FAQ's about SCI.
A Spinal Cord Injury is a life changing experience for not only the person with the injury but also their family and friends. Here are some frequently asked questions which arise when your loved one is injured. They may currently be in hospital, receiving treatment, leaving you to wonder what happens next.Or you may have suffered an SCI and could be looking for a little more information.
Our answers to these FAQ's are drawn from Dr Leanne McAlister who is an expert in the field on Spinal Cord Injuries with her vast experience at Burwood hospital in Christchurch New Zealand.
- What are the options for bladder management?
- What are the options for bowel management?
- Why do I get Spasm?
- Why do I suffer from pain?
- Will I be able to get an erection/ejaculate/orgasm?
- Will I ever be able to father a child/have a baby?
- How will I be able to return to the work force?
- Are there any treatments that can fix a damaged spinal cord?
- Questions on Stem Cells
For a male the options are Self Intermittent Catheterisation (SIC), a Suprapubic Catheter (SPC) or an External Collecting Device (ECD/Uridome/Uritip). For women options include SIC or SPC. In very basic and general terms if there is adequate hand function and trunk control, SIC would be the usual option. If there is not adequate hand function and/or trunk control, or if there are other reasons why SIC is not appropriate, a SPC or ECD (in men only) is considered. An ECD can only be used if there is automatic emptying of the bladder when full (like a newborn baby) which is usually possible if the spinal cord injury (SCI) is above about T12/L1.
If with any of the above management options there is significant problems, then surgical procedures and various implants may be helpful, but require careful assessment, planning and thought before embarked upon.
For those with injuries above T12/L1, bowel management usually relies on the preservation of the 'evacuation reflex'. A suppository, or digital stimulation can help trigger the reflex to empty the rectum. Laxatives may or may not be required to aid the passage of bowel material through the bowel to the rectum. Those with injuries below L1 are usually unable to utilise this reflex and the bowel needs to be emptied manually. Usually fibre is required to aid stool passage to the rectum. There may be overlap around injury levels of T12/L1 where the picture can be one or the other, or a combination of both. For some, a colostomy - where a section of the bowel is brought to the abdomen wall and the stool matter collected in a bag - is becoming a increasingly utilised option.
Before SCI, a normal function of the spinal cord is reflex activity. Usually however this reflex activity is only obvious when your body needs to instantly react without you thinking - for example when your hand draws back without conscious thought if you place it in hot water. For those with SCI above about T12/L1 these reflexes still occur - but now the messages from the brain that modulates these reflexes don't get through the damaged part of the spinal cord well, causing spasticity - or over exaggeration of these reflexes. If the SCI is below about L1, spasticity is very unlikely.
For many people with a SCI chronic pain can be a major issue. The source of pain can be many. Aches and pains particularly in shoulders and upper back due to wheelchair use are common and may respond to local therapy such as physiotherapy and massage. Spasticity can also lead to pain and anti spasticity medications may be useful. Often the most troublesome pain is due to pain generated in the damaged part of the spinal cord. This 'neuropathic' pain is mediated by the damaged spinal cord. It is often described as 'electric shock like' or a 'hot burning poker'.
There are various modalities for treatment of this type of pain including medications, TENS machines (electrical stimulation) and as a last resort surgical procedures. If useful, these treatments usually only dampen the pain and are unlikely to eliminate it completely. An important part of treatment involves diversion tactics such as keeping active and relaxation techniques.
Most men and women with SCI experience changes in sexual function after injury. For men there can be problems gaining and/or maintaining erections, lost or decreased sensation and inability to ejaculate. For women, changes include less vaginal lubrication and decreased sensation. For men, paraplegics are more at risk of erectile dysfunction than tetraplegics. However the good news for men is that Viagra and other medications for erectile dysfunction, vacuum pumps and penile rings can help most men achieve and maintain erections for intercourse.
If these don't work, there a whole range of other approaches to sex and intimacy that those with SCI and their partners can find very satisfying. It can be relatively easy for women with SCI's to maintain normal sexual activities. However, there are often changes to the way women feel or respond to stimulation. Many can still achieve orgasm. Often areas of the body that still have sensation become more sensitive and new erogenous zones are found. Communication with partners and their lovers is the key to enable those with SCI and their partners to explore different ideas and approaches to sex and intimacy.
There are virtually no fertility issues due to SCI for women. A full term pregnancy with natural delivery is still possible with SCI. There are increased risks associated with pregnancy and labour and an experienced medical team is essential. The most significant impact for men's fertility is the ability to produce and ejaculate sperm. Even if ejaculation is possible, most men need to look at fertility treatment if they wish to father children. In spite of this there is a good chance of fathering children. There is also good evidence that there is no psychological effect on children across all domains whom have a mother or father with a SCI.
Getting back to work is proven to be good for people with SCI. Those with SCI who work have fewer health problems, better physical and mental health, a wider social group and generally better quality of life. For some, their old job may not be suitable to do with SCI, but this is just an opportunity to consider something different. There are many different vocational rehabilitation organisations which can aid return to work and retraining if needed.
At the moment - unfortunately there isn't. However there is a lot of research interest being shown in regard to the possibilities of medications given at the time of spinal cord injury to limit the damage, and the use of stem cell implants to repair damaged spinal cord some time after the injury has occurred. The research is certainly still in its infancy, but it is progressing.
CatWalks goal is to support research that will lead to a cure for Spinal Cord Injury. Internationally, there are many areas of investigation. One promising area is the cell-based approach in which damaged spinal cord cells are replaced.
There are many potential candidates for these cells. Currently, the use of cells derived from the patients themselves are thought to be the most promising candidates, such as those derived from nerve tissue at the back of the nose.
Other cells from the patient, such as from the bone marrow, hold possibilities and need further investigation. These are known as adult stem cells. Cells derived from the discarded umbilical cord and placenta without any harm to the newborn baby may also be of value. These are known as foetal stem cells.
Other sources of cells, such as embryonic stem cells, are possibilities for the future, but a number of issues must be addressed before these become a real option.