question-icon

What is the cause and treatment for back pain with urinary incontinence?

default
Posted on Fri, 1 Aug 2014
Question: experiencing severe back pain S/P fusion L4-S1. Sx was in 2001. Now with this exacerbation of pain I am incontinent of urine starting this AM. I do not have saddle numbness and don't think I have Cauda Equina Syndrome, What should I do and what can cause this besides a dysraphism and CES?
doctor
Answered by Dr. Karl Logan (16 minutes later)
Brief Answer:
Spinal cord or cauda equina compression

Detailed Answer:
Hi thanks for your question,

My first concern is that you may have compression of you cauda equina or possibly a little higher in your spinal cord at the conus and so I would encourage you to seek medical attention to have an urgent further MRI scan or CT scan (if you have metal work insitu) of your lumbar spine. You may need a CT myelogram.

There are of course other causes of urinary incontinence, possibly the commonest being a urinary tract infection which could be diagnosed on a urine dipstick and culture.

I hope this helps answer your question.

Best wishes
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
default
Follow up: Dr. Karl Logan (34 minutes later)
No, I am not satisfied with your answer. I knew all of that prior to contacting you. I am sure I do not have C.E.S. since I lack most of the symptoms except for intermittent urinary incontinence. My back pain exacerbation is related to this and I do not have a UTI! Please, I am looking for a better diagnostic differential than that! I am a poor 4th. year medical student and cannot afford more CT and MRI's unless I am confident about a new spinal pathology. I want to know if this can be due to an autonomic response or anything else besides the obvious
doctor
Answered by Dr. Karl Logan (1 hour later)
Brief Answer:
Occums Razor, further causes of urinary Incont.

Detailed Answer:
Hi,

Thanks for you follow up question.

If your not satisfied with my answer you can indicate that to HCM. If you want to know the other potential causes of urinary incontinence I have included a list, but you should bear in mind 'Occums Razor'.

Occam's razor (also written as Ockham's razor and in Latin lex parsimoniae) is a principle of parsimony, economy, or succinctness used in problem-solving devised by XXXXXXX of Ockham (c. 1287–1347). It states that among competing hypotheses, the one with the fewest assumptions should be selected. Other, more complicated solutions may ultimately prove correct, but—in the absence of certainty—the fewer assumptions that are made, the better.

Certain foods, drinks and medications can cause temporary urinary incontinence.

•Alcohol. Alcohol acts as a bladder stimulant and a diuretic, which can cause an urgent need to urinate.
•Overhydration. Drinking a lot of fluids, especially in a short period of time, increases the amount of urine your bladder has to deal with.
•Caffeine. Caffeine is a diuretic and a bladder stimulant that can cause a sudden need to urinate.
•Bladder irritation. Carbonated drinks, tea and coffee — with or without caffeine — artificial sweeteners, corn syrup, and foods and beverages that are high in spice, sugar and acid, such as citrus and tomatoes, can aggravate your bladder.
•Medications. Heart medications, blood pressure drugs, sedatives, muscle relaxants and other medications may contribute to bladder control problems.
Easily treatable medical conditions also may be responsible for urinary incontinence.

Urinary tract infection. Infections can irritate your bladder, causing you to have strong urges to urinate. These urges may result in episodes of incontinence, which may be your only warning sign of a urinary tract infection. Other possible signs and symptoms include a burning sensation when you urinate and foul-smelling urine.
•Constipation. The rectum is located near the bladder and shares many of the same nerves. Hard, compacted stool in your rectum causes these nerves to be overactive and increase urinary frequency. In addition, compacted stool can sometimes interfere with the emptying of the bladder, which may cause overflow incontinence.

Causes of persistent urinary incontinence
Urinary incontinence can also be a persistent condition caused by underlying physical problems or changes, including:

•Pregnancy and childbirth. Pregnant women may experience stress incontinence because of hormonal changes and the increased weight of an enlarging uterus. In addition, the stress of a vaginal delivery can weaken muscles needed for bladder control. The changes that occur during childbirth can also damage bladder nerves and supportive tissue, leading to a dropped (prolapsed) pelvic floor. With prolapse, your bladder, uterus, rectum or small bowel can get pushed down from the usual position and protrude into your vagina. Such protrusions can be associated with incontinence.
•Changes with aging. Aging of the bladder muscle leads to a decrease in the bladder's capacity to store urine and an increase in overactive bladder symptoms. Risk of overactive bladder increases if you have blood vessel disease, so maintaining good overall health — including stopping smoking, treating high blood pressure and keeping your weight within a healthy range — can help curb symptoms of overactive bladder.

After menopause women produce less estrogen, a hormone that helps keep the lining of the bladder and urethra healthy. With less estrogen, these tissues may deteriorate, which can aggravate incontinence.

•Hysterectomy. In women, the bladder and uterus lie close to one another and are supported by many of the same muscles and ligaments. Any surgery that involves a woman's reproductive system — for example, removal of the uterus (hysterectomy) — may damage the supporting pelvic floor muscles, which can lead to incontinence.
Painful bladder syndrome (interstitial cystitis). This chronic condition causes painful and frequent urination, and rarely, urinary incontinence.
•Prostatitis. Loss of bladder control isn't a typical sign of prostatitis, which is inflammation of the prostate gland — a walnut-sized organ located just below the male bladder. Even so, urinary incontinence sometimes occurs with this common condition.
•Enlarged prostate. In older men, incontinence often stems from enlargement of the prostate gland, a condition also known as benign prostatic hyperplasia (BPH).
•Prostate cancer. In men, stress incontinence or urge incontinence can be associated with untreated prostate cancer. However, more often, incontinence is a side effect of treatments — surgery or radiation — for prostate cancer.
•Bladder cancer or bladder stones. Incontinence, urinary urgency and burning with urination can be signs and symptoms of bladder cancer or bladder stones. Other signs and symptoms include blood in the urine and pelvic pain.
•Neurological disorders. Multiple sclerosis, Parkinson's disease, stroke, a brain tumor or a spinal injury can interfere with nerve signals involved in bladder control, causing urinary incontinence.
•Obstruction. A tumor anywhere along your urinary tract can block the normal flow of urine and cause incontinence, usually overflow incontinence. Urinary stones — hard, stone-like masses that can form in the bladder — may be to blame for urine leakage. Stones can be present in your kidneys, bladder or ureters.

I hope this further answers your question.

Best wishes


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Karl Logan

Orthopaedic Surgeon

Practicing since :1999

Answered : 705 Questions

premium_optimized

The User accepted the expert's answer

Share on
What is the cause and treatment for back pain with urinary incontinence?

Brief Answer: Spinal cord or cauda equina compression Detailed Answer: Hi thanks for your question, My first concern is that you may have compression of you cauda equina or possibly a little higher in your spinal cord at the conus and so I would encourage you to seek medical attention to have an urgent further MRI scan or CT scan (if you have metal work insitu) of your lumbar spine. You may need a CT myelogram. There are of course other causes of urinary incontinence, possibly the commonest being a urinary tract infection which could be diagnosed on a urine dipstick and culture. I hope this helps answer your question. Best wishes