Conservative treatment for leg oedema and the effect on nocturnal polyuria in patients with spinal cord injury.

Abstract

To evaluate the possible influence of non-pharmacological interventions, such as compressive bandages and intermittent pneumatic compression (IPC), on leg oedema and nocturnal polyuria (NP), and the possible interrelation between both pathologies in patients with spinal cord injury (SCI), as patients with SCI often have leg oedema and during the night the oedema decreases as a result of natural drainage mechanisms that can cause NP. Patients with SCI who followed their first rehabilitation after their SCI with bilateral leg oedema and/or with as much or a larger urine volume at night as during the day. The patients were all wheelchair users and followed the rehabilitation programme daily for 3weeks. In all, 24 patients, aged between 21 and 63years, were selected for participation in the 3-week rehabilitation programme. During the first week, baseline data were collected. During the second week, IPC was executed from the moment the patient went to lie down. During the third week, the patients wore multilayer compressive bandages. Leg circumference was measured in the morning before sitting up and at the moment they went to lie down in bed. During each study week, a daily frequency-volume chart (24h) was completed. The leg volume of both legs was significantly different between the morning and evening (right leg F=103.90, P<0.001; left leg F=100.77, P<0.001) and between the three treatments (right F=9.70, P<0.001; left F=9.66, P<0.001). There was a significant difference between the compressive bandages and the baseline period (right and left leg, both P<0.001) and between the compressive bandages and IPC (right leg P=0.009 and left leg P=0.015). There was no significant difference between IPC and the baseline. When no treatment or IPC was used, urine production was significantly higher during the bed-rest period. The urine production was significantly lower comparing the use of compressive bandages to baseline and IPC, during bed rest (P=0.009) and during sleep (P<0.001). There was a significant decrease in absolute voided volume at night with the compressive bandages as treatment (P<0.001). There was a significant positive association between the leg volume change during the day and the urine-production ratio, 100mL increase in leg volume was associated with 8% increase in the log-transformed urine-production ratio. There are alternative treatment options for patients with SCI who have oedema or NP. Oedema formation and urine production appear to be related to each other. Therefore, the use of compressive bandages was shown to be a valuable treatment option to improve both leg oedema and NP.