Doctors Lounge - Urology Answers
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Forum Name: Urology Topics
Question: bladder wont empty
|werstardust - Mon Jul 05, 2010 12:36 am|
bladder wont empty all the way strong stream,no blood,no pain, no periods diabetic type II
|Dr.M.Aroon kamath - Tue Jul 13, 2010 9:01 am|
The first condition that needs to be considered is a diabetic autonomic neuropathy affecting the urinary bladder resulting in a number of "voiding dysfunctions".
Diabetes mellitus(DM) is the most common cause of urinary dysfunction secondary to peripheral nervous system pathology. Symptoms of bladder dysfunction have been observed in about 37−50% of patients, and urodynamic evidence for bladder malfunction has been observed in 43−87% of insulin−dependent diabetics.
The most common abnormalities seen are, impaired detrusor contractility and "detrusor areflexia". Detrusor areflexia, results from impaired sensation of bladder filling. This results in overdistention of the urinary bladder causing an ''overdistention injury".This disorder is also called "diabetic cystopathy".
Patients with bladder hypomotility and high residual urine volumes are at greater risk for urinary tract infections.
On the other hand, some diabetic patients, particularly the elderly, may have uninhibited bladder contractions and "detrusor hyperreflexia".
Initial therapy of bladder hypomotility should emphasize on timing voiding schedules to coincide with bladder contractions,
enhanced by a Valsalva maneuvers (forced expiration against a closed glottis) and Credé maneuver(where, a patient is taught to apply nonforceful, smooth, even pressure from the umbilicus toward the urinary bladder).
Clean intermittent self-catheterization, is the primary therapy for impaired or absent detrusor muscle activity. The interval between catheterizations should be tailored to maintain a residual volume of less than 100 cc to avoid incontinence. Bacteruria is fairly common and antibiotic therapy is only indicated if symptomatic urinary tract infections develop.
Patients who present with overflow incontinence and an overdistended bladder may regain bladder tone with the temporary use of an indwelling urinary catheter.
Your symptom needs a full urological work-up early in order to avoid worsening of your symptom. Also, your glycemic control needs to be reviewed and optimized.
|seekinghelpplease - Thu Jul 29, 2010 9:53 pm|
Five months ago my 36 year old sister went into the emergency room with severe back and side pain. She had already had both her gall bladder and appendix removed so the doctors ruled that out immediately. They did several tests and found that her bladder was not emptying properly and was the side of her head. She spent the night in the hospital and went home the next day with a catheter. She had the catheter for 3 weeks because they told her that her bladder needed to rest in order to have further tests run to find the underlying issue. After 3 weeks she went in and they tested to see if her bladder was functioning again- there was no bladder response. For the next 2 weeks she was told to straight catheterize herself until she could get in for further tests. Initially they thought it might have something to do with a nerve in her back. They ruled that out. Then she had a series of bladder test including a cystoscopy. Everything came back completely normal. They ruled out bladder cancer and MS. Then in an open MRI they found a small canal in her cervical spine that had fluid in it. They thought that this was the answer and sent her to a neurologist. He dismissed this immediately saying that it was too small to cause the issue. She just went back to the urologist today and he wants to try to surgically insert a nerve stimulator to force her bladder function to return. This seems odd to me to try a treatment when there is no diagnosis of the issue. At this point she is so frustrated and discouraged that the entire process is taking so long and she still has no answers. Five months without bladder function and no answer in sight is too long for an otherwise healthy 36 year old woman. We are looking for someone to help us navigate the health system and get some answers quickly. Any advise you can provide is greatly appreciated. We are desperate and need to find hope.
|Dr.M.Aroon kamath - Sat Aug 07, 2010 1:51 pm|
One differential diagnosis for her condition could be an Acute transverse myelitis (ATM).
ATM is an inflammatory process(myelopathy) of the spinal cord, that can cause axonal demyelination.
The segment of the spinal cord at which the damage occurs determines which parts of the body are affected.Bladder and bowel sphincter control are disturbed in the majority of patients.
The severity of the motor involvement can range from complete paralysis below the level of the lesion to mild weakness which may even go unnoticed.Severe back pain and radicular pain are quite common.Sensory deficits also can be variable.Sensation is usually diminished below the level of spinal cord lesion in the majority of patients. Some experience tingling or numbness in the legs. Pain on pinprick testing and temperature sensation are diminished in the majority of patients.Vibration sense and joint position sense may also be blunted or spared.
In cases of suspected acute transverse myelopathy,
acute compressive causes must be urgently excluded first. A magnetic resonance imaging (MRI) scan is invaluable in this regard. MRI in most cases can reveal the intrinsic spinal cord lesion. Once a compressive cause is excluded, a detailed history and an examination followed by focused investigations are necessary to diagnose the underlying cause.
The three main conditions in the differential diagnosis are idiopathic
transverse myelitis, demyelination, including multiple sclerosis (MS), and neuromyelitis optica (NMO). Infections such as herpes simplex virus, herpes zoster and inflammatory disorders such as neurosarcoidosis and systemic lupus erythematosus (SLE) also need to be considered and excluded.
ATM is by far, a monophasic illness (one-time occurrence). However, in a small number of patients recurrences may ensue, especially in the setting of an underlying precipitating illness.
In your sister's case, there could be a remote possibility of ATM involving the sacral cord and the manifestation tending to be very atypical(the neurological symptoms could have been very minimal and fleeting). Her doctor will be certainly better placed to evaluate her and arrive at a diagnosis.
I hope this information happens to be useful.
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