bladder and bowel accidents

A 19 year old male had a MVA, leaving him a complete T7 paraplegic. He has been attending physio rehab daily and is keen to become as independent as possible so that he is not a burden on his parents. The gym is a very friendly and open environment where all the physios and patients are in the same space, socialising and doing rehab. Last week, this particular patient had a bowel accident during treatment. The patient was embarressed over the ordeal. I was lucky enough to have another physio with me at the time and together we calmly alerted the patient, cleaned the area, put a bluey on his W/C and sent his back to the ward.

In conjunction to loosing all motor and sensory function below the level of the lesion, having a complete spinal cord injury (and incomplete, depending on the extent of injury) leaves the patient with an involuntary bowel and bladder. For this patient (as the lesion is above T12), he has a neurogenic/reflexive bladder and bowel, whereby the spinal reflexes are still intact without allowing cortical voluntary inhibition and voiding. Therefore to prevent leaking and overdistention a strict bladder and bowel routine needs to be inplace. This patient can do his own catheters, however needs assistance with his bowels. I think before this placement i was unaware of the reality of having a involuntary bowel and bladder. We being physios, focus on the motor and sensory areas.

I was glad that another physio was present at the time, so the issue was dealt with discreately and quickly. Having the guidance has shown me how to deal with situation if it is to arise again. In addition, this patient being so young and close to my age, i felt that he was more embarressed with me there. i feel that i acted appropriately, staying calm and asured him not to worry. The issue was obviously dealt with appropriately as at physio the next day, he felt comfortable to talk about it and continue rehab.

My supervisor explained that most of these patients are not bothered by their loss of limb function later down the track, its the bowel and bladder problems that become the main concern and frustration. In the future i will now endevour to educate patients on the importance of a strick bowel and bladder routine to prevent accidents not only in hospital but in the community where people will not understand. i am now confident i will be able to handle this situation adaquetely if it is to arise again. I just thought it would be interesting to inform you guys of additional issues we may have to deal with and to stay calm infront of the patient. Just put yourself in their shoes.