Back to Basics: The unsung heroes of spinal cord injury health - bladder, bowel & skin
By Taylor Sarantidis, Spinal Nurse Consultant, estara
When we talk about spinal cord injury (SCI), conversations often focus on mobility, independence, or assistive technology. But some of the most impactful, and often most private challenges, are those that affect bowel, bladder, and skin health.
These three core areas are closely linked to a person’s dignity, confidence, and overall wellbeing. While they might not make headlines, they absolutely deserve the spotlight during SCI awareness week.
Bladder health: control confidence & complications
After a spinal cord injury, bladder function is almost always affected. This is because the injury disrupts communication between the bladder, spinal cord and brain (neurogenic bladder). Whether it’s difficulty sensing a full bladder, being unable to empty it or frequent infections, neurogenic bladder is a common and ongoing challenge.
Without proper management people may experience:
Urinary tract infections (UTIs)
Kidney complications
Incontinence or leakage leading to embarrassment or skin issues
Overdistention of the bladder which can be painful or harmful
But it’s not all doom and gloom, there are many ways to regain control and confidence.
Bladder management strategies
Bladder management strategies include:
Intermittent catheterisation: many people learn to self-catheterise on a schedule.
Indwelling catheters or suprapubic catheters, depending on individual needs.
Fluid tracking and bladder diaries to spot patterns and prevent accidents.
Close support from continence nurses and Spinal Nurses from estara and urologists.
UTI prevention is key to staying well-hydrated, keeping equipment clean, and knowing the early signs of infection (cloudy urine, strong smell, fever) can make a big difference.
Bladder routines can feel overwhelming at first and it’s normal for this to impact confidence or cause stress. But with the right plan and ongoing support, they become part of life and a path to renewed freedom, dignity, self-esteem and mental peace.
Bowel health: routine is everything
Bowel care after SCI is all about finding a predictable and manageable routine. Neurogenic bowel can cause constipation, leakage or impaction none of which are pleasant especially when out and about or trying to get on with life.
Bowel issues are also linked to mental health. In my experience, many people with SCI report that bowel accidents affect their confidence more than any other complication.
Key components of a successful bowel program
There are several things you can prioritise to manage your bowels after SCI
Regular timing usually once every 1-3 days aiming for predictability.
Use of suppositories, enema’s, transanal irrigation digital stimulation, or other techniques to trigger bowel movements.
A diet high in fibre, plenty of hydration, and sometimes laxatives or stool softeners.
Consistency, patience, and support because it can take time to find what works and what doesn’t.
It’s important to remember there’s no one size-fits all bowel routine. It often requires trial and error with help from allied health professionals like nurses, occupational therapists or dietitians. Having a reliable plan can help reduce anxiety and support social participation, travel, and daily activities things that strongly impact mental wellbeing and independence.
Skin health: pressure free is the way to be
Skin is the body’s largest organ and one of the most vulnerable after a SCI. With reduced movement and sensation, many people are at risk of developing pressure injuries (also known as pressure sores or ulcers).
These injuries often start small, a red mark or area of warmth but can progress quickly into open wounds that are painful, slow to heal and potentially life threatening. Sometimes they can progress quickly requiring surgery or hospital stays. They can also cause a serious hit to self-image, emotional wellbeing and freedom.
Common pressure areas include (to name a few)
Tailbone (sacrum)
Hips and buttocks
Heels
Shoulders or elbows
How to protect your skin:
Pressure relief every 30 minutes when sitting (tilts, lifts, or leans).
Daily skin checks using mirrors or support from support workers/carers
Use of special cushions like ROHO’s, mattresses and breathable clothing.
Keep skin clean, dry and moisturised especially if managing incontinence.
Skin care is a team effort, between the person with SCI, carers, nurses, and therapists and it can make the difference between independence and hospital stays. Consistent prevention supports physical health and protects confidence and mental peace by avoiding the disruption and distress that wounds can cause.
Why these topics matter?
Bowel, bladder and skin health aren’t always talked about but they affect every person with a spinal cord injury every day. They influence social life, mental health, work, relationships, and the simple ability to feel comfortable in your own body.
During Spinal Cord Injury Awareness Week, estara celebrates strength, resilience, and community. We also push for better awareness, education, and support for these vital health areas.
Bladder accidents, bowel routines, and pressure sores are often seen as taboo things people feel they have to deal with quietly or even hide. But the truth is, these issues are part of everyday life for many people with spinal cord injury. We want to change the conversation.
Together, lets break the silence and keep advocating for care that supports the whole person inside and out. The more we talk about these challenges openly and honestly the more we reduce stigma, share solutions, and build confidence. It’s time to make it comfortable to talk about the uncomfortable. Because no one should feel alone when it comes to their basic health needs. Because, at estara, you matter.