Incontinence Living with Incontinence

The Problems of Paralysis: It's Not Just About the Wheelchair

This autumn, the country mourned the loss of Christopher Reeve, the actor who played Superman and became a hero to many people with spinal cord injuries because of his activism following his own paralysis. Reeve's outspokenness helped to spotlight an often hidden community, and his death on October 10th from an infection highlights the medical challenges faced by people living with spinal cord injury.

It's estimated that about 247,000 people in the United States are living with a spinal cord injury. While Reeve's injury resulted from a fall from a horse, most injuries occur during motor vehicle accidents, or from falls, violent acts or sports and recreation accidents. A spinal cord injury occurs when the nerves in the spinal cord, which carry messages to and from the brain, are damaged.

There are different kinds of spinal cord injury, which lead to different complications. With complete spinal cord injury, the spinal cord nerves are damaged to the point that no messages can be transmitted to or from the brain and total paralysis results below the affected area. An incomplete injury causes partial paralysis and leaves people with some sensation. People may maintain sexual function and control of their bladder and bowels, for example.

Amie B. Jackson, MD, chair of the department of physical medicine and rehabilitation at the University of Alabama at Birmingham, says many of the complications of spinal cord injury can be more difficult than paralysis itself.

"I think that most people who are not familiar with spinal cord injury think that the major issue is walking," Dr. Jackson says. "Obviously people with spinal cord injury want to walk. Or, if they're quadriplegic, they want to use their arms. But after an injury, their major focus is not paralysis, but their bladder and bowel management, for example."

Below, Dr. Jackson discusses the major medical issues that people with spinal cord injury live with—and how they cope.

Why are bladder and bowel dysfunction top concerns for many people with spinal cord injury?
People with spinal cord injury often experience bladder dysfunction. To deal with this, some individuals will have an indwelling catheter and some will put a catheter in periodically during the day to drain their bladder. For some people, their bladder may start working, but they have no awareness that it's working or no control over it. Men with this condition may have what's called a condom catheter that collects the urine.

Many people with spinal cord injury don't have control of their bowels either, so they develop bowel disorders and chronic constipation.

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