Intermitant Incontinence for 5 years now...doctors puzzled

[nww636]

Female. Now 49 yrs old. Perimenopausal. Urge incontinence began in 2000 right before procedure to relieve back pain (L4-L5)--IDET procedure to shrink buldging disk. No bladder infection. Orthopedic surgeon has stated numerous times after MRIs... not related to back problems. (back problems very minor now) Have seen 2 neurologists--cannot find neurological problem. MRI's of entire spine and brain done. Do Klegal exercises; tried retraining bladder; do pelvic floor exercises. Incontinence comes and goes. Progressively getting worse through the years until now when having problems with incontinence, loss of control is complete. Wear Depends during those periods of time. Bladder has dropped slightly. When incontinent, it seems like the sphincter muscle does not respond at all or very weakly. When not having problem with incontinence, sphincter muscles strong. Have not been able to figure out pattern of when incontinence appears and disappears. Sometimes appears related to period but then it doesn't. Incontinence can last up to 2 months, then disappear for one month. Incontinence period always lasts longer than in control period. Was over weight but have lost 40 pounds--now at good weight. That did not seem to make any difference. Coughing, sneezing, laughing does not cause problems even when having incontinence...just when the urge appears, I have maybe 1 minute to get on toilet...if I don't make it, loss of control is complete. Medication had no effect...(Detrol and the like).

Almost all urologists in town no longer accept my insurance (BC/BS). I am scared of the exams and that all urologists are men in town with only one exception. But can a urologist help? All the other doctors are stumped since it comes and goes and all the standard causes and treatments have been ruled out/haven't helped. I resigned myself to live with it but am urged not to give up yet. Have you heard of such symptms before? Any ideas or suggestions? Thank you from the bottom of my heart.

[Kevin Pho, MD]

I would certainly recommend a referral to a urologist.

I would assume that basic causes like an infection and diabetes have been ruled out by a urine and blood test respectively.

You can consider a cystoscopy to evaluate for any anatomical abnormalities that can lead to your symptoms.

A urologist can arrange for a set of tests, known as urodynamic testing, which can evalute for bladder function as well as lower GI tract pathology.

You can discuss these options with your personal physician - at this time, a urology referral can be helpful.

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.

Kevin, M.D.
Medical Weblog:
kevinmd_b

[rjc33c]

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