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Severe bladder spasms

  I am a nurse and helping care for my brother-in-law who had a stroke 2 years ago.  Due to incontinence a suprapubic catheter was put in about 1 1/2 years ago.  He has spells of severe bladder spasms and nothing seems to get rid of them for good.  He has been on many medications and has tried other methods for treating urine leaking besides the suprapubic catheter but nothing seems to help.  He does not want the catheter out because he would be wet all the time and he hates the idea of smelling like urine and being wet.  
  Since his stroke it has been nothing but one problem after another and he is becoming very depressed.  On good days, which are few and far between, he does quite well and we feel if these spasms could be brought under control he would stop talking about wanting to commit sucide to get rid of the pain.
  Any and all suggestions would be appreciated at this point.  
  Also, if you could suggest a good urologist who specializes in this problem along with dealing with stroke patient it would be a big help.  We have seen 3 urologist so far and they all seem to give up on his problem and suggest its part of the stroke and nothing can be done.  
  We live in Green Bay, Wisconsin but at this point we are willing to travel anywhere to help him.  He is even willing to become part of any research studies being done in this area.
  Thank You,

Dear Janice,
Incontinence after a stroke is a very common problem. The area of the brain that controls the elimination of urine is in the back of the brain in an area called the pons. This is located in the brain stem. After a stroke patients often develop uninhibited bladder contractions. In addition there is loss of ability to control urination . The treatment regimen for incontinence is based in large part on the amount of disability the patient has and the ability of the caregiver to provide assistance.
Incontinence can be treated medically with agents that relax the bladder such as ditropan or Detrol. The side effects of ditropan include dry mouth and constipation. These are lessened with Detrol. In addition catherization with a suprapubic tube or clean intermittent  catheterization is performed to keep the bladder empty and the patient dry. Suprapubic catheters are not a good long term solution. Complications include contraction of the bladder decreasing the bladder capacity, recurrent bladder infections,  and increased risk of cancer of the bladder from chronic.
There are many institutions that specialize in neuro-urology. Institutions in your area include Mayo Clinic in Rochester Minnesota, University of Wisconsin, University of Michigan and Henry Ford Hospital. This information is provided for general medical education 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).
*keyword : incontinence

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