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Treatment for urinary retention - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Good Posted in: Urinary and Bladder Problems
Answered by

General & Family Physician
Practicing since : 2005
Answered : 2585 Questions
User :   I am suffering from urinary retention since the past 18 months after i suffered a lower back pain but my MRI says that i have a Diffuse annular disc bulge at L4-5 level indenting the thecal sac and all the doctors are saying that it is normal.
Cystoscopy was done and it was found that kidneys prostate and bladder are normal.
Doctor :   hi
Doctor :   may i know your age ?
User :   26
User :   no history of back pain or urine retention ever
User :   until this episode
Doctor :   so u have had backpain as of now ?
User :   yes
User :   morning stiffness also
User :   and weakness in legs
User :   esp in lumbar region
Doctor :   ok
Doctor :   have you done any tests anytime
User :   of what sort??
Doctor :   like a ultrasound ?
User :   yes
User :   that was normal
User :   MRI
User :   of pelvic region
User :   also that was also normal
Doctor :   MAY I know your gender please ?
User :   male
Doctor :   the causes of urinary retension in male ,at a young patient could be due to a over active bladder sphincter
User :   but this retention started only after my onset of back pain
User :   before that i was very well able to empty my bladder normally
Doctor :   also since this could have occured after a back injury, there could be a involvement of the pelvic nerves as well
User :   so sir what should be my line of treatment
User :   spinal surgery
Doctor :   no
User :   to remove the bulging disc
Doctor :   not spinal surgery,
Doctor :   the bulging disc repair is only needed if it is proved that the symptoms are due to this bulged disc
User :   my current MRI says this it is a tilting vertical MRI
User :   Findings: Vertebrae: Lumbar spine shows changes of mild spondylosis with mild scoliosis towards left side. Facetal joints: No significant hypertrophic changes noted. Spinal canal: Anteroposterior bony spinal canal diameters are within normal range. Intervertebral discs: L4-5: Diffuse annular disc bulge with mild impression on thecal sac. No focal root compressions. No extension into the foramina. Other Discs: No significant disc herniations. Cord: Shows normal signal morphology. Pre and para vertebral soft tissues appear normal. IMPRESSION: Mild lumbar spondylosis with mild scoliosis towards left side. Diffuse annular disc bulge at L4-5 level with mild impression on thecal sac.
Doctor :   that is fine as it says no nerve compression in the report
Doctor :   you might benefit by medications that help the urethral sphinter to relax
User :   so sir since retention is increasing
User :   i have to use a cathreter
User :   for the rest of my life
Doctor :   this medications help to relax the bladder sphincter
Doctor :   and this will help to releive the retention
Doctor :   some of these medications include anticholinergic medications
Doctor :   that are given by prescription
Doctor :   eg bethenechol,
Doctor :   the situation will improve with time
User :   sir can you please tell me the reason of my radiating leg pain
User :   and one more symptom
User :   i have decreased sensation in the groin and my hips i.e. rectum
Doctor :   ok these symptoms could indicate that there is defintiely nerve compression else where
User :   my all MRI's have been somewhat normal
User :   except l4 l5 and l5s1
User :   where it shows disc bulge and disc protrusion
Doctor :   the pain may be helped by medications like cymbalta or gabapentin
Doctor :   these could be the site where the nerves might be compressed
User :   actually doc i am able to withstand the pain my only
User :   concern is the urinary retention
Doctor :   we rely on presence of symptoms like these to check if there is nerve compression
Doctor :   as i said ., bethenechol like medications can help to solve this issues
User :   can my case be cauda equina
Doctor :   no
Doctor :   this is not cauda equina as you dont have rectal retention
User :   i have constipation though
User :   after this incident
Doctor :   can you tell me if you have the pain running from the back of the thigh to the lower leg ?
User :   yes
Doctor :   constipation, the pain as you have described, and urinary retension are some signs that indicate severe neurological involvement
Doctor :   but in cauda equina , there should be sensory symptoms as well
User :   of what type??
Doctor :   numbness and tingling sensation in the pelvic region and lumbosacral region
User :   ok
Doctor :   if these symptoms are present, then, a sugical decompression can help your symptoms
User :   because also the doctors have ruled out tumours and TB and other infections
User :   i have this feeling in the legs
User :   foot
User :   left
Doctor :   what kind of feeling ?
User :   ting ting like
User :   like needles
User :   sometimes
Doctor :   this could be due to nerve compression that is causing the same pain
User :   but the MRI doesn't show any compression
User :   this is the strange case actually
Doctor :   No
Doctor :   these things can be determined clinically
User :   ok
User :   i am sort of fed up after seeing so many doctord
User :   nothing concrete has happened
Doctor :   i do understand you situation
User :   nobody is able to find out anything
User :   it is affecting my job and career now
Doctor :   as i mentioned , taking medictions (bethenechol) will help
Doctor :   and gabapentin will help the pain in the legs
User :   fine doc i will consult and take this medicines and see if any improvement happens
Doctor :   sure
User :   thanks for your time
Doctor :   u r welcome

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