incontinence after laminectomy

[worriedpatient]

My mom aged 71 had laminectomy L4-5 on 27 August 2007.  Right after the operation, she lost control of her bladder and bowel.  She does feel the urge to urinate but she just cannot void by herself.  Her urine flows out involuntarily as soon as she stands up from the toilet seat.  She also feels to urge to defecate and can do so sometimes by herself.  But she is always constipated and has "overflow incontinence".

However, she had perfect control of both bladder and bowel BEFORE the operation.

On 19 Sep. 2007, she had a MRI which reveals another compression at the cervical spine which is supposedly the cause of her incontinence and lack of strength in the legs.  She had another "decompression" surgery at the cervical level on 25 Sep. 2007

My questions are :
(1) Why did my mom have incontinence RIGHT AFTER after her first laminectomy L4-L5?  Would there be anything connected with laminectomy that might have caused or triggered the incontinence?
(2) From the first onset of incontinence on 28 Aug. 07 to her second decompression on 25 Sep. 07, her incontinence went on for about a month.   Can we expect any chance of full or partial recovery from her incontinence?  If there is no improvement right after her second decompression on 25 Sep. 07, should we assume that the nerve is permanently damaged and that there is no hope that she can regain her bladder and bowel control?

[hophead]

I would ask the doctor about Cauda equina syndrome....that's what your mother's symptoms sound like to me.  It's usually caused by a herniated nucleus pulposus (herniation from the center of the disc) pressing against the spinal cord itself, causing leg weakness, and bowel and bladder dysfunction.  I recently had a microdiscectomy (8-29-07) at the L5 and S1 level, and prior to my surgery, I felt like i had to "go" all the time.  Fortunately, I didn't have a problem with incontinence, but the Doc was concerned about Cauda Equina Syndrome, and checking the CT scans, I didn't have it.  It is definitely something to be concerned about, though. Cauda Equina syndrome affects from L2 thru S5, and causes loss of motor/sensory function in various patterns, with potential for recovery of function with regeneration of the peripheral nerves. Like praying_ stated, it does take a long time for the nerves to heal.  Again, talk to the doc about Cauda Equina syndrome, find out as much as you can on the syndrome....be your mother's advocate!  Good luck to you.

[Stephen Ryu, MD]

It is hard to know why she had incontinence after the laminectomy. If it was a routine and uncomplicated procedure, the operation should not have caused this. I know of patients who have had incontinece after a foley was placed - did she have a foley. It is weird and unusual but it happens. There is also the possibility of really weird coincidence. And finally, just going through anesthesia and surgery could have triggered it. The nerves that control micturation (going to the bathroom) are floating in the canal and unless there was some nerve injury, they should have have been damaged.

Surgical decompressin of the cervical spine should be done to prevent further injury and might reverse some. So it is quite possible that there will be no change after surgery. If she gets better, great! Urinary problems can come from lots of sources including the brain. There is a condition where older people get demented, can't walk, and can't control their urine that comes from the brain.

I would right now be patient and see how things go. It would not be a bad idea to see a urologist and determine what kind of bladder issue she has - weak bladd, weak sphincter, - they can run some tests. That way you can quantify any improvment over time.

[praying_]

I know what she is going through.  I had emergency ( I was going numb from the compressed nerves in my back unable to urinate) back surgery in 2000 due to ruptured disc at L4 - L5 S1 which did prevent further damage but I still have urinary incontinence and bowel if (which is rare since most of the time I constipated) by some twisted form of luck my bowels become "loose".  So from my experience and many others I have spoken with she probably will retain some level of incontinence but it may (more than likely) get better over time.  The nerves take an amazingly long time to heal.

[pstone]

worriedpatient,

I also had leaking bladder and this last year my bowel would leak especially when my back was in so much pain. well i had nerve damage, compression at L5. I had L3 L4 L5 S1 fused with facet joints removed i also had all the nerves twisted in my spine with my siatic nerve beet red and 3 times the size surgery may 07. So far somedays my bladder leaks and i have only had my bowel leak about 1 time. It has to do with the nerves in her back talk to the doctor have nerve test at a nuerologist. I know what she is going threw i am only53 and my bladder did that for over 14 years but my bowel only started last 9 months as things got worse. good luck to her she is a real trooper.

pstone