Incontinence: Neurogenic Bladder and now Fecal Incontinence..Please help

[Kadi__0]

Posted by Kadi on April 20, 1999 at 11:42:46

This is such an embarrassing topic to talk about, but I need to get some sort of advise on where to turn.  Im a 29 yr old female, have a 5 yr old child that was born c-section..never had any type of surgery  that would bring on incontinence. About a year ago I started getting chronic UTI's..Urologist found it was because  I was retaining urine and started me on self cath.  The last 10 months have progressed rapidly.  I have had many many UTIs and a few kidney infections.  I have chronic abdomen/pelvic area pain, along with a lot of right back kidney pain.  Seven months ago I went through Mayo In Minnesota and could not get a diagnosis.  Went through all the urology and neurology tests.  They show that I have a non functioning bladder..have no sensation until about 1100 CC full.  Self cathing wasnt working real well and I had a supra pubic cath put in about 6 months ago.  I still have pain and get UTIs from time to time.  Each time a larger tube is put in, I stop draining a couple times and have to go to ER.  So, no signs of MS..just a neurogenic bladder of unknown etiology.  About three months ago I started having problems controlling my bowels.  Not an everyday problem, but it has started happening more and more often.  In the last two weeks, I have had 7 accidents.  I have abdomen and lower back pain, and bowel movements are very painful.  Dont have any diarrhea or constipation. No changes in bowels..always formed..sometimes a little blodd is visual.  I continuously feel the need to empty my bowels even when empty, but then I have an accident and dont even feel the urge when it happens.  I was very embarrassed about this and pretty scared to tell you the truth, so I didnt tell my doctor.  Since it was happening more and more often, i told my doctor last week.  he is setting me up for more MRI's (Im assuming he is thinking of MS again) and is sending me back to my urologist and to a GI Doc. Here are my questions:
My mind is racing and Im pretty stressed about this..bladder incontinence is one thing, but fecal is another.  Can you please tell me what your initial concerns might be?
Could this be related to the bladder incontinence?
Can you think of anything that might cause this?
Is this a symptom of MS or anything else you can think of?
Please point me in the right direction as far as who to see, what to do, or places to research.
Thank you very much for any resonse.
Kadi

Posted by HFHS M.D.-AK on April 20, 1999 at 15:04:56
Dear Kadi,
The first thought that runs through my mind is MS but there are other problems that could cause these problems.  It is possible that spinal radiologic studies can miss lesions that are small or still developing.  I think the MRI (sacral spinal area)is a good way to start because you most likely have a centralized lesion in your spinal cord.  The fact that the bladder and bowel are both involved, tells me that the lesion is in the sacral area of the spinal cord.  The output(motor) and input(sensory) to the spine are somehow both compromised.  When both are affected it is most likely a lesion in the cord.
You should be seen by a neurologist to perform a full neurologic exam particularly below the abdomen.  These problems could start affecting the strength of your legs if a diagnosis is not made soon.   You may also want to have a CT scan of the abdomen/pelvis looking for a pelvic mass or pelvic nerve impingement.  A pelvic lesions could account for pressure on your spine.
To answer your question directly, I do think these two symptoms are related and you should tell your doctor everything else that you think may be related.  Information from a patients history will help localize a lesion such that a diagnostic test can be better directed to evaluate the suspicious area.  This will save money , but more important, time.
With your history, the urologist has little more to offer that clean intermittent catheterization(CIC).  Personally I think an SP tube is a bad idea unless of course you cannot perform the task(CIC).  SP tubes get infected, increase your risk for cancer(over ten years) and as you said, cause a larger holes around the catheter to form.  Your urologist has identified that the sensory fibers to your bladder area not functioning well.  It also sounds like you can’t empty your bladder and were placed on CIC.  Seeing your urologist will not change your care, but rather confirm that CIC is the best management of your bladder problem to prevent damage to your kidneys.  The sensory/motor loss to your bladder is most likely not your ultimate diagnosis, but rather a symptom of your bigger neurologic problem.  Likewise, seeing the GI doctors can give you suggestions on how to treat the symptoms of fecal incontinence, but you still don’t know the root of your problem.
On a more optimistic note, it is possible that treatment of your neurologic problem may return the function of both your bladder and bowel, but only time will tell.  It is also possible that you have two very unlikely problems with your bowels and bladder.  I tend to think it is more common that one problem has occurred and is causing both of your symptoms rather than two problems simultaneously.  I think your best bet is to see a nuerologist.
I wish you Good Luck and hope the best for you!
This information is provided for general medical educational 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).
Sincerely,
HFHS M.D.-AK
*keyword:Neurogenic Bladder