Bladder Spasms due to Cauda Equina Syndrome

I have had Cauda Equina Syndrome since 1998 my first surgery, my second being in 2000, this resulting from a herniated disc at the L5/S1 level of my spinal cord.  I do have the saddle anesthia, loss of bladder and bowel, weakness in the right leg coupled with the loss of reflexes. After the first surgery I still had the urge to go still intact while after the 2nd it was gone. I have had and increasingly worse "bladder Spasms"  in which they are extreamly painful with the loss of all bladder contents, sometimes coupled with the spasm I do have orgasms, but the pain wins. At times when I go to cath when I touch myself this also couses the loss of bladder contents with no spasm. I have had Urodynamic Testing in which the bladder is totaly flaccid along with an pelvic floor and rectal floor EMG which also shows no tone of those muscles. I have tried Detrol, Detrol LA and Ditropan.  No go with these meds.  I currently take Baclophen 10mg three times a day.  According to the top Urologist in my area (Kevin Pranikoff) they shouldn't be happening, but he does think that my body becomes used to a drug therefore the efficacy just isn't there.  I know that the peripheral pathway has been severed and probably contributes to this and that the pathway that may have "grown back" is not the correct pathway.  Would there be any other suggestions that I may suggest to my doctor or any other testing that may be helpful in this matter, I will be seeing him in the middle of June. Thankyou for your time and consideration.  Cordelia

[Kevin Pho, MD]

Hello - thanks for asking your question.

If you have been seen by a top urologist and have been already on Detrol and Ditropan, it is unlikely that I would be able to come up with anything that hasn't already been thought of.  Here are some other considerations that you may want to discuss.

There are other medications that are used to reduce bladder spasms.  They are similar to Ditropan but may work better in some patients than others.  One would be Propantheline bromide (Pro-Banthine).  It is a medication that stops muscle contractions in the normal bladder.

Another medication is Hyoscyamine sulfate (Levbid; Cytospaz).  Again, it works in a similar way to Ditropan and may be considered if Ditropan has failed.

Tricyclic antidepressants - such as imipramine, doxepin, desipramine, and nortryptyline - are often prescribed as part of incontinence treatment programs and may be discussed as a secondary option.

If medications don't work, you may want to consider a more permanent catheter such as a suprapubic catheter.  This is something that should be discussed with your urologist.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[Pextrojen]

A related discussion, Cauda Equina Syndrome - How Can I manage ED without Pills or Injections? was started.