Questions posted in the The Urology Forum have been answered by urologists from Henry Ford Health System and by Dr. Kevin Pho.

Question Title: Urgency/Overflow and Herniated L5-S1

Forum: The Urology Forum
Topic: Incontinence


I suffered a trauma to my lower back which cause a large L5-S1 disc herniated impinging on the S1 nerve root. Three days later I developed what has been called "urgency/overflow" incontinence. Basically, I have no time to get to the bathroom, even if I am in my own kitchen! I am a 29 yr old female. I have had a cystoscopy which revealed the type of incontinence and a "flaccid" type bladder and the urologist felt that my symptoms were the result of the trauma and that most patients would have been "jumping off the table" with the amount of CO2 my bladder sustained with no sensation to void ( I was physically attacked and thrown against a brick wall). I still have low back pain and the incontinence is getting worse (it has been about 5 months since the attack). I have seen a neurologist and had an EMG within normal limits, ob/gyn reveals good tone and no problems, a urologist, orthopaedist, among others. My orthopaedist wants me to have another cystoscopy with cystometrogram before he considers surgery and/or can link it to the L5-S1 herniation.

My questions are: Could the herniation cause this type of incontinence? Is there any other possible cause for the onset of this type of incontinence? I now have resigned myself to wearing pads or have to change my clothes 3 times a day!

Thank you for your time. I am sure you are aware of the emotional and physical frustrations involved in patients with such a condition.

Dear Dee,
The nerves that supply the bladder are located at the end of the spinal cord at the sacral levels S2 to S4. Injury to these nerves can result in inability to empty the bladder. Often, patients that suffer from injury to the spinal cord can have a condition called spinal shock. This results in a flaccid paralysis that can recover over time. It is thought to be due swelling of the spinal cord. This can last 6 to 8 weeks and in some sources even state 3 months.
Herniation of the L5-S1 disk can reproduce the symptoms of spinal shock if it occurs acutely. However, the spinal cord ends at L2-L3 level and the nerves exit from the vertebral levels below the spinal cord level. It is possible that your symptoms relate to your herniated disk. Other neurologic conditions could cause your symptoms as well. These include multiple sclerosis, peripheral neuropathy, and guillan barre . If your symptoms of incontinence persist, urodynamic evaluation to specify the urologic diagnosis may be worthwhile.
This information is provided for general medical education purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653 6568).

HFHS MD-KR
*keyword : urinary retention
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