How does aging affect the bladder with SCI?

Authors: SCIRE Community Team | Reviewer: Bonnie Nybo | Published: 18 January 2018 | Updated: 16 October 2024

Watch SCIRE’s video on bladder care to understand more about managing your bladder as you age.¹¹

Typically, people will experience changes in urination as they age. Some may need to go to the bathroom more often because the bladder can’t store as much urine, or find that the flow of urine is weaker. Others may experience more urine leaking because the muscles that keep the bladder closed are weaker or the bladder contracts when it is not supposed to. The kidneys that filter your blood and produce urine may not function as well, and the risk of developing kidney stones increases.

Women, both during and post-menopause may experience an increase in the frequency of UTIs.

For people aging with SCI, the long-term use of indwelling catheters to manage the bladder increases risk for bladder stones, bladder cancer, UTIs, and urinary tract deterioration. Long-term use of intermittent catheterization can increase risk for urethral strictures. People with neurogenic bladder can experience high pressures in the urinary tract and urine back up to the kidneys. Over time, this damages the structures of the urinary system and increases the risk for stones.

Bladder changes that people aging with SCI may experience:

• Increased UTIs
• Increased urine leaking (incontinence)
• Urethral strictures
• Bladder/kidney stones
• Increased risk of bladder cancer
• Damage to urinary tracts and kidneys
• Reduced kidney function

Bladder changes may also trigger spasticity and autonomic dysreflexia. Other aspects of aging like pain, osteoarthritis, decreased strength and mobility, and thinning of the skin, may also affect the ability to carry out bladder routines.

All of the changes from aging listed above could lead to a need to reassess bladder management strategies.

Refer to the “What other complications are related to bladder changes?” section for more information on specific bladder problems.

If you experience changes to your bladder function as you age with SCI, consult regularly with a health care provider about your bladder management. Your family doctor, physiatrist, or urologist may be familiar with the check-ins necessary for bladder care as you age with a SCI.

Strategies to consider for the management of bladder changes may include:

• Changing the catheterization method to reduce UTIs, avoid urinary tract damage, or accommodate reduced hand and wrist function
• Screenings for bladder/kidney stones and urinary tract/kidney damage
• Regular screening for bladder cancer if indwelling catheter has been used for 5-10 years
• Consulting with professionals to determine the root cause of recurrent UTIs
• Antibiotic medication to treat UTIs (only use if experiencing symptoms to avoid developing antibiotic resistance)
• Supplements to prevent UTIs (i.e. D-mannose)
• Botulinum toxin (Botox) injections to relax bladder muscles
• Surgical procedures to make the bladder bigger, improve emptying, or make catheterization easier
• Additional caregiver help
• Quit or avoid smoking (smoking can up to quadruple risk for bladder cancer)

Many people with SCI change their bladder management as they age. In one study, half of participants changed their bladder management methods over 20 years. Over time, men who used condom drainage and women who used straining to manage their bladder were most likely to change their management methods. The use of indwelling catheters increased for men. A change to intermittent catheters or suprapubic indwelling catheters for bladder management increased for both men and women.

There is research looking at the potential for epidural and transcutaneous nerve stimulation to improve bladder function and management. This may be available depending on your location.

1. Your current routine is not working anymore.
2. The time and energy you spend on bladder management is limiting time spent with family/friends or doing things you love.

• What has changed (issues, challenges, barriers)?
• When did the change start?
• What is the root cause of the change? (medical illness, injury, surgery, mobility, weakness, cognitive changes, social changes, financial changes)
• What treatments or recommendations have been tried so far?
• What has worked and what has not?
• When was the most recent review of bladder with a family doctor or specialist such as a urologist or physiatrist?

Refer to the “Medications and injections”, “Bladder surgery and stents”, and “What other complications are related to bladder changes?” sections above for more information.)