Urinary Retention-Possible MS question

[beth0277]

Hi all,

I was doing some research on medhelp and came across several posts concerning my topic from this forum so I thought I would ask my question here. I have not been diagnosed with MS, but the term has been thrown around a little. Here is my question and I thank anyone who has the time to give me any insight-

For the past 18 months, since having my son, I have struggled with asymptomatic UTI's. I have not had ANY symptoms of these UTI's at all, and only found out about them after going to the doctor or hospital for something else. I have, at times, been told they were "raging" and the doctors couldn't believe I didn't have symptoms. I have had at least 7-10 in the last year. Before having my son, I had a few very painful UTI's with the urinary problems and everything, so I know what they are *supposed* to feel like.

Any any rate, I recently went to the Urologist and they discovered I am not completely emptying my bladder. My post void residual was 118 mL, with 50 or less being "normal", though the clinical signifigance of 50-100 is debateable. The PA that I saw was not that concerned, said it could be a one time thing, or it could be caused by my recurring UTI's (though I did not have one when I went to the office that day). I didn't struggle or even really pay attention to if I was fully emptying my bladder. I had to give a urine sample right before that and was hovering over the toilet and using those muscles to start and stop my flow so there is a chance I just didn't empty well enough because I was doing the urine sample. Had they told me they were checking my post void residual, I would have been much more careful in making sure to get as much out as I could.
She put me on a 60 day course of antibiotics and wants to check me again in 2 months. After talking to my psychiatrist, he thinks my retention could be because of an antidepressant (Prozac) that I am (was) on because I took one in the past and it gave me acute and severe urinary retention in which I could not empty my bladder at all. I had to be cath'd 3 days in a row after starting to take the medicine but within a day or two of stopping it things were back to normal. I didn't have that same feeling on this medicine, in fact I felt the urge to pee and felt like I was emptying, but I guess I wasn't completely. I have stopped taking the Prozac and hope this will alleviate my issues.

It makes sense to me that the reason I keep getting these UTI's is because my bladder is not emptying, which hopefully is just due to the antidepressants, which I did not start taking until after my son was born, and around the time this problem started. If I am still having issues, they want to test me for neurological issues and MS was a big one that they were throwing around. I'm wondering if MS would cause me not to have any UTI symptoms. I know for a fact that I did not have a single UTI during my pregnancy (was tested at least once a week), so this is something that started shortly after giving birth, though my bladder position is fine and did not prolapse after childbirth. Also, does anyone know at what point does your post void residual risk damaging your kidneys? Mine is not that much above normal and my PA was not that concerned, but I have a (probably irrational) fear that my kidneys are being damaged and there is a medicine that I need to start taking for another issue (PCOS) that can only be taken if you have healthy kidneys so I am very hesitant to start taking it until I get my retention issue figured out.

I am hoping that my level of retention is not serious enough yet to warrant concern for my kidneys, since I am emptying my bladder frequently and only leaving around 120 mL or so in there (normal bladder capacity is around 400 mL so I don't believe my bladder is filled with urine most of the time, especially since I usually go at the first tinge of having to go).

So, to make a very long question short...

1. Does anyone know at what point urinary retention causes concern? My PA said that she would not start being too worried unless I am retaining 200-300 mL's every time, but I can't help but being concerned.

2. Does MS tend to cause asymptomatic UTI's?

3. I had a clean CT scan about 13 months ago, how likely is it that I could still have MS but it was not seen at that time?

Thanks so much for anyone who takes the time to answer those questions!!

[beth0277]

Thanks so much Lulu. So...I guess my urinary retention should not be a *huge* concern at this point, since I do not seem to be retaining enough to damage my kidneys, but who knows really. It does make me feel better to hear that it would be several hundred mL's before damage should be considered. Not saying what I have isn't serious, but it does help me relax a little. I am pretty confident that I am not retaining more than 120ish mL a time, if even that now that I have stopped taking my medicine. Since I had such bad urinary retention with a similar medicine, I am hopeful that this is what was causing it all along. At any rate...I will be figuring out why I have this so we can hopefully treat the cause.


You know, I'm not sure if I had an MRI or a CT scan. I developed weakness in my arms suddenly and they sent me for a test to look for a stroke. It was some sort of test for my brain where I was on a table lying down with the thing spinning around my head. No contrast was used. I'm not sure if this is an MRI or a CT scan now that I think about it.

I never strain to urinate, and my stream is pretty strong. When I was dealing with blatant retention from my medicine, I was unable to start a stream and when I did it was very weak, almost like a dribble. I do not have those same symptoms now. I do urinate often, maybe once every couple hours (2 hours or so) but I think I am just more conscious of it and go at the first signal that I have to.

Thanks so much for taking the time to answer my questions...you have really eased my mind. I go back to see my Urologist in 2 weeks and thought I was going to have a nervous breakdown before then imagining my kidneys being damaged every second of the day.

I'm still nervous about possibly having MS. I have no family history of it, but I'm not sure how hereditary it is. I find it reassuring that these symptoms didn't start until after I had my son, and starting taking antidepressants, so I'm hopeful that this is the cause, instead of a perfect storm that caused MS to flair up.

[Lulu54]

Hi Beth and welcome to the group here.  You ask some excellent questions that I can answer from my first hand experience.  Urinary retention is very common with MS - the signals needed to pee and completely empty the bladder are very complicated  and sometimes the message doesn't get through if you have spinal lesions.

I have serious retention problems -  The normal adult bladder can hold up to 750ml of urine  or usually 16-24 ounces. I've read that the concern about urine backing up in to the kidneys kicks in at about the 600ml part.  

If you have a full bladder and strain to urinate, it is possible to force the urine not only down but also up - both ways!

The most they have captured with me on ultrasound is 425 ml retained.  Yikes!!!   The urogynecologist instructed me on intermittent self catherization and I do that about 4 times a day to completely void my bladder.  I am often surprised how much is in there when I ISC.  

You're right that the retained urine is a breeding ground for bacteria and can quickly go into a UTI.  I was UTI free for the first 55 years of my life, and now I am constantly on antibiotics - one is a prophylaxis dose that I take twice a day.  Right now I am also back on bactrim for a fresh UTI.

I have NO symptoms when I have one other than the smell of my urine seems to change a bit.  I've become attuned to when I need to call my urologist for the lab orders.  

Last fall I had a scarey episode that I had a raging UTI and not a clue.  It did ascend to my kidneys and hit my blood stream.  I had sepsis and didn't now it until I developed rigors, a severe shaking, that would come and go.I ended up in the hospital for several days waiting for it to clear.  All the while the medical personnel were all amazed at how well I looked and I was walking the halls and in very good spirits.  I did not feel at all sick.  I think feeling that way was the scariest part, because I was really sick and didn't know it.

A CT scan will be of no use in looking for MS.  What is used is an MRI - scanning both the brain and the spine to look for demyelination is the norm.

Good luck in looking for answers. FEel free to come through any time and ask all the questions you want.

be well,
Lulu

[beth0277]

I should add...I have had a kidney & bladder ultrasound recently that looked normal, though I will be going for a kidney x-ray to check for possible stones that could have been missed. Also, my kidney function blood tests were taken recently and were all normal.