If you were paralyzed, would you have any greater wish than to be able to walk again?
For many people with spinal cord injuries, regaining control of their bladder actually ranks higher than the ability to regain use of their legs.
That’s why a new treatment involving magnetic stimulation is creating hope in the spinal cord injury community.
The treatment has assisted those with spinal cord injuries to recover a significant level of bladder control for up to four weeks.
Neuroscientists from the University of California at Los Angeles (UCLA) worked with five people with spinal cord injuries, stimulating their lower spinal cords using a magnetic device placed at the base of the spine.
The study is the first of its kind to show a significant improvement in bladder control between treatments.
The men participating in the study said the technique improved their quality of life by an average of 60 percent.
More than 250,000 people in the United States live with a spinal cord injury. Of those, 80 percent lose the ability to urinate voluntarily.
Bladder dysfunction can lead to urinary tract infections, incontinence, renal impairment, kidney stones, and an overall poor quality of life.
A 2012 study found that for many people with a spinal cord injury, a desire to regain bladder control outranked their hope to walk again.
“Some patients rate bladder function above walking because bladder incontinence imparts a societal stigma. It prevents them from going out to dinner or attending social events. In patients with cervical injury without hand function, this requires a caregiver to assist in catheterization and restricts their freedom,” Dr. Daniel Lu, principal investigator of the study and an associate professor of neurosurgery at the David Geffen School of Medicine at UCLA, told Healthline.
“From a medical perspective, bladder dysfunction could lead to sepsis, kidney failure, or even death,” he added.
Life without bladder control
People living with spinal cord injuries empty their bladders with the assistance of a narrow tube called a catheter. The device is slid into the bladder several times throughout the day to drain urine from the body.
For some people who have injuries that also prevent them from using their hands, a caregiver is required to insert the catheter.
Alexander “Sasha” Rabchevsky, PhD, is an endowed professor of physiology at the Spinal Cord & Brain Injury Research Center at the University of Kentucky. He’s been a T5 complete paraplegic since 1985.
He says that managing the bladder is one of the biggest challenges in a life of paralysis, from both a physical and psychological standpoint.
“There is a general lack of understanding as to the critical importance and the difficulties associated with [catheters’] routine usage in the spinal cord injury population,” Rabchevsky told Healthline.
Although Rabchevsky says he’s become accustomed to catheters, for many people with a spinal cord injury, it’s an ongoing struggle.
“I’ve used catheters for over 30 years, and while I was timid early on about stigmas of sticking a tube into my penis to pee, eventually it became so routine that now my issues are more about keeping things as clean as possible and where and when I can use my catheters, like on a plane,” he said.
“But that doesn’t speak for the countless folks who have serious social impediments due entirely to their need for catheterization in the public arena, whether self-administered or with required assistance,” Rabchevsky added.
The health risks with catheters
Catheter use is associated with a number of health risks. Long-term use can lead to recurring urinary tract infections and permanent scarring.
As catheters are inserted into the bladder from outside the body, this can act as an entry point for bacteria and lead to infections.
These can be life-threatening if not diagnosed and treated promptly.
Hinesh Patel is a student at the University of California at Irvine studying for his medical doctorate and PhD.
He suffered a spinal cord injury slightly more than a year ago after an accidental fall.
His injury has resulted in him losing complete function of his bladder. In the past year, he says he’s had more infections than he ever would’ve anticipated. A large part of that is due to lack of sensation.
“Especially with limited sensation as a result of spinal cord injury, the symptoms you experience aren’t necessarily the same as the average person might experience to catch the infection early,” Patel told Healthline.
Regaining bladder control is a high priority.
“It’s a lot higher on my list than I would have anticipated or would have thought about before,” he said.
How the study was conducted
The researchers worked with five men who had spinal cord injuries. The men underwent 15 minutes of magnetic stimulation every week from a device that’s approved by the U.S. Food and Drug Administration (FDA) but is experimental when used in bladder rehabilitation.
After four sessions, the men saw a noticeable improvement in their bladder function. All five were able to urinate on their own. One participant was able to stop using his catheter completely and urinate by himself — 13 years after his injury.
These improvements lasted for up to four weeks after the magnetic stimulation.
The other four men still had to use the catheter at least once daily, but that was an improvement from their previous frequency of six or more times a day.
The participants’ bladder capacity also increased, as did the volume of urine they were able to produce voluntarily without a catheter.
Lu says the results are promising and gave the study participants hope.
“They were highly encouraged and could not wait until this strategy is available for clinical treatment,” he said.
The researchers intend to broaden the study with a larger cohort of men and women.
They also want to examine whether different stimulation patterns will improve the response of people who don’t achieve the same benefit as others studied.
If the results of this study are repeated, then more refined approaches may indeed revolutionize how bladder care is managed in the clinic and at home.
Rabchevsky says that if the results of the study were able to be repeated in a larger, independent experiment and the approach is refined, this technique could revolutionize how bladder care is managed after spinal cord injury.
“This ‘out of the box’ burgeoning innovative approach to treat bladder dysfunction in particular may lead the way to standardized, inexpensive and relatively simple procedures offered to folks with SCI, who may then not be condemned to a life of catheterizations and UTIs… which would be a monumental achievement, at least in my lifetime since being bound to a wheelchair,” he said.
“Of course, we all want to walk again. However, while we wait for therapies to allow us to move our paralyzed legs and/or arms volitionally, it sure would be a true life-changer if we did not have to manage our bladders 24/7,” Rabchevsky said.