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Urinary incontinence, losing stool, hyperpigmentation, fatigue, thigh pain, normal blood work. What else could it be?

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My spouse is having the following symptoms: (1) bouts of urinary incontinence and also loses a small amount of stool sometimes(this is not consistent but seems to come in episodes and then goes away. Episodes last occurred over a year ago but suddenly this week started again.)
(2) Marked hyperpigmentation that gradually increased over past 4 years(especially on forehead and knuckles, cuticles, scars, around eyes), (3)increased fatigue,(4) bouts of shooting pain in thighs that seems to change location meaning sometimes they are in in arms, sometimes thighs, and once occurred in lower leg( these pains last a few days and can get quite painful at times even to the point of him just staying in bed at times. These pains are generally much worse and can arise right after he eats something sweet)

All blood work has been normal including fasting glucose, cbc, chem 7, thyroid. Cortisol was normal. ACTH results aren't back yet but dr. says since cortisol is normal they are probably normal. What else could it be? What should we be looking for in your opinion?
Posted Tue, 22 May 2012 in Urinary and Bladder Problems
Answered by Dr. Shiva Kumar R 10 hours later

Thanks for query

Regarding the episodic double incontinence, I feel problem could be in the neural control of the bowel and bladder or weakness of the muscles of the pelvic floor. Shooting pains in the limbs would probably indicate radiculopathy.

Hyperpigmentation in the forehead, knuckles, scars and around the eyes has many causes and common reasons are Vit B 12 deficiency and Addison's disease. As your cortisol is normal, look for the ACTH results to rule out endocrine problems. Vit B12 deficiency can rarely cause most of the symptoms described by you in your wife.

So I personally request you to XXXXXXX your Neurologist for a good neurological examination and consultation. MRI of the spinal cord would exclude spinal cord lesions and to look for characteristic changes of Vit B12 deficiency. Blood tests like CPK, LDH, B12 levels, homocysteine, and XXXXXXX profile is required to exclude other causes of pigmentation. Nerve conduction studies would be required to look for underlying neuropathy in suspected B12 deficiency.

Thanks again for the query. I hope you found my response to be helpful. If you have any additional concerns i would be happy to address them.


Dr Shiva Kumar R
Consultant Neurologist & Epileptologist
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