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Help Is this Neurological? Embarrasing!
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Help Is this Neurological? Embarrasing!

Hi Guys,
This problem is not new, I have had it on and off in the last 6mths or so.  I have always had some urinary urgency etc. and of late sometimes the other way the sensation of not emptying completely which I believe is neurological but in the last 6mths I have had what I call leakage. Just enough to cause a wet spot on my pants but not a flooding, it's like for some reason the urine just seaps out but my bladder doesn't have to be full for this to happen.

The last few days I have had really bad pins and needles in my feet and my right hand along with my extension tremor thing and some painful spasms in my butt and thigh on the leg that keeps going numb, I don't think this feels like migraine but to top it off I have had this leaky thing, it is like the urine some people might lose when they sneeze etc. but I haven't sneezed or coughed and to be honest I have only ever done that once when I had an extreme full bladder just after I had one of my kids.

Questions:
Is this bladder loss neurological or would it be from a weak pelvic floor?

Does this kind of bladder loss occur with MS/TM?

Do you think my symptoms at the moment are migraine? I don't think these leg symptoms are, it has got rather hot here as well but I am a bit concerned I might be having or heading for another attack as my leg feels extra weak too.

Thanks, I hope someone can help with the bladder thing, I go back to the urologist next week and will ask then but it's another 10 days before I see him.

Udkas.
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572651_tn?1333939396
Yes. It could be neurological or it could  be pelvic floor weakness.  The only way to tell would be a good urological exam.

Yes, this kind of bladder loss could be related to MS.

Probably not - it sounds more like MS symptoms than the migraine stuff, but I'm still foggy about how migraines can be in other parts of the body than the brain! :-)


For the feeling of not emptying, you might talk to your uro about self-catherization.  Sounds icky, but really works to control the problem and once you get the hang of it, it can become second nature.

for the leaking, the incontinence products available are wonderful  - try poise or teena and see which one is better for you. Changing clothes and having extra laundry to do is a real drag and can be avoided with either of these products.

be well,
Lulu
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410281_tn?1254232664
I don't have an answer, but I have the same problem sometimes.  I have not brought it up to a doctor yet. I've been lucky enough that it's never happened when I wasn't home or close enough to a restroom to "control" the pending disaster.

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147426_tn?1317269232
All of the problems you describe can be seen in MS and probably can be worsened with a weakened pelvic floor.

The urge incontinence and the incomplete emptying are the two most common urinary problems in MS.  The leaking without any sensation of needing to urinate is more likely also an MS problem.  

A weak pelvic floor typically causes stress incontinence and much less often urge incontinence.

I think it is important to understand how we hold our urine successfully and what keeps it from leaking out along with understanding how we empty our bladder successfully.  I wrote an HP called "The Neurology of Bladder Incontinence".  In this I describe the balance between the strength of the urethral sphincter and the pressure inside the bladder.  If the sphincter pressure is higher than the bladder pressure the urine will stay in the bladder.  If the pressure inside the bladder rises higher than the tightness of the schincter muscle then urine will escape.

http://www.medhelp.org/health_pages/Multiple%20Sclerosis/The-Neurology-of-Bladder-Incontinence/show/758?cid=36

Your problem of spontaneously leaking urine is most likely neurological, I think.  It could be from inappropriate relaxation of the urethral sphincter or it might be from an unsensed rise in pressure within the bladder.  Somewhere your nerves are not sending the right signals either to the muscles of of the urinary system or carrying the right sensation to your brain.  You have got to tell your neuroloigist about this.  You likely need a referral to a urogynecologist who will likely do a testing called Urodyamics.

There is something that can add to this problem, and that is constipation.  In women, especially, the stool in the rectum presses on the bladder, giving it less room.  Just moving around can change the pressure within the bladder and, if the sphincter is weak can press some urine out.  So people with urinary incontinence must take extra precautions to prevent or deal with constipation.

Fifty percent of MSers will deal with problem constipation during their disease.

INCONTINENCE PHYSICAL THERAPY CAN OFTEN HELP WITH THE PROBLEM

I also wrote a series of descriptions of what Incontinence Physical Therapy was like, but people haven't been very interested in reading it.  Oh, well.

Incontinence PT is important to us because 50% of people with MS - women AND men - who have incontinence will benefit some from PT.  The process of PT is largely to strengthen the pelvic floor.  Why do we improve with PT when the problem is neurological to begin with?  The answer is simply that along with the neuro deficits many of us also have lost strength in the external muscles that help us contract around the urethra, the vagina (in women) and around the rectum.  We also have often developed maladaptive habits which contribute especially to urge incontinence.

After having just one episode of leaking urine at the wrong time most of us begin the pattern of emptying our bladder at the first sign of fullness.  We also begin to empty our bladder more often just for convenience and before we leave the house or a comfort zone.  This leads to the abnormal state of our bladders becoming accustomed to always be near empty.  The result of that is that they send the signal of "full" at inappropriately levels of fullness.  So we get into an increasing cycle of needing to urinate too early and having the bladder contract to remind us.

I was absolutely sure that my urge incontinence was not behavioral.  Somehow, that made me feel like I was being told that my neuro problems were self-induced.  But, by problems improved a great deal with therapy.  They didn't completely go away, but they improved measurably.

Why go through the therapy when the problem will usually respond with drugs?  The therapy might let us go longer before needing yet another drug or it might let us use a lower dose.  The meds used with incontinence have many uncomfortable side effects and may actually interfere with one of the other drugs we might be on.  

Hope this helps.

Quix
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Thanks seems such a small word for my appreciation of your post and answer.  THANKS!  

For the record I have read all your articles on bladder training and the physio etc. and re read them, but most of the stuff I read talked about the urge incontinence and the incomplete emptying but not what I am having at the moment.  I do suspect my pelvic floor is weak, but I do the exercises and have always done them.  I would be happy to do physio both for the bladder and for my mobility if it helped as I am so damn stiff these days.  I do also suffer from constipation but I don't have full feeling in that region.

Would you believe we don't have a urogyny anywhere in my state, I would have to travel over seas to access one.  I don't want to take drugs but I am so confused at the moment with my burning coming back, blood in my urine and now this!! I do think certain movement might be causing it, it happens several times a day, but I still have enough strength in my pelvic floor to stop my urine mid stream.. (sometimes).

I go back to the urologist Thursday week and I will tell him, as I concentrated on my burning more than my urinary problems but he is aware I have some neuro problems too and told me they most likely will get worse... I guess he will tell my neurologist as he is sending all the reports and info on to him.  I am just a bit depressed at the moment, shouldn't be but the whole burning, spasms in my urethra etc. are getting to me and confusing me.

Thanks a million to all who replied, and a big thank you to Quix for explaining things for us all to understand.

Udkas.
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147426_tn?1317269232
Forgive me, but in the moment I wrote all that I forgot all about your burning and blood.

With all the inflammation you have had, I would think about a change in the anatomy of the area.  Sometimes people can get a little out-pouching in the urethra that hold a drop or two of urine.  This can fill and empty at odd times, but is often positional.  Typically, when you urine the pouch does not empty, but it does when you stand up, thus the little stream down the leg.

Just a thought.  I also asked whether your and your doctor had considered a urologic second opinion.

It just seems that your symptoms are progressing.  Would this be typical of TM?

Quix
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I answered you on the other post but I don't think things are typical of TM, I am not sure if my "progression" is just migraine but I went for so long with very little symptoms where now I seem to have more.  I think when they did the ultra sound they checked for pouching.  

My own gut feeling is the bladder is neurological as I really don't do anything to make it happen (ie: lift or sneeze etc.) but my burning I have no idea, might need to accept the answer he has given me.  As for TM versus MS, if I read a diary on someone with MS I think my symptoms sound classic MS, remissions, relapses, good days and bad days etc. but my MRI and LP are not pointing this way, which is good, so I then think must be migraine..lol, but my neuro is keeping a close eye on me and repeating MRI and LP etc. so what more can he do.

Maybe I will make medical history...lol the longest person with symptoms then getting diagnosed.. as I always believe there are exceptions to any rule and rules are to be broken.

CHeers,
udkas.
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Avatar_f_tn
I am a limbolander.  Several years ago dx with weak pelvic floor, but it hasn't been bothering me lately, except for the stress incontinence, and just the opposite, sometimes I feel like I'm dribbling urine, I could swear it, but nothing is coming out.
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Avatar_f_tn
Good information here... Thanks for the info Quix.

I also have urinary urgency, frequency and leakage. I always feel like I could pee. I don't have stress incontinence and my pelvic floor muscles were checked out and they were good. So it leaves me to think it might neurologicaly related. When I had my hysterectomy last year I asked the gyne to check my bladder while he was there just to make sure it looked alright and he said it looked good.

I will have to discuss this once I get my first appt with Neuro #3 in a few months.

Shelley
un-dx
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