In the initial years after spinal cord injury, I was often stricken with urinary tract infections (UTI). This could be due to the indwelling catheter that was not properly maintained, insufficient intake of water, improper diet and low-resistance to infections. Urinary tract infection can lead to serious complications such as infection of the kidneys (acute pyelonephritis), inflammation of the bladder (cystitis) and inflammation of the urethra (urethritis) if not properly treated.

Early symptoms of urinary tract infection includes the urge to urinate often but only passing out small amounts of urine (cystitis), a burning sensation while urinating (urethritis), blood in urine (hematuria) and urine that is cloudy and strong-smelling. Advanced symptoms includes tremors, chills, high fever and symptoms related to high fever such as nausea, hallucination, poor appetite and vomiting.

Antibiotics were prescribed each time I had urinary tract infection. Little did I realise that over the years, I had to take stronger and stronger antibiotics because the infection-causing bacteria became progressively resistant to the more common antibiotics. It came to a stage where the urologist advised me to try to clear the infection by drinking more water because the urine culture and sensitivity (C & S) showed that nothing but the strongest antibiotics will work for me and some of the bacteria are already multi-drug resistant. In addition to that, I have to avoid antibiotics that are nephrotoxic to prevent further damage to my kidneys.

We all know that prevention is better than cure. Therefore it is important to take steps to reduce or even prevent the occurrences of urinary tract infections. Good practices include drinking sufficient water, replacing an indwelling catheter according to schedule, ensure cleanliness during intermittent catheterisation and bowel programmes, and emptying the bladder at predetermined intervals to prevent bacteria from multiplying.

If there is a need to take antibiotics for urinary tract infections, the full course must be completed. Stopping the course halfway when the symptoms have disappeared may not have fully eliminated all the bacteria and could even restart another infection. Taking partial courses can make the bacteria resistant to the same antibiotic later on. One should never self-medicate with antibiotics bought over the counter without proper medical diagnosis and advice. It is important not to abuse the use of antibiotics to prevent the occurrences of antibiotic resistant and multi-drug resistant bacteria as it will leave doctors with very few treatment choices and may result in the use of more expensive drugs.

Persons with spinal cord injury understand too well the perils of not drinking sufficient water. Constipation and urinary tract infections are two symptoms related to insufficient intake of water. Constipation can cause autonomic hyperreflexia while persistent urinary tract infection may damage the kidneys. To avert those problems, they are often advised to drink at least two litres of water. More often than not, many drink too much.

Drinking too much, known as hyperhydration, gives rise to another set health complications. Hyperhydration causes hyponatremia where sodium in the body is over-diluted and washed out from the body by the kidneys in the forum of urine. Sodium regulates fluid balance in the body, maintains blood pressure, helps transmit nerve impulses and is vital for muscle contraction. If sodium is not replaced, essential cellular functions will be disrupted.

Symptoms of hyponatremia include nausea, fatigue, dizziness, muscle cramps, disorientation and can lead to coma or even death. Minor hyponatremia can be treated by eating salty food and drinking sports drinks like 100Plus and Gatorade. Severe hyponatremia needs urgent medical attention. The problem of hyperhydration is apparent on hot days when too much water is drunk to quench thirst, especially by those who are taking Detrusitol which tends to cause dryness to the eyes, nose and mouth.

Therefore, it is important to pace the intake of water throughout the day. An adult needs to drink an average of two litres of water daily. A regulated intake of water not only reduces the likelihood of hyperhydration but also allows better bladder management by keeping the schedule for intermittent catheterisation and eliminating instances of a full bladder in between that.