Medical Update 8/25/09 - (Part 2)

Okay, sorry this has taken me so long. Part of the delay was me trying to wrap my head around the situation enough to be able to explain it to someone else. Which is, in part, why this blog has been so helpful to me. It is one thing to say you understand something. It is quite another when you try to explain it to someone else.

So here goes - this is Annabelle's situation as best I understand - anyone out there with more knowledge or information is welcome to chime in!

Your Bladder: The Guest Bed

Your bladder is like one of those blow-up air mattresses that you haul out for guests. It has a hole on one side where the air goes in, and a hole on the other where the air goes out. When the bladder (air mattress) is empty, it just sits there.

Your kidneys are like the air pump - constantly filtering your blood stream and filling the air mattress with the waste they filter out. Only your kidneys don't have an off switch. 24/7 they are pushing urine into your bladder. If the bladder does not empty itself often enough, the urine will back up into your kidneys and that causes all sorts of problems. So remember: Bladder=air mattress, Kidneys=air pump that never shuts off.

As soon as your bladder (air mattress) has a certain amount of urine (air) in it, it starts to contract and push urine (air) out the urethra (hole where air goes out). Picture your air mattress filling up 1/2 way and then laying a big book equal to the size of the air mattress on top to push all the air out.

To a certain degree, your urethra is programed to not let urine pass until it gets to a certain amount of pressure (picture one of those rubber valves with the little silicon flap inside that requires you to pinch the valve in order to blow air in or let air out). Since that little flap inside the valve can only handle a minimal amount of pressure, potty training is all about learning to jam the plug in the valve. Keep in mind, the air pump is still on, the enormous book is pressing down on the air mattress trying to deflate it, and you are concentrating on keeping that plug tightly in place until you can get to a bathroom.

Once in the bathroom, we essentially pull the plug and our bladder contracts and empties.

Here is Annie's situation:

Because of her Spina bifida, the nerves running to the lower half of her body do not function properly and it appears that her bladder does not fully contract.

So her kidneys (air pump) are constantly filling her bladder just as they should. Once her bladder gets to a certain point, it starts to contract just as it should. Only, instead of having one massive book the same size as the mattress pressing all the air out, she just has a few normal sized dictionaries scattered about the mattress. since the air pump is always on, her mattress remains partially inflated all the time. The only air that ever escapes is that which essentially overflows.

In other words, her kidneys are working fine, filling her bladder with urine as they should. But since her bladder does not appear to be fully contracting, she always has a certain amount of urine in her bladder. The only urine that is passed is the overflow.

During the exam last week, electrodes monitored whether or not her body is capable of plugging the exit hole and it appears that she has muscle contraction in that area but it is unclear how effective it is. And since her tank is always partially full, she has to "go" far more often.

Without treatment:

If this remains untreated, Annie's bladder will stiffen. Remember, your bladder is programed to contract whenever there is a certain amount of urine present. Annie always has urine present so the portions of her bladder that do contract are doing so much more often than typical. Over a course of years, the muscles will tire out. If your bladder looses its elasticity, there is an increase in chances that the urine could back up to the kidneys and that is not helpful.

So what we need to do is figure out a way to drain the remaining air (urine) out of her air mattress (bladder) so that her bladder is periodically empty and it can relax - just like yours and mine.

The way to do that is to stick in a tube periodically and let it drain completely. It is essentially like pulling the plug on the air valve in the mattress and sticking a straw through the valve so that the flap inside stays open.

Short Term Plan, Long Term Treatment to Follow in another post.