Incontinence due to Lumbar problems

[Pino]

Just read a thread in a German Forum and i am surprised about it. Somebody complains about operation / problems at L5/S1 with spinal stenosis and foraminal stenosis resulting in complete or gush emptying of the bladder. Many people comment that this is unusual, because damage at this point will cause retention. (@mickdl)

I do have formaninal stenosis as well and some disc prolapse and i do have got NDO and not retention, just DSD additional as a result of a (over) compensating pelvic floor. Other neurological problems could be the reason for my problems as well, like POTS and ME are both either related to bladder problems, mostly OAB.

But i am very sure there are several people here with NDO / OAB symptoms and lumbar problems, but i can not remember one with retention only.

Is my personal view that incorrect? I know in the medical books lumbar problems are usually related to inactive bladder, but my personal impression is different.
And specifically the foraminal stenosis on the right side of the spine, like in my case, seems to stop the "suppress reaction" of the brain, leading to OAB symptoms, the left side would result in no information about bladder status to the brain, as far as i understand it, and cause retention and overflow problems.

So people with lumbar problems, tell me please your personal experience, i am eager to know.

 

[Edgewater]

It is very important to read or listen very closely as such comments near always have a disclaimer as a result of the vast variations that occur regarding Incontinence. It is much like the 'Bell Shaped Curve' in that there is the large center populations, but, one tends to forget the right and left sides of that curve. Point is, the effects caused by issues at the L5/S1 do effect incontinence. What precisely, varies client to client!

 

[Tenaman]

Can’t say that I understand half the medical terms but I can speak from experience. Original neck fracture and nerve damage caused me to start wetting the bed again. Subsequent spinal injuries/issues and operations at L3/L4/L5 and S1 caused further problems and I now have no feeling of needing to go to the loo so wear nappies 24/7. The first I know I am weeing is when I feel my nappy getting wet.

 

[mickdl]

Hi Pino,

Unfortunately, the answer to the question is not easy and some things have not yet been 100% researched, but I'll give it a try.

In principle, it is assumed that there are four control loops that work together and thus enable continence in the end. To answer your question, you can summarize the first two loops because they are located in the brain.

If you can exclude the brain as a cause, two areas of the spine remain. At the point of why it's two areas and how it all works, it gets a little more complicated.

Different nerve pathways (descending) are "switched" on their way from and to the brain. The switching of the impulses from the brain to the muscles takes place in the lower motor neuron (LMN). The motor neurons are located in the anterior horn of the spinal cord and in the motor cerebral nerve nuclei. From there, they give their impulses directly to the muscles. Without the LMN, voluntary movement is not possible. If parts of it fall out, this leads to paralysis of the muscle in question.

The head - more precisely the pontine miction center (PMC) sends impulses via the nerves in the spinal cord channel (down) to the sacred miction center (SNC) which is located between S2 and S4. Here, too, the LMN's will be switched over again. Injury or damage to the LMN between S2 and S4 thus also leads to damage to the PMC and subsequently to blistering and/or sphincter paralysis. As a result, the bladder can no longer be emptied voluntarily. There is an exception here, which is in the PMC. The PMC can "bridge" the brain control. This happens when the pressure in the bladder becomes too high. In this case, an emptying reflex is created - which then (was) also called reflex incontinence.

When such spinal cord damage occurs, one speaks - depending on the degree of damage also of an incomplete or complete paraplegia because almost always the lower limbs are also affected. This damage can be clearly proven by means of S-SEP. If the S-SEP is normal, the problem is somewhere else.

In order for something like this to happen at all, however, the spine must be severely damaged. This is because the motor pathways run quite far in the spinal cord on the one hand and on the other hand also on the side facing away from the intervertebral disc. A slight spinal cord compression, e.g. due to a herniated disc, cannot cause such damage - at least as long as there are still enough cerebrospinal fluid reserves. This actually only works through a possible subsequent inflammation that may lead to the demise of nerves. Another typical case for such a disorder would be diabetic polyneuropathy.

The situation is slightly different with the ascending nerve pathways that are responsible for perception. Many of these pathways run on the outside of the spinal cord canal and are therefore a little more sensitive to disturbances.

These disorders can become the cause of an overactive bladder because they lead to the fact that the brain simply evaluates an incorrect bladder filling level due to the nerve disorder in the ascending pathways and then mistakenly generates urinary urgency, although this would not be necessary at all, which can then lead to urge incontinence in the worst case. Especially if there is also a pelvic floor weakness.

By the way, a similar phenomenon can also occur with BPH - only that the misinformation in this case is generated by the bladder itself in connection with the prostate.

A neurogenic de-combladder as it is often presented here is caused by a malfunction in the brain (the first and second control loop). The causes here are e.g. strokes, Alzheimer's, Parkinson's and similar diseases.

I hope that helps a bit for understanding.

cu
Mick

 

[EcoIncon]

I have issues with L5-S3 and suffer from OAB but not so much with retention. Not sure if the L5-S3 issues are causal for my issues as there are other things going on for me but perhaps contributory.

 

[Pino]

"Other things going on" is the exact problem i think, i was told my lower back is responsible for my problems by a Neuro-Urologist, who did the UDM and diagnosed Neurogenic Detrusosor Overactivity and Detrusor Sphincter Dysfunction. Later my Pelvic Floor Specialist, who talked with me for about two hours, asking a ton of questions, stated, that this diagnosis makes no sense at all. At least the cause to it.
She said my description sounds very much more like Interstitial Cystitis and some problem with my brain, as the lower back problems would cause retention. Later i learned that Dysautonomia can cause bladder problems as well and i do have got Polyneuropathy on top of it.
I did for three month TENS stimulated training of the pelvic floor and it was obvious that my back pain makes my control worse, i am able to control my pelvic floor, but when the pain level raises, the device could barely "see" it. I thought that to be very interesting, by my doctors did not seem to care much. In the end it does not change the diagnosis and my problems. I really just like to know.

 

[mickdl]

Hi Pino,
You probably mean Detrusor Sphincter Dyssynergy? There is also a malfunction of both - that would then be a paralysis of both muscles. In this case, from a certain filling amount, the bladder would eventually build up so much pressure that the sphincter opens independently through the pressure and the bladder overflows. She then does this regularly in small quantities - exactly until the time when the natural closing pressure of the sphincter is sufficient to close again. In this case, reflex emptying is usually no longer possible.

A dyssynergy occurs when Detruor and sphincter work against each other - more precisely when the detrusor contracts without the sphincter opening. One cause of this may lie in a "decoupling" of the upper and lower micturition center. So with reference to the spine above the lower micturition center - or above the lumbar spine.

In contrast to this, there is also the Detrusor Sphinkter Dyscoordination. This has no neurological correlate but is often the result of a "learning process" that can occur, for example, in an overactive bladder. This is due to the fact that due to the detrusor hyperactivity, an attempt is always made to maintain the urine by tightening the sphincter and pelvic floor. At some point, this also happens automatically if you actually want to empty the bubble voluntarily.

As long as the lower miction center still has complete control over detrusor and sphincter and the LMN are not destroyed, reflex loops can also form more clearly, which then ensure autonomous emptying. However, this is rather not the case with a real lumbar spine problem because the LNM's are almost always affected and so the reflex function is no longer given.

However the topic of detrusor hyperactivity is much more difficult to encircle than the detrusor or sphincter hypoactivity.

There can be many more problems on the topic of overactivity than on the LMN topic. This is already mentioned here and it is often the case in this area that in addition to possible neurological disorders, other multimorbilities are also involved, which then have a negative effect in the result. The topic of PNP is also special again and in this context has a more or less identical (urological) complaint such as MS.

Just as with MS, diagnostics in the initial stage can be difficult, because foci of inflammation can only be detected radiologically from a certain extent and sensory disorders are on the one hand more difficult and on the other hand much more complex to measure in this area.

In the end, this is a minor role for the treatment. As a rule, this become important when it comes to expert opinions, e.g. for a disability pension or the recognition of a severe disability.

 

[EcoIncon]

In the end it does not change the diagnosis and my problems. I really just like to know.

I feel your pain... (I hope this expression is translatable to Deutsch). I would really like to know the root cause of my issues too. But our doctors are only "practicing" medicine and it seems that a lot of the time they simply don't know. So I live with an OAB diabnosis and seemingly medieval approaches (botulism toxin and diapers) to making it less impactful to my life.

I hope some day we both find the "smoking gun".

 

[Pino]

In my case it is classified as DS-Dyscoordination, with the explanation you wrote @mickdl , i used the wrong "D".

ME and MS are very close in symptoms, but ME is much, much less documented. Most of the time my bladder is OAB like, but sometimes, when the back pain is higher and i take a "relaxing" position for my spine, my bladder will just let go without warning, i can not control my pelvic floor in that moment. It happens not that often and of course it was not seen and can not be seen in UDM done "upright".

My UDM diagnosis is "suprapontine lesion", my back problems would more be like "supraspinal lesion", but the ice-water test at the last UDM was negative. My compliance is normal.

 

[mickdl]

Hi Pino,

So when talking about a suprapontine lesion, the first control loop is meant to lie between the upper miction center that is located in the brain stem and the cerebrum. The equivalent in the UD would be an uninhibited neurogenic bladder. It may be that this actually occurred at the UD - however, this suspicion should have been confirmed in the MRI - which was probably not the case, because otherwise you would not write here as you write ;-) In addition, the ice water test would have been positive in this case with an error rate between 3-9%. Since he is not, there is probably an all-clear at this point.

I think if it comes from the PNP then it has caught the outer nerve pathways in the spine somewhere. In general, you can try to treat this, for example, with immune globulins and vitamin B12. However, if it has actually affected the nerves sustainably, the chances of regeneration are rather subdued. What could help in this case would be a bladder pacemaker.

As long as the thing is not big enough for a clever MRI image, you will (in this case probably rather fortunately) continue to grop in the dark.

 

[Pino]

The cMRI was indeed without result, but for ME a fMRI is needed, but that is a different story. In ME the brain stem and / or the communication to the higher brain is damaged or compromised as studies show, so an inhibited neurogenic bladder may be a result.
As far as i can tell my problems sound very much like it. The icewater test was done when the BTX still worked.

My B12 was always O.K. and not part of the problem, an gluten ataxia in the cerebellum may present in a very light form as well.

The bladder pacemaker is on the option list, but at the moment i do not like to do that for different reason. I like to keep something in reserve for the case it gets much worse.