BLADDER MANAGEMENT

02/14/2026

Quadriplegics have “neurogenic” bladders which are considered “spastic". They empty when or if they feel like it. So how do we prevent accidents? How do we prevent retaining too much urine inside?

 Catheterization 

A catheter is most often recommended. You and/or a caregiver will be trained on how to take care of your catheter before you leave the hospital. 

 

With intermittent straight catheterization you or a caregiver will insert a catheter into your urethra every 4-6 hours. There is less chance for urinary tract infection than indwelling catheters. Straight catheterization helps maintain the health of your bladder because it’s filling and emptying like it’s supposed to do.
Indwelling Foley catheters are the method most commonly used at the hospital. A thin, hollow tube is inserted through the urethra into the bladder and a balloon is inflated to keep it in place. It drains into a sterile drainage bag that hangs on your leg, chair, or bed. The catheter stays in, replaced by your doctor or nurse every 4-6 weeks. 


Remember to check for kinks if your Foley isn’t draining and have a doctor or nurse check placement if it’s leaking. Keep the bag below your waist.

Men often prefer condom catheters. External urinary catheters are worn like a condom. They collect urine as it drains out of your bladder and send it to a collection bag. Condom catheters are easy to use, can be changed at home, and are noninvasive. Some men use skin cement and stretchy tape to keep the catheter in place. Others recommend wideband condom catheters which have more adhesive.

Suprapubic catheters are an option that avoids having a catheter in the urethra. Most quadriplegics with suprapubic catheters say it was one of their best decisions and they should have done it sooner. During surgery, a tube is inserted into your bladder through a small hole in your belly. You’ll keep the catheter taped to your belly and empty your urine bag as needed. Your doctor will change your catheter every 4-6 weeks. 


Check the catheter site a few times a day for redness, pain, swelling, or pus. Wash the area around your catheter every day with mild soap and water. Apply bandages around the site the way your doctor showed you. To avoid clogging, check for kinks, and move the tubing around if it is not draining. Avoid sugar and drink lots of water. You may need to go up a catheter size to avoid clogging. Disconnect and flush with warm water and vinegar when you notice sediment. Some of us swear by irrigating with Renacidine.

You may choose to get a valve put on your suprapubic catheter so you don’t have to wear a leg bag at all times. It’s a flap-like device that fits into the end of a suprapubic catheter. The valve can be switched on to stop drainage or off to drain urine from the bladder thus allowing the bladder to fill and empty as normally as possible. The valve gets the bladder used to holding a volume of urine again and improves bladder capacity. Downsides, anything indwelling has an increased chance of infection.

“I've had the suprapubic catheter for 10 years and although it does stop up and I have UTIs on occasion, it has been better than intermittent cathing the 14 years prior to getting it”. Tiffany, C5-6 

 

"I love it. Don’t have to worry about finding a bathroom, fitting into a bathroom, waking up at night to cath, drinking too much. I use a belly bag so I don’t have tubes everywhere. When it gets full I just unzip my pants and empty it into a urinal and I’m good to go again. EZ PZ.” Brian, C6-7 
         

“Be sure to drink plenty of water. I drink 8 bottles a day that are 16.9 ounces each. My doctor also recommended getting Ellura (a cranberry supplement). You can take 1 every day, 2 on days that you have UTI symptoms. Or just take 2 on the days you have symptoms. I change my catheter every 30 days. Also, once you have it 10 years you will need to schedule a cystoscopy to be done once every year.” Pam, C4-6 

Surgical Options

Some quadriplegics get Botox injections regularly to calm leaky, spastic bladders. The majority of people with spinal cord injuries who try it report positive results. The effects are temporary, typically lasting between 8 to 10 months. You must be able to perform clean intermittent catheterization, as Botox inhibits bladder muscle contraction, which can lead to increased residual urine. 


Bladder spasms can be a complication of catheter usage or triggered by a urinary tract infection. Avoid caffeine and drink cranberry juice to help prevent bladder spasms. 

 

With this surgery, catheterization can be performed through your belly button. This type of diversion can have several different variations. The pouch can be made from the bladder, large or small intestines, or a combination. The outlet is made from the appendix, a fallopian tube, or part of the ureter. A narrow tube is sewn to your skin. The opening is called a stoma, and it is usually placed in the belly button, making it fairly inconspicuous.

To drain the bladder, a catheter is passed 4 to 5 times a day through the one-way flap valve. Once the bladder is drained (this usually takes a couple of minutes), the catheter is removed. A one way flap valve is used to maintain urine control.
If your bladder is small, it will be enlarged by patching it with a piece of bowel.
Mitrofanoff has been especially successful in women who have difficulty with self-catheterizations through the urethra and in people with recurrent and severe autonomic dysreflexia related to their bladder. Mitrofanoff is a major surgery if they have to use bowel for augmentation of the bladder or for the conduit if your appendix is too short.  


Urostomy Procedure

In a more drastic measure, you can also have your bladder surgically removed and drain urine through an opening in your belly that uses a piece of your intestine. Your urostomy bag will attach directly to your abdomen. The bag will be fitted with a non-return valve, which prevents the urine in the pouch from flowing back over the stoma, and a tap at the bottom for emptying. 

Surgical options, including urostomies, are usually considered when non-surgical approaches aren't sufficient to manage bladder function. For many, these surgeries significantly improve bladder control and quality of life, reducing accidents and complications, though it's a major decision.
 

Indiana Pouch Procedure

An alternative to urostomy is called continent urinary diversion. In this procedure, the surgeon uses a piece of your intestine to create a pouch that holds urine inside your body after the bladder is removed. The pouch either drains to a stoma or replaces your bladder. It’s sewn to the skin at the level of the belly button or to the lower abdomen on the right side. To drain the urine, a catheter is pushed through a stoma and down into the colon pouch several times a day. 
 

“I had a Suprapubic Catheter for 7 years and now have an Indiana pouch with a stoma in my belly, it’s SO MUCH BETTER!! I dealt with monthly UTIs and my bladder was very tiny, spastic, leaky, so got rid of it. Amazing life changing decision!” Sally, C7 

 

HEALTH INFORMATION ON THIS PAGE RETRIEVED FROM CLEVELAND CLINIC

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