A spinal cord injury (SCI) can have a profound impact on a person's life, affecting their central nervous system and altering basic bodily functions. In this post, we aim to explain some of the common complications associated with SCIs, such as bladder and bowel management issues, joint contractures, breathing difficulties in cases of high-level injuries, skin care to prevent pressure ulcers, and changes in sexual function. We will also provide straightforward, practical advice to help those affected by SCI manage these challenges effectively.

Bladder and Bowel Management

After a spinal cord injury, the ability to control your bladder and bowel may be significantly affected due to the disruption of nerve signals between the brain and these areas of the body. The challenge of dealing with incontinence can be difficult because you are faced with a heightened risk of urinary tract infections, which aren’t only uncomfortable but can also have serious health implications if not properly managed.

To avoid these risks,  adopting a structured bladder management programme, which may involve the use of catheters, is essential. The goal is to empty the bladder regularly and effectively, reducing the chance of infections and maintaining good bladder and kidney health.

Similarly, managing your bowel movements post-injury requires a tailored approach, often referred to as a 'bowel programme'. This will usually include scheduling attempts to pass stools at round the same time every day or every other day. Adjusting your diet to ensure regularity and stool consistency, and possibly medications to stimulate bowel movements may all be part of a bowel programme. Consistency and routine are key in preventing constipation and ensuring comfort.

Successfully managing your bladder and bowel following a spinal cord injury requires patience, practice and, perseverance to navigate what can often be a difficult aspect of daily life. They are, however, crucial for maintaining autonomy, health and quality of life following spinal cord injuries. It’s important to work closely with healthcare providers to establish a routine that is effective and tailored to your individual lifestyle and needs.

Joint Contractures

Joint contractures are a common complication for individuals with spinal cord injuries, particularly in the initial phase following injury. Contractures occur when the elasticity of the muscles and tendons reduces, leading to a limitation in joint movement and often resulting in chronic pain. The lack of movement can cause the tissues around the joint to shorten and harden, ultimately restricting the range of motion.

Prevention is paramount when it comes to joint contractures. Even in the immediate days and weeks after injury, incorporating a daily regimen of stretching and range-of-motion exercises can help maintain joint mobility and muscle flexibility, whether performed independently or with assistance.

Engagement in regular physiotherapy is also important in preventing contractures. Therapists can guide you through specific exercises tailored to your individual needs and provide strategies for incorporating them into everyday routines. They also play an important role in monitoring progress and adjusting treatment plans as needed.

For those living with a spinal cord injury, attention to joint health is about remaining mobile and preserving independence and quality of life. By committing to a daily routine focused on movement and flexibility, you can significantly reduce the risk factors associated with joint contractures and the discomfort they bring.

Breathing

Injuries to the upper spine, particularly those affecting the neck or chest region, can impair the muscles that facilitate breathing. As a result, lung capacity is reduced and the ability to cough impaired, leading to an increased likelihood of respiratory complications. 

Breathing exercises designed to strengthen the diaphragm and increase lung capacity are often recommended. These exercises can be simple, such as deep breathing techniques or may involve using specialised equipment to assist with inhalation and exhalation.

It’s important to be vigilant for symptoms of respiratory problems such as shortness of breath, an inability to clear secretions, or reduced oxygen levels in the blood. Such symptoms demand immediate medical attention to prevent further complications.

Assistive devices, like ventilators, may be necessary for some individuals with high-level spinal cord damage to aid with breathing, especially when sleeping or during respiratory infections. 

Skin Care/Pressure Ulcers

A lack of movement after a spinal cord injury, coupled with the loss of sensation, can lead to pressure ulcers, also known as bedsores, which occur when the skin and underlying tissues are damaged from prolonged pressure.

Skin care, therefore, becomes an essential part of daily life. Regular inspection of the skin, particularly in areas that bear weight such as the buttocks, heels and elbows is vital. Checking your own skin can be challenging, so getting assistance from a carer may be necessary. Keeping the skin clean and dry, ensuring proper nutrition and hydration, and using a pressure-relieving cushion on your wheelchair and a specialist mattress on your bed can also help prevent ulcers.

If you do develop a pressure ulcer, early intervention is vital. This includes relieving pressure on the affected area, and if the skin has broken down, ensuring the wound is kept clean and dressed, usually with the help of a district nurse. Even with meticulous care, ulcers can occur, but recognising them early and responding promptly can prevent prolonged periods of bed rest and long-term implications.

Sexual Function

The loss of sexual function is a sensitive topic for most people affected by spinal cord injury. For the majority of people, sex and sexuality remains an important aspect of life after injury. The changes in sexual function due to SCI can vary greatly, depending on the level and severity of the injury.

It's not uncommon for individuals with spinal cord injuries to experience changes in sexual response, including arousal and sensation. Men may experience erectile dysfunction and difficulty with ejaculation, while women might experience changes in lubrication. Both men and women may struggle to achieve orgasm. However, it's important to note that intimacy, sexual pleasure and parenthood can still be possible with the right support and mindset.

Communication plays an important role in navigating these changes. Open dialogue with partners, as well as with healthcare professionals, can lead to the exploration of different methods and aids that can facilitate sexual activity. This can include medication, assistive devices and alternative techniques for achieving sexual satisfaction.

Rekindling intimacy after a spinal cord injury requires patience, understanding, and sometimes a redefinition of sexual health and pleasure. There's a spectrum of possibilities for maintaining an active sexual life post-injury, and while it may involve a journey of adjustment, the exploration can lead to fulfilling experiences that bolster not just physical, but also emotional wellbeing.