Avoiding bladder infection (UTI)
Individuals who use catheters both indwelling and intermittent have a higher risk for bladder infection. Bacteria can become introduced into the bladder mostly by even a minor slip in catheterization technique but also just through daily life of health fluctuations.
People tend to have ups and downs in health. Lower resistance and stress can weaken your body’s immune system. You can become compromised by a minor cold or just feeling generally run down. All sorts of issues can affect the well-being of our bodies from over excitement and joy to stress and fatigue. As humans, we cannot control every movement or thought but we can do our best to reduce the chance of a bladder infection.
A bladder infection may include some or all of these symptoms: cloudy urine or an odor, fever, chills, nausea, headache, increased spasms, Autonomic Dysreflexia (AD), abdominal pain. If you have sensation, you might have pain when passing urine or a cramp in your abdomen over your bladder. If sensation is affected, you might feel pain referred to another part of your body, most commonly the shoulder. With any type of paralysis you may have one or all of these symptoms. Many of the individual symptoms can also be signs of other problems so it can be difficult to figure out source of the problem.
The only definitive test for a Urinary Tract Infection (UTI) is a urinalysis (UA) which is an examination of your urine for bacteria. At the time of a urinalysis, if bacteria are present, a culture and sensitivity (C&S) test can be completed using the same urine sample. In this test, the urine is put onto a sterile plate and observed to see what type of bacteria grows and which antibiotic will destroy the bacteria. The UA test takes only minutes at the laboratory but the C&S takes several days to complete, usually three days. Treatment will begin when the bacteria is discovered. Typically, a broad spectrum antibiotic will be started but the C&S test will indicate if the proper treatment is underway. Not all antibiotics destroy all bacteria. Each antibiotic is designed to affect specific bacteria. Even though you might feel better during your treatment, you need to take all of the prescribed medication to ensure the bacterial growth is destroyed.
There are some things that you can do to help prevent the development of a urinary tract infection (UTI). These include reviewing your fluid intake and catheter technique. It is easy to become lax in treatment as you rush through your day or as you pick up short cuts to maintaining your regimen.
The best prevention for an infection in your bladder is to wash your hands. This seems simple but it is very important as a first step barrier to infection. Wash your hands before you catheterize as well as washing the urethra or opening to the bladder. This should be done with very warm water using a cleanser or the cleaning solution provided in the catheter kit. When cleaning your urethra, be sure to rinse off the soap residue if used. When washing your hands, create a lather all over your hands and up to your wrists. Pay attention to washing between your fingers and your fingernails. Use the friction of rubbing your hands together as you wash all sides of your hands, fingers and nails. Let the water drip off your finger tips and dry with a clean towel. If you are out and unable to get to a sink, you can use sanitizing lotion or wipes. Be sure you create that same friction with sanitizing lotion or wipe.
Another safety tip is to drink water. As you put fluid into your body, it will keep the fluid moving through your system and flowing out. The less you drink, the more you dehydrate your body. Then your body will try to hold on to fluid in your cells. You want to keep the fluid moving through your body and out creating a one way exit for your fluid. You can drink anything you would like in moderation, even water. Smaller amounts consistently throughout the day will help. Do not overload your system by drinking vast amounts at one time. Six to eight glasses of eight ounces of water will keep you hydrated but do not try to drink this full amount all at once or starting too quickly. Create a schedule to build up your fluid intake over time.
Think about your technique for catheterizing or care of your catheter. It is easy to fall into habits that are less than perfect when you are rushing. If you are using intermittent catheterization (IMC), the catheter should touch nothing but the opening to the bladder. If you miss, you need another catheter. If it hits against your thigh or the sheet or the toilet seat, you need another catheter. Men can easily find the urethra but women can have trouble locating theirs due to anatomical differences. As a woman, you will need to find the urethra using a mirror. Then use other landmarks so you can insert the catheter directly in the urethra every time. This take practice. But just like typing or playing the piano, you fingers will eventually get to know where to be go without looking.
Be sure you have lubricated the catheter well. A dry catheter will cause little micro-abrasions or cuts inside your urethra, the tract to the bladder. These abrasions are a welcome area to bacteria.
If you use other sorts of bladder draining technique, be sure to examine your technique. If you have a suprapubic catheter, be sure the dressing is dry and intact. Change the dressing and catheter as instructed. Report to your healthcare professional if there is any drainage around the opening.
Gravity is your friend in bladder and bowel activities. Human bodies are made to expel in the upright position. For men this helps push urine out around the prostate gland and for women it is far more convenient. Often people with paralysis are taught to catheterize in the bed because it is more convenient for the care providers. However, use of gravity by sitting up when catheterizing can help completely drain the bladder. The opening to the bladder is right at the bottom of the bladder when sitting. It is to the side when in bed. If you sit while draining your bladder, you will ensure all of the urine is removed. If you catheterize in bed, you can leave a small amount of urine behind. Most urine will come out with a slow removal of the catheter but it is much more effective to sit upright if your condition allows it. Clean up is much easier, too. A flush and the urine is gone.
In my experience, adults know what the feeling of a toilet seat is and what to do when they sit there. Individuals with even the most severe stroke or head injury know what to do when they feel the seat. It is fascinating that someone who cannot communicate with you will know immediately what to do when they feel the toilet seat. People are conditioned to eliminate in the toilet. They learn from an early age what the toilet feels like and they learn what to do when there. I wonder what connection the brain can make just from feeling that same connection after paralysis. Since we are learning so much from muscle movement and functional stimulation, doesn’t it make sense that when you use the toilet, you are actually performing a therapy? It makes sense to me but there is no scientific evidence at this time.
An issue for individuals with paralysis is dependent edema. Fluid travels to all parts of the body to keep us hydrated for body functions. The fluid is generally removed in part by cardiac function and in part by use of our muscles squeezing to pump the blood containing fluid out of our bodies as waste. When our bodies do not move, the squeezing actions of the muscles is reduced or lost. When movement is impaired, you might see some swelling in your feet and lower legs or in your fingers and hands. You might not see an increase in fluid collection in your bottom and lower back but it can collect there, too. If your legs, hands and back become too edematous that cannot be controlled with adjustment of fluids, you may be prescribed a diuretic to reduce fluid collection.
Therefore, movement function has to be supplied in other ways. This can be accomplished by wearing support stockings to supply some external pressure evenly throughout the extremities, legs and arms. You can elevate your legs and arms to help the heart pump the fluid back up and out of your body. You can change your seating position throughout the day to reduce the collection of fluid from your back side from sitting. Any activity that you can engage in will assist with not only stimulation to your nerves and muscles below the level of your spinal cord injury or paralysis but also will help move fluid back up and out of your body. You can practice range of motion exercises or some of the therapies that will assist your body in recovery. Any movement to your body will move urine in your bladder which will keep bacteria from clumping together. Standing therapy might temporarily increase fluid collection in your legs unless you have the glider motion for your legs. You will want to be sure to provide movement and elevation afterwards if you engage in this very helpful treatment.
Individuals often comment that when they lay down at night, their bladders fill quickly. This is the result of dependent edema being removed by the body when the arms and legs are being elevated. Laying down about an hour before bedtime and reading or watching TV allows time for this fluid to be removed. Cath about an hour after laying down to remove this fluid from your bladder so it will be empty before going to sleep for the night.
Be mindful of your equipment. If you have a drainage bag that is used either in the day or at night, to avoid infection keep the bag below the level of the bladder at all times. Be extra cautious of this at transfer time. It is very easy to move the bag above the level of your bladder when moving or turning over in bed and moving the bag over your body to put on the other side of the bed after turning. Instruct your care giver so this never happens. There are valves in the drainage bag to keep the urine from backing up, but there is always some urine in the tubing to the bag. The drainage bag will not work to full capacity if the tubing is dependent. Urine will back up in the bladder if all of the tubing is hanging down over the side of the bed. Keep the tubing curled on the edge of the bed with just enough tubing going straight down to reach the collection bag. You do not want so much tubing hanging over the side of the bed that the urine has to go down and then back up to the collection bag. The urine will not travel uphill.
Lastly, but sure to keep up with your urodynamic testing to maintain your bladder health. Your bladder type can change even after years of consistency. There might not be any warning signs of a change in your function. You want to be sure your kidneys are protected and you elimination practices are in your best interest.
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