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Wednesday, July 23, 2014
Urinary Disorder After Multiple Back Surgery
Hello, My question is related to possible bladder dysfunction. In 2005 I ruptured my disc at level L5S1. I had constant lower-back pain and sciatic pain down the back of my left leg. The disc rupture seemed to keep reoccurring as after surgery I still had symptoms so had an MRI and needed the same surgery in 2006. I still had symptoms so again had an MRI and again had the same surgery (for the third time) also in 2006 - and yes still had symptoms, so another MRI and I still had a disc bulge. So, this time, in 2007 I had a anterior fusion at the same level L5S1 to completely remove the disc. Mt question is, somewhere around the second or third surgery I noticed I often felt I still needed to micturate - even after just going. I would go back to the toilet and stand there (I`m male by the way) but nothing would happen - perhaps a dribble sometimes but it wouldn`t take away that feeling of still needing to go. I don`t have this all the time - cold weather seems to aggravate the feeling more of needing to micturate but the cold also aggravates my back and leg symptoms more so it could be my leg and back aggravating the micturae feeling. This has been happening for three years or so now so I try and ignore the micturate feeling as I know when I`ve just been so I know it`s a `false-alarm` I would really appreciate your time if you could please offer suggestions on why I seem to have the micturate feelings only some of the time and would this be linked to my back and leg sciatic symptoms or could something else separate be happing. I don`t have bowel dysfunction except it`s difficult to strain or push with my back pain. Thank you very much for you time and I really look forward to your reply.
The urinary voiding symptoms you describe could be related to various factors such as, but not limited to:
- Enlarged prostate (bladder outflow obstruction)
- Primary bladder dysfunction (due to nerve supply to the bladder being affected such as in spinal problems, diabetes, central neurologic causes i.e. stroke, due to age related bladder wall changes, due to bladder wall changes secondary to bladder outflow obstruction such as enlarged prostate or sometimes in the absence of any definite identifiable underlying cause)
- Urine infection
- Bladder/lower ureteral stones
Some of the conditions are more common with increasing age (you have not mentioned your age).
You do have a spinal (neurologic) cause which could can sometimes cause voiding symptoms but these can also be seen in early prostate enlargement (even though your urine stream might be otherwise good, which I assume is the situation with you). I would suggest that you consult with a urologist who could evaluate you clinically, assess bladder emptying (post void residual urine in your bladder) and possibly with cystoscopy and urodynamics (functional study of bladder pressures/urine flow which would be informative given your underlying history of spinal issues) as required.
My response is based on the limited information available to me though your mail and feel that you would benefit further from seeing a urologist, who could evaluate you based on the actual clinical situation. I hope you find this information useful.
Krishnanath Gaitonde, MD
Assistant Professor of Clinical Urology
College of Medicine
University of Cincinnati