Urinary Tract Infections
Urinary tract infections are quite common in the general population. They can be mild when they only affect the bladder (cystitis) or more serious if they affect the kidneys (pyelonephritis).
When able-bodied people have cystitis, they generally need to pass urine more often than usual and they may have to hurry to the lavatory (urgency). Passing urine hurts or scalds and leaves them feeling sore and uncomfortable afterwards. The urine looks cloudy instead of clear and may smell different from usual. Because of the discomfort and inconvenience, they soon go to their doctor for advice. They are told to drink extra fluids and take the antibiotics prescribed and they get better within a day or two. Cystitis is the commonest kind of urinary tract infection and it does not usually make the person ill. A much more serious situation arises in pyelonephritis in which the infection affects the kidneys causing a high temperature, tummy ache, backache, and sickness. Fortunately pyelonephritis rarely occurs in people who can empty their bladders normally and so have good drainage from the kidneys.
But, in people with spina bifida who cannot empty their bladders well, it is quite a different story. . .
Why urinary tract infections are a problem in people with spina bifida
People with spina bifida often lack feeling and control of their bladder and bowel in the same way as they may lack feeling and control of their feet and legs. This is because the nerves in the spine connecting the brain to the bladder (or bowel or legs) have been interrupted, or disconnected, by the spina bifida. The result is that they cannot usually feel when their bladder is full, nor can they empty it properly. The bladder still contains urine (the residual urine) after they have tried to empty it. The stagnant pool or residual urine left in the bladder gets smelly and easily becomes infected and sometimes develops stones (urinary calculi) as well. Infections may spread to the kidneys causing pyelonephritis and kidney damage making the person ill. This happens because the bladder does not empty out the infected urine. It may also happen in children with reflux in whom the infected urine travels up towards the kidneys.
Many people with spina bifida do not know when they have a urinary infection. Because they lack feeling they do not suffer from the scalding pain which other people feel when they get cystitis, nor do they know their bladder is not emptying properly. Treating someone with spina bifida for a urinary infection with antibiotics and extra fluids works more slowly if the bladder is not emptying. The best way to prevent urinary infections damaging the kidneys is to be sure that the bladder empties regularly and completely. One way of doing this is by clean intermittent catheterisation.
How clean intermittent catheterisation improves urinary infections
Intermittent catheterisation means inserting a narrow tube (catheter) along the usual passage (urethra) into the bladder. The urine flows out of the bladder through the catheter into the lavatory, or into a container, until the bladder is completely empty and then the catheter is removed. By doing this several times a day the person is kept much drier, or even completely dry. Provided the bladder is not allowed to remain full, urinary infections are most unlikely to spread to the kidneys.
People should catheterise at least four times a day but those who have a smaller bladder or who drink a lot may need to catheterise six or even eight times. With practice catheterisation becomes quite easy and may take less than five minutes.
Before starting intermittent catheterisation some people may have needed several courses of antibiotics for their urinary infections. But, after they start using catheterisation, their urine becomes quite clear once catheterisation has removed the stagnant pool of residual urine. They cease to get attacks of pyelonephritis even though, when their urine samples are examined, they often show a mild infection. These mild infections are better left untreated: they do not spread to the kidneys so long as the bladder is not allowed to remain full.
Twenty-five years of experience of intermittent catheterisation has shown that it actually prevents damage to the kidneys as well as improving those already damaged.
