy urine, fever, body shaking, nausea, vomiting, or feeling bad. Unique to the individual with spinal cord injury who has a urinary tract infection are increased spasms, referred pain to an area where you have sensation, usually the shoulder or jaw, and symptoms of autonomic dysreflexia.

Kidney infections can have the same symptoms as above. Pain is typically felt in the flank or referred to as an area of the body where you have sensation. Also, unique to individuals with spinal cord injury who have a kidney infection are increased spasms, and symptoms of autonomic dysreflexia.

Know how bacteria like to enter the urinary system. Primarily it is through the urethra or other created opening to the urinary tract. Bacteria like to live right inside the opening of the urethra, especially in men. In women, the natural anatomy is a bacteria risk. During sexual activity is a time for bacteria to enter for women and men. The use of a diaphragm and spermicide increase the risks for both men and women. Menopause can increase infection in women due to dryness. In men, the urethra can become blocked due to an erection or an enlarged prostate. Keeping your genitals clean reduces your risk.

Learn the difference between sediment in the urine and cloudy urine. Sediment and infection can appear together.

Sepsis is an extremely dangerous condition where an infection spreads throughout your body, affecting major organs. It is a medical emergency. If you have the signs of sepsis, it is time to call 911. This emergency does not wait. Know the signs of sepsis:

S Shivering/Cold/Fever

E Extreme pain or general discomfort

P Pale or discolored skin

S Sleepy, difficult to arouse, confused

I I feel like I might die-feeling of doom.

S Shortness of Breath


Get treatment for a urinary tract infection early. Do not wait. Treating an infection earlier will eliminate it quicker than waiting while the bacteria grows in the body. You can also treat early infections with lower-level antibiotics, which avoids antibiotic resistance.

Have a urodynamics study performed annually. If there is no change, great. If there is something, it can be corrected early before damage is done to your urinary system.

Control diabetes as it affects the immune system.

Eye drops work on the smooth muscles of your eyes. The bladder is also a smooth muscle. If you begin eye drops and notice incontinence, tell your healthcare professional so you can obtain a different prescription.

Wear loose-fitting clothing, so nothing is pinched or rubbed.

Add activity into your life either actively or passively. The movement of any muscle groups above or below your bladder will shake the urine in your bladder, making it more difficult for bacteria to clump together or to cling to the inside of your bladder.

Can you add to this list? Please help your community—write-in suggestions to this list. Let’s see if we can get a huge list that will help everyone reflect on urinary tract infections. Nurse Linda

Pediatric Consideration:

The suggestions listed above apply to the pediatric population as well. Differences are with the size of the child and equipment. For example, as a child grows, they will require a larger catheter if that is used.

Appropriate voiding amounts for the pediatric group can be calculated. This is just a rough estimate as children come in all sizes at all ages. The formula is:

(AGE + 2)30 = BLADDER CAPACITY in milliliters/cubic centimeters

Alternatively: AGE +2 = BLADDER CAPACITY in ounces.

Feel free to add to the list of tips for a healthy urinary system. The tip might work for all individuals, or a pediatric list can be started. You will be helping other children gain from your experience. Nurse Linda

Linda Schultz, Ph.D., CRRN, a leader and provider of rehabilitation nursing for over 30 years, and a friend of the Christopher & Dana Reeve Foundation for close to two decades. Within our online community, she writes about and answers your SCI-related healthcare questions in our Heath & Wellness discussion.

The National Paralysis Resource Center website is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $8,700,000 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government.