The skin is the largest and heaviest organ in the body. In adults, it is approximately two square meters and makes up about 15% of the body’s weight. Skin is very pliable. Its major function is to protect the body from the environment. It acts as a layer to keep out micro-organisms and prevent infections. It is responsible for regulating body temperature. Many other important functions of the body are also dependent on healthy skin.

People with spinal cord injury and those with severe mobility impairments spend a lot of time in bed or wheelchair. The scapulas (shoulder blades), sacral region (tailbone), elbows, buttocks and heels are spots where the skin is constantly being pressed against the bed or wheelchair. Continuous pressure against those parts will result in pressure sores. Pain is a precursor to developing pressure sore and the loss of sensation or numbness after spinal cord injury exacerbates the condition.

The severity of a pressure sore is categorised into four stages. When one sits or lie down in the same position for too long, the skin around those pressure spots will become red, tender and warm to the tough. This is Stage I. The problem will go away as soon as the pressure is relieved. The tenderness can be reduced and soothed by gentle massaging with skin lotion.

In Stage II, skin loss occurs because the pressure is not relieved. Blood supply to the area is cut off causing tissue to die. It becomes an open sore. This skin loss is usually limited to the epidermis (outer layer of the skin) or includes some of the underlying tissue. It heals fairly quickly if treated promptly.

If continuously left untreated, the open sore becomes deep and crater-like. This is Stage III. All the layers of the skin from epidermis to the dermis (inner layer of the skin) are damaged. There will be muscles and tissue loss too. Even with proper care the sore may take a long time to heal.

By Stage IV, apart from damage of skin, muscle and tissue, bone loss occurs as well. Tendons and ligaments would have been irreparably damaged or destroyed. Pressure sore that has reached this stage will be difficult to treat and may result in fatality resulting from infection.

Pressure sore can be avoided by constantly relieving skin and tissue stress in the body commonly affected by this problem. Paraplegics who have good strength in the arms know the importance of periodically lifting their buttocks off the wheelchair. Quadriplegics should perform assisted pressure relief often with the help of caregivers for the same purpose.

Other factors that can cause pressure sores include the seams of pants, creases on cushion cover and wheelchair seat, skin damage from sliding on coarse surfaces and dampness of the skin from wearing diapers or leaked urine. It is easier and cheaper to prevent pressure sores than treating them. Therefore it is of utmost importance to do a thorough check of the pressure points every morning and before bed for potential signs of pressure sores.

Related Link: Spinal cord injury solicitor Brian Camp & Co. Solicitors, a UK based personal injury solicitors specialising in spinal injury claims.

Renal failure is the major cause of death in people with spinal cord injury (SCI). For those who are living with it, this adds an unwelcome burden to an already strained financial situation. Renal failure will eventually lead to a stage where hemodialysis is needed. Dialysis is a tedious and expensive process that many with SCI can ill afford.

The kidneys filter waste products from blood to form urine which is then stored in the bladder and discharged through the urethra. In some people with SCI, the bladder can go into uncontrolled contractions. These are called spasms. It causes urine to be pushed back into the kidneys. This is called a reflux. Spasms and reflux will eventually lead to irreparable damage to the kidneys and cause them to fail.

The other cause of kidney failure is urinary tract infection (UTI). This can occur in the bladder, kidneys or other parts of the urinary tract. If left untreated, it can also damage the kidneys. Among the factors contributing to UTI are poor hygiene around the genitals, sexual intercourse and diet.

There are several methods to reduce the occurrences of spasms and reflux. One is through medication. There are drugs to relax the bladder. The other is to empty the bladder at regular intervals, usually every four hourly, through intermittent catheterization.

In intermittent catheterization, a catheter, which is essentially a tube made from either PVC or latex, is inserted through the urethra into the bladder to drain the urine completely. The catheter is then removed, cleaned and stored for use later.

Unfortunately, intermittent catheterization is also a major cause of UTI by introducing bacteria into the bladder. Therefore, it is important that the catheter be kept as clean as possible and hands are properly washed prior to the procedure.

The act of drinking sufficient water throughout the day and emptying the bladder regularly reduces the opportunity for bacteria to multiply. A balanced diet is essential. However, the intake of coffee and carbonated drinks should be restricted as they are known to irritate the bladder and promote UTI.

Prevention is certainly better than cure when it comes to renal failure. The damage cannot be reversed. It can only get from bad to worse. The quality of life for people with renal failure is greatly reduced, more so when it occurs in those with severe physical impairments.

Medical and rehabilitation personnel must provide such information to people with SCI who are under their care to allow them to make informed decisions. I have known of cases where doctors were not in favour of good bladder management practices for whatever reasons best known to themselves. Pity those who regarded the doctors’ advice as the Gospel truth only to realise too late that they could have avoided renal failure had they been properly educated in these matters.

This entry first appeared in Monster Blog on August 22, 2006.

Related Link: Spinal cord injury solicitor Brian Camp & Co. Solicitors, a UK based personal injury solicitors specialising in spinal injury claims.