Neurogenic Bladder

Caring for your bladder after SCI to stay healthy and dry.

What is it?

After a spinal cord injury, your bladder cannot talk normally to your brain. The bladder may squeeze when it should not, or it may not empty when it should. Without a plan, urine can back up, infections can set in, and your kidneys can be hurt.

A good bladder program protects your kidneys, prevents infections, and keeps you dry between catheterizations.

How you might feel

A sense of fullness or pressure (in some people)
Sweating, headache, or AD signs (above T6) when the bladder is full
Leaking between cath times
Cloudy, smelly, or bloody urine — possible infection
Burning or fever — possible infection

Common bladder programs

Clean intermittent catheterization (CIC). The most common program. You pass a catheter every 4–6 hours to empty the bladder. Aim for less than 400–500 mL per cath. If you keep getting more, you may need to cath more often or drink less between caths.
Indwelling catheter (urethral or suprapubic). A catheter that stays in place. Lower work, but higher risk of infection and stones over time. Change every 2–4 weeks.
Reflex voiding with a condom catheter (for some men). The bladder empties on a reflex into a condom catheter. Needs check-ups for safe pressures.

What you can do at home

Keep your cath schedule. Not skipping is the single best thing for avoiding UTIs.
Hand hygiene every time before you cath. Use a fresh catheter (or one cleaned by your team's protocol).
Drink steady water. Aim for clear-to-pale-yellow urine. Most people need 2 liters a day; ask your team for a target.
Watch your output. Track 24-hour urine totals and per-cath volumes for a few days when something feels off.
Empty fully. If you are not sure, scan with a bladder scanner if you have one, or ask for one at clinic.

💡 Tip

Cranberry has weak evidence for UTI prevention. It will not hurt — and it will not replace a good cath schedule. Save your money for catheters and water.

💊 Medicines

Anticholinergics (oxybutynin, tolterodine, trospium) calm an overactive bladder so you stay dry. Watch for dry mouth and constipation.
Mirabegron is a different class with fewer dry-mouth effects.
Botulinum toxin injected into the bladder wall every 6–9 months can replace pills.

📞 Call your doctor if

Fever with chills, cloudy or smelly urine, low back or flank pain — likely UTI.
Burning or pain that is new.
AD symptoms with a full bladder you cannot empty.
Blood in the urine more than once.
Catheter will not pass, or will not drain.

At your next clinic visit

Bring a 3-day cath log: time, volume, any leaks, and fluid in. A yearly upper-tract scan and a urodynamics study (every 1–2 years for high-risk SCI) protect your kidneys.

Education only. Not medical advice. If you have a clinical question, talk to your rehab team. For emergencies call 911.