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Special Edition on Neuro-urology

A qualitative assessment of psychosocial aspects that play a role in bladder management after spinal cord injury


Study design

Prospective qualitative study using semi-structured, open-ended interviews.


To better understand psychosocial aspects of bladder management after spinal cord injury (SCI).


People with SCI, recruited through three tertiary care centres in North America.


Thirty-four community-dwelling individuals with SCI were selected using purposive sampling to ensure men and women with both tetraplegia and paraplegia were represented. The interviews were audio recorded and transcribed. NVivo software was used to code psychosocial domains, medical complications, and methods of bladder management. A qualitative interpretive approach was used, and four participants participated in a debrief session to review the study findings.


The median age was 49 (IQR 40–62) years and 61% (21/34) were male. Most had complete injuries (AIS A, 47%, 16/34), and most had a cervical lesion (56%, 19/34). There was a large range of time living with a SCI (median 20 years, IQR 9–31), and most participants managed their bladder with intermittent catheterisation (67% 23/34). The five most common psychosocial domains were anxiety (often in the context of urinary infections, incontinence, or not being able to catheterise), loss of control (due to irregular bladder behaviour), and embarrassment (from incontinence occurring in public); the domains of confidence and independence/planning included both positive and negative examples of bladder management experiences.


This study demonstrated consistent psychosocial topics related to bladder management in people living with SCI. This information will help counsel people regarding bladder management and identify areas for education and optimisation of bladder function from a psychosocial perspective.

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Fig. 1: Intersection of psychosocial domains and bladder complications.

Data availability

The datasets generated during the current study are available from the corresponding author on reasonable request.


  1. 1.

    Linsenmeyer TA, Linsenmeyer MA. Impact of annual urodynamic evaluations on guiding bladder management in individuals with spinal cord injuries. J Spinal Cord Med. 2013;36:420–6.

    Article  Google Scholar 

  2. 2.

    Bellucci CHS, Wöllner J, Gregorini F, Birnböck D, Kozomara M, Mehnert U, et al. Acute spinal cord injury-do ambulatory patients need urodynamic investigations? J Urol. 2013;189:1369–73.

    Article  Google Scholar 

  3. 3.

    Simpson LA, Eng JJ, Hsieh JTC, Wolfe DL. The health and life priorities of individuals with spinal cord injury: a systematic review. J Neurotrauma. 2012;29:1548–55.

    Article  Google Scholar 

  4. 4.

    van der Meer P, Post MWM, van Leeuwen CMC, van Kuppevelt HJM, Smit CAJ, van Asbeck FWA. Impact of health problems secondary to SCI one and five years after first inpatient rehabilitation. Spinal Cord. 2017;55:98–104.

    Article  Google Scholar 

  5. 5.

    Jensen MP, Truitt AR, Schomer KG, Yorkston KM, Baylor C, Molton IR. Frequency and age effects of secondary health conditions in individuals with spinal cord injury: a scoping review. Spinal Cord. 2013;51:882–92.

    CAS  Article  Google Scholar 

  6. 6.

    Adriaansen JJE, Post MWM, de Groot S, van Asbeck FWA, Stolwijk-Swüste JM, Tepper M, et al. Secondary health conditions in persons with spinal cord injury: a longitudinal study from one to five years post-discharge. J Rehabil Med. 2013;45:1016–22.

    Article  Google Scholar 

  7. 7.

    Haisma JA, van der Woude LH, Stam HJ, Bergen MP, Sluis TA, Post MW, et al. Complications following spinal cord injury: occurrence and risk factors in a longitudinal study during and after inpatient rehabilitation. J Rehabil Med. 2007;39:393–8.

    Article  Google Scholar 

  8. 8.

    Liu C-W, Attar KH, Gall A, Shah J, Craggs M. The relationship between bladder management and health-related quality of life in patients with spinal cord injury in the UK. Spinal Cord. 2010;48:319–24.

    Article  Google Scholar 

  9. 9.

    Hansen RB, Biering-Sørensen F, Kristensen JK. Urinary incontinence in spinal cord injured individuals 10-45 years after injury. Spinal Cord. 2010;48:27–33.

    CAS  Article  Google Scholar 

  10. 10.

    Welk B, Liu K, Winick-Ng J, Shariff SZ. Urinary tract infections, urologic surgery, and renal dysfunction in a contemporary cohort of traumatic spinal cord injured patients. Neurourol Urodyn. 2017;36:640–7.

    Article  Google Scholar 

  11. 11.

    Cameron AP, Wallner LP, Forchheimer MB, CLEMENS JQ, Dunn RL, Rodriguez G, et al. Medical and psychosocial complications associated with method of bladder management after traumatic spinal cord injury. Arch Phys Med Rehabil. 2011;92:449–56.

    Article  Google Scholar 

  12. 12.

    Welk B, McGarry P, Kennelly M, Myers J, Neurogenic Bladder Research Group. Bladder management experiences among people living with neurologic disease: a systematic review and meta-synthesis of qualitative research. Neurourol Urodyn. 2018.

  13. 13.

    Nevedal A, Kratz AL, Tate DG. Women’s experiences of living with neurogenic bladder and bowel after spinal cord injury: life controlled by bladder and bowel. Disabil Rehabil. 2016;38:573–81.

    Article  Google Scholar 

  14. 14.

    Braaf S, Lennox A, Nunn A, Gabbe B. Social activity and relationship changes experienced by people with bowel and bladder dysfunction following spinal cord injury. Spinal Cord. 2017;55:679–86.

    CAS  Article  Google Scholar 

  15. 15.

    Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19:349–57.

    Article  Google Scholar 

  16. 16.

    Smith JA, Flowers P, Larkin M. Interpretative phenomenological analysis: theory, method and research. SAGE publications Ltd. London UK, 2009.

  17. 17.

    Halcomb EJ, Gholizadeh L, DiGiacomo M, Phillips J, Davidson PM. Literature review: considerations in undertaking focus group research with culturally and linguistically diverse groups. J Clin Nurs. 2007;16:1000–11.

    Article  Google Scholar 

  18. 18.

    Post MWM, van Leeuwen CMC. Psychosocial issues in spinal cord injury: a review. Spinal Cord. 2012;50:382–9.

    CAS  Article  Google Scholar 

  19. 19.

    van Leeuwen CMC, Kraaijeveld S, Lindeman E, Post MWM. Associations between psychological factors and quality of life ratings in persons with spinal cord injury: a systematic review. Spinal Cord. 2012;50:174–87.

    Article  Google Scholar 

  20. 20.

    Bolinger R, Engberg S. Barriers, complications, adherence, and self-reported quality of life for people using clean intermittent catheterization. J Wound Ostomy Cont Nurs. 2013;40:83–9.

    Article  Google Scholar 

  21. 21.

    Logan K, Shaw C, Webber I, Samuel S, Broome L. Patients’ experiences of learning clean intermittent self-catheterization: a qualitative study. J Adv Nurs. 2008;62:32–40.

    Article  Google Scholar 

  22. 22.

    Yılmaz B, Akkoç Y, Alaca R, Erhan B, Gündüz B, Yıldız N, et al. Intermittent catheterization in patients with traumatic spinal cord injury: obstacles, worries, level of satisfaction. Spinal Cord. 2014;52:826–30.

    Article  Google Scholar 

  23. 23.

    Kelly L, Spencer S, Barrett G. Using intermittent self-catheters: experiences of people with neurological damage to their spinal cord. Disabil Rehabil. 2014;36:220–6.

    Article  Google Scholar 

  24. 24.

    Shaw C, Logan K. Psychological coping with intermittent self-catheterisation (ISC) in people with spinal injury: a qualitative study. Int J Nurs Stud. 2013;50:1341–50.

    Article  Google Scholar 

  25. 25.

    Wilde MH. Life with an indwelling urinary catheter: the dialectic of stigma and acceptance. Qual Health Res. 2003;13:1189–204.

    Article  Google Scholar 

  26. 26.

    Wilde MH, Brasch J, Zhang Y. A qualitative descriptive study of self-management issues in people with long-term intermittent urinary catheters. J Adv Nurs. 2011;67:1254–63.

    Article  Google Scholar 

  27. 27.

    Fowler S, Godfrey H, Fader M, Timoney AG, Long A. Living with a long-term, indwelling urinary catheter: catheter users’ experience. J Wound Ostomy Cont Nurs. 2014;41:597–603.

    Article  Google Scholar 

  28. 28.

    Barratt A. Evidence based medicine and shared decision making: the challenge of getting both evidence and preferences into health care. Patient Educ Couns. 2008;73:407–12.

    Article  Google Scholar 

  29. 29.

    Afsar SI, Yemisci OU, Cosar SNS, Cetin N. Compliance with clean intermittent catheterization in spinal cord injury patients: a long-term follow-up study. Spinal Cord. 2013;51:645–9.

    CAS  Article  Google Scholar 

  30. 30.

    Park HC, Son JH, Jang SH. Rethinking suprapubic cystostomy in voiding dysfunction: new trial with timed drainage. Korean J Urol. 2010;51:847–52.

    Article  Google Scholar 

  31. 31.

    Yavuzer G, Gök H, Tuncer S, Soygür T, Arikan N, Arasil T. Compliance with bladder management in spinal cord injury patients. Spinal Cord. 2000;38:762–5.

    CAS  Article  Google Scholar 

  32. 32.

    McKinley WO, Jackson AB, Cardenas DD, DeVivo MJ. Long-term medical complications after traumatic spinal cord injury: a regional model systems analysis. Arch Phys Med Rehabil. 1999;80:1402–10.

    CAS  Article  Google Scholar 

  33. 33.

    MacGillivray MK, Sadeghi M, Mills PB, Adams J, Sawatzky BJ, Mortenson WB. Implementing a self-management mobile app for spinal cord injury during inpatient rehabilitation and following community discharge: a feasibility study. J Spinal Cord Med. 2019;3:1–9.

    Google Scholar 

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Ashlea Wilkes, Robbin Clark and Cameron Futral are thanked for their assistance with this project.


This study was supported by a Psychosocial Research Grant from the Craig H. Neilsen Foundation.

Author information





BW initiated the collaborative project, obtained funding, co-designed and edited the study protocol, conducted the analysis, and drafted and revised the paper. JM, MK, MM, JW and KG co-designed the study protocol, contributed to the analysis of the results and revised the paper. All authors approved the final paper.

Corresponding author

Correspondence to Blayne Welk.

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The authors declare that they have no conflict of interest.

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Welk, B., Myers, J.B., Kennelly, M. et al. A qualitative assessment of psychosocial aspects that play a role in bladder management after spinal cord injury. Spinal Cord 59, 978–986 (2021).

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