Improving Bladder Control After Spinal Cord Injuries

Introduction to Bladder Control Loss

Loss of bladder control is a prevalent issue following spinal cord injuries (SCI). A recent study published in *Scientific Reports* demonstrates that magnetic stimulation applied to the lower spinal cord may enhance voluntary bladder control in affected individuals.

Understanding the Spinal Cord

The spinal cord is a delicate structure composed of nerves that extends through the spine’s center. It is a crucial component of the central nervous system, containing sensory and motor neurons that transmit signals between the brain and the body. The spinal cord is safeguarded by vertebrae, and its sections are named according to the vertebrae encasing them. For instance, the cervical spinal cord corresponds to the area passing through the cervical vertebrae at the top, while the thoracic spinal cord pertains to the middle section associated with thoracic vertebrae. The lumbar spinal cord refers to the lower section encompassing the lumbar vertebrae.

Impact of Spinal Cord Injuries on Urinary Function

Damage to the spinal cord from an injury or accident can lead to varying degrees of impairment, depending on the injury’s location and severity. This can result in temporary or permanent loss of sensation, voluntary motor functions, and autonomic functions, including urination. Over 80% of individuals with SCI report difficulties with voluntary urination. To facilitate bladder emptying and protect kidney health, Foley catheters are commonly used. For those with cervical injuries affecting hand mobility, catheter management often requires assistance from caregivers. Consequently, the inability to control bladder function and the increased risk of urinary tract infections (UTIs) associated with catheter use can significantly diminish a patient’s quality of life.

Transcutaneous Magnetic Stimulation (TMS)

Transcutaneous magnetic stimulation (TMS) is a non-invasive and painless technique that employs electrical pulses through a coil to create a magnetic field. While still relatively new, TMS has been utilized diagnostically to assess neural damage and alleviate depression symptoms.

Study on TMS and Bladder Control

In a recent proof-of-concept study published in *Scientific Reports*, a team of neuroscientists from California explored the feasibility of using TMS to enhance bladder control in patients with SCIs. The researchers hypothesized that a weak, residual connection between the spinal cord and the brain remains intact despite injury, which TMS could potentially amplify.

The study involved five participants who experienced SCIs 5 to 13 years prior. TMS was applied to the spinal cord to stimulate neurons responsible for urination. Each participant received 15 minutes of TMS weekly over four weeks. After four sessions, participants reported improvements in bladder capacity, and by the end of four months, all regained the ability to urinate voluntarily during stimulation. Additionally, the frequency of self-catheterization decreased for several weeks after TMS treatment, and participants noted an enhanced quality of life.

Future Research Directions

This study is significant as it suggests that magnetic stimulation of the lower spinal cord can improve quality of life by reducing catheter dependency and increasing independence for individuals with spinal cord injuries. Dr. Lu and the research team aim to conduct a larger follow-up study to examine how varying TMS patterns may affect neural activity in the spinal cord.

Reference

Niu, T., Bennett, C. J., Keller, T. L., Leiter, J. C., & Lu, D. C. (2018). A Proof-of-Concept Study of Transcutaneous Magnetic Spinal Cord Stimulation for Neurogenic Bladder. *Scientific Reports*, 8(1), 12549. DOI:10.1038/s41598-018-30232-z