Effect of Intermittent Catheterization Combined with Pelvic Floor Muscle Training on Neurogenic Bladder in Spinal Cord Injury Patients

Neurogenic bladder following spinal cord injury (SCI) is highly prone to causing urinary tract infections, stones, and hydronephrosis, which may progressively develop into chronic renal insufficiency, severely affecting patients' quality of life. It is also one of the leading causes of death in SCI patients. Therefore, reconstructing bladder function after SCI is of great significance for improving renal function, enhancing quality of life, and reducing mortality in these patients.

Intermittent catheterization (IC) enables regular, intermittent bladder expansion, prevents overdistension, and preserves bladder capacity and contractility. It effectively prevents infections of the urinary and reproductive systems and is currently the internationally and domestically recommended method for bladder management. However, clinical observations have found that some SCI patients with neurogenic bladder who use IC alone still experience urinary incontinence. Combining IC with pelvic floor muscle training for voiding dysfunction addresses the limitations of previous treatment approaches.

Compared with IC alone, the combination of IC and pelvic floor muscle training can enhance detrusor contractility and improve the coordination between the detrusor muscle and the urethral sphincter, thereby improving bladder function and gradually restoring it toward a physiological state, ultimately achieving the ability to void voluntarily.

Pelvic floor electrical stimulation uses low-frequency pulsed currents to stimulate the reflex pathways of the pudendal nerve, promoting pelvic floor muscle contraction. It helps balance the excitation and inhibition functions of the detrusor-sphincter unit, facilitates neural recovery, promotes urination, normalizes bladder capacity, and improves voiding function.

Pelvic floor muscle exercise training strengthens the pelvic floor muscle group as well as the strength and control of the detrusor and urethral sphincter, thereby improving bladder function.

Therefore, pelvic floor electrical stimulation and pelvic floor muscle training act by stimulating the pelvic floor muscles and their innervating nerve fibers and nerve centers, producing direct effects on the effector organs or influencing neural pathway activity, ultimately altering the functional state of the bladder and urethra and improving storage or voiding function.

In summary, intermittent catheterization combined with pelvic floor muscle training can significantly improve bladder function, bringing bladder capacity, residual urine volume, and detrusor-sphincter coordination closer to a physiological state. It effectively alleviates patient suffering and improves quality of life, making it worthy of widespread clinical adoption.

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