Q: What is Bladder Sphincter Dysnergia?

A: Bladder Sphincter Dysnergia (BSD) refers to incoordination between the contraction of the bladder and the relaxation of the bladder sphincter.

The sphincter is supposed to relax when the bladder contracts, but in BSD it contracts instead making it hard for the urine to come out.

Often even when the urine does come out, the bladder doesn�t completely empty.

Q: Does Bladder Sphincter Dysnergia happen with all persons with Spinal Cord Injury?

A: No, BSD happens in about half of people with spinal cord injuries.

Q: Will Bladder Sphincter Dysnergia cause other problems for me?

A: Since the coordination between bladder contraction and the outlet sphincter are lost, when the bladder contracts and the outlet sphincter doesn�t relax, increased pressure may develop in the bladder.

A person with SCI generally can�t feel this rise in pressure, so problems may develop without the person realizing it.

Q: What happens to my bladder when this increased pressure occurs?

A: The higher pressure may cause the bladder wall to thicken and outpouchings in the bladder called diverticula to develop.

If these diverticula get infected it may be very difficult to get rid of the infection.

The higher pressure may also cause the one way valves that separate the ureters from the bladder to fail. The higher bladder pressure is then transmitted up to the kidneys.

This is condition is called hydronephrosis, which may permanently harm your kidneys.

Bladder sphincter dysynergia may also cause autonomic dysreflexia if your injury is above T6. Sometimes this is the first sign that BSD is developing.

Q: How will I know if I have bladder sphincter dysnergia?

A: Because bladder sphincter dysnergia can develop without symptoms, it is important to follow up regularly with a health care provider who understands this potential complication and knows how to monitor for it.

Q: What will my doctor do to find out if I have bladder sphincter dysnergia?

A: Screening for this problem may involve x-rays or special scans of the kidneys. These usually need to be done every year or two.

Q: What will I have to do if I have bladder sphincter dysnergia?

A: If you use an external catheter you may need to switch to an indwelling catheter or intermittent catheter so the bladder is completely emptied and the pressure relieved.

For males who want to continue to use an external collective device, an alternative that would allow this would be to have a Botox injection into the sphincter or to have the sphincter surgically cut.

Q: What is involved with injections into the sphincter?

A: Injections into the sphincter are a new approach that involves the doctor looking through a cystoscope and injecting botulinum toxin (Botox) into the sphincter muscle. This procedure needs to be repeated about every four months to keep the sphincter relaxed.

Q: What is involved with cutting the sphincter?

A: Cutting the sphincter, an operation called an sphincterotomy, involves cutting the sphincter muscle so that it doesn�t block the flow of urine when the bladder contracts.

Q: How is the operation done?

A: The operation is done through a cystoscope that is inserted into the urethra that allows the doctor to see the bladder and the sphincter. A surgical knife is then used to cut the sphincter in about three places.

After this procedure pressure problems generally go away.

Q: Are there side effects with having a sphincterotomy?

A: Some men lose their ability to have erections after this procedure and the sphincter cannot be repaired.

Q: Will I be able to use any type of bladder technique after a sphincterotomy?

A: After a sphincterotomy it is not possible to use the intermittent catheterization or bladder stimulator approach to bladder management. The bladder just doesn�t hold urine very well after a sphincterotomy.