3 replies to this topic

[AHolland]

So what do you want to know? Please be graphic because we will.

I guess the first point to make is that not all T5's will be the same. None of us are exactly alike. I will make the assumption that your patient has good hand/arm control, but zero control below that.

The bladder control may fall into two general categories. Those that can hold a reasonable amount of urine in their bladder without leakage and those that cannot hold their bladder reliably. I've been both. Originally I had good bladder control of up to a litre. This means that I could move around for hours without problems as long as I catheterised about once every 4-6 hours, including getting up at night. In short, catheterising is the process of passing a long tube up into the bladder and manually draining off the urine. in the last 6-8 months I got a particularily nasty urinary infection and have lost my bladder control. This means that I cannot reliably hold urine in my bladder. I pee myself, without any warning, whenever the bladder choose. To help manage this, I wear an external condom catheter. This is basically a condom with a tube connection whereby the urine is passed down a tube to a urine collection bag on my leg. It is semi reliable for me, but not perfect. At any time, I may get the dreaded male shrinkage and literaly peel the condom off resulting in a mess. This is particularly likely during a urinary infection that tends to cause the shrinkage. I also use the same system at night. As a last note, my bladder does not empty itself completely so I still do the catheterising to completely empty the bladder any time I take off the condom catheter. I am working to cure the chronic bladder infection and hope to get back to just using cathertisation in the future. There is no guarantee.

On the bowel side of thing, again I have to say we are all really different. A fair percentage of people are lucky enough to be able to train their bowels after a year or two. Some never really get control of them. disabled people may train their bowels to work every day, use 2 days, or 3 days. I have not heard of anyone pushing it past that, although who knows. Bowel routines usually take a fair while to get through. I suppose some lucky people get in and out in 20 minutes with no adverse affects, but that certainly is not me. Should we do a pooping poll...lol I Fight a lot to get in a good bowel routine. Because of this I choose a 2 day routine. I combine my bowel routine with my shower. The bowel routine for me consists of sitting on my commode chair for 1-1.25 hours.

I start by cleaning out my lower bowels, using my hand in a rubber glove and lubricant. After cleaning out the lower bowel I insert a suppository and wait 20 mins. Every ten minutes I insert a finger up my rectum and twiddle it around a bit, rubbing the back insides to stimulate the bowels into moving. If I think a reasonable amount of material has passed through me then I move onto my shower. If not then I continue the periodic stimulation. Eventually I give up and move to the shower. The shower works to clean me off before going to bed. It is not unusual to have more fecal matter come out if my bowel routine was bad. I tend to shower for a reasonably long period of time becacause the heat tends to help with my chronic pain. After that I may wait a period longer over the toilet if I feel I am still loaded up. Yes I hate my bowels. This all said, there is no guarantee that I will not have a bowel accident at any time, any place. I try to avoid the high gas foods which may pressure the system into an accident. For me, it's a toss up which is the worst part of being a SCI person. ...Bowels/pain..pain/bowels. Having no control of your bowels affects all aspects of your life. I'm hoping others here can give you the good and bad of their routines. To end this, time taken from getting undressed to bed is usually 2.5 hours which is why I shoot for a 2 day routine. If I went for a three day routine which is common for quads, then there would be too high a chance of a bowel accident at the wrong time/place.

[kanga2433]

Can I add a bit about bladders? I started off with a reflex bladder in the 80s when ISC was not used. I used a condom cath and bag and continued to do so until the late 90s when I was having a lot of problems with the penile skin and with output. I moved on to a Supra-pubic Catheter (SPC) one that is inserted through the abdomen wall. Ths worked well.

I think you will find the SPC is often used as it makes life easy to manage for those with pooor hand movement and those who don't get on with ISC. It has a good track record for being infection free; in some studies actually less infection than ISC.