Directly after the spinal cord injury, all reflexes below the neurologic lesion have disappeared. This is called spinal shock. In this phase, the bladder is hypotonic. This phase takes normally 4-6 weeks, sometimes up to 6-8 months.
To prevent the bladder from overdistension (due to polyuria), it is important to drain the urine continu ously. Usually indwelling catheters are used. A better approach is a suprapubic catheter, especially in men, to prevent the patient from urethral trauma and prostatic infections.
After the polyuria phase, the patient should start with an intermittent catheterization program (if possible dependent on neurologic lesion and hand function) (Dietz 1996).
When the spinal shock phase ends, bladder dysfunction will develop and a urodynamic investigation is needed to treat the dysfunction properly.
Bladder rehabilitation should beapartof the overall rehabilitation routine after spinal cord injury and should be adjusted to the result of the urodynamic investigation.
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