Everybody has to go. For those of us with neurological conditions like spinal cord injury, multiple sclerosis, or even complications from a stroke, you can often feel tethered to the toilet. In fact, bladder and bowel control consistently rank among the most important functions to regain among people living with spinal cord injury, according to a study led by Dr. Kim Anderson-Erisman of the Miami Project that surveyed nearly 700 cohorts.

Understanding bladder and bowel options starts with knowing how the systems work. The urinary system consists of an upper tract and a lower tract. The upper tract includes the kidneys and ureters — the ducts that drain urine from the kidneys. The lower tract consists of the bladder, sphincter and urethra. Think of the bladder as the body’s holding tank for urine, while the sphincter is the door and the urethra is the pathway. In a normal functioning system, when the bladder is full, a sensory signal sent to the brain says, “Hey, you need to go.” Once you are in an appropriate position to release, a signal is sent from the brain through the spinal cord telling the sphincter to relax and open the door, allowing urine to pass through the urethra. But for those of us with neurological conditions, the process doesn’t work like that.

For spinal cord injury, neurogenic bladder dysfunction is dependent on the level of injury. Those with lower level injuries can have a flaccid bladder, meaning the bladder does not contract when it is full. High level injuries tend to have a hyperactive bladder (the bladder is overactive with contractions, while the sphincter is underactive). Complications fro