Common Urinary Symptoms in SCI Patients 

Symptoms of Neurogenic Bladder in General

  • Wide spectrum of presentation:
    • Varied combination
    • Varies in severity
    • Also depends on the types of treatment current and in the past
  • Symptoms and signs:
    • Frequency and nocturia:
      • urge type of incontinence in patients with hyperreflexic bladder
    • Urinary incontinence
      • overflow type of incontinence in patients with areflexic bladder if untreated
      • urge type of incontinence in patients with hyperreflexic bladder
    • Urinary retention:
      • in patients with areflexic bladder if untreated
        • overflow type of incontinence
    • Suprapubic or pelvic pain
    • Incomplete voiding
      • due to poorly sustained contractility or hypocontractility
      • due to outlet obstruction (functional or anatomical)
    • UTI
      • fever, flank pain: may not be typical as in normal persons
      • turbid urine

Symptoms Specific to the Patients with SCI

  • During spinal shock phase
    • Acute urinary retention: spinal shock phase
    • Incontinence: overflow type
  • During recovery phase
    • Leakage between catheterization in CIC patients
    • Spasticity in the lower extremities
  • Chronic stage
    • AD symptoms

Symptoms Specific to the Patients with MS

  • Mostly symptoms are the same as those of the SCI.
  • Voiding symptoms at some time: 50%-90% [Litwiller 1999]
    • Frequency, urgency: 31%-85%
    • Urinary incontinence: 37%-72%
    • Obstructive symptoms with urinary retention: 2%-52%
    • Difficulty in initiating the urinary stream: 40-90

Key Points of This Section
  • In multiple sclerosis there is little correlation between symptoms and the precise findings on urodynamic evaluation which are relatively constant over long periods. The course of the MS seems to determine the relative severity of symptoms.
  • Therefore, treatment decision should not be made on symptoms.
  • In all neuropathic conditions the risk posed by lower urinary tract dysfunction is related to bladder pressure.
  • There are no symptoms directly related to bladder pressure, although incontinence, symptomatic infection, pyelonephritis, can be related to high intravesical pressures. It is important to recognize that, especially in males, there may be no outward sign of elevated detrusor pressures at all.
  • No treatment can be predicated on symptoms alone and thus periodic urodynamic evaluation is mandatory.

References

  • Litwiller SE, Frohman EM, Zimmern PE. Multiple sclerosis and the urologist. J Urol. 1999 Mar;161(3):743-57.

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