Tuesday, September 27, 2022

Spinal Stenosis And Urinary Retention

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The Vagal Nerves Blood Pressure Regulation Heartbeat Regulation Urinary Incontinence Problems Could All Trace A Common Source To The Neck

#38 Urinary evaluations of decompression surgery for cervical myelopathy and lumbar canal stenosis

Two years later a different set of researchers from the Department of Cardiovascular Studies, University of Leeds in the United Kingdom published a follow up study in the Quarterly Journal of Experimental Physiology. They found: inhibition of vagus nerve activity caused by bladder distension was affected by the level of carotid sinus pressure. The filled bladder and the nerve impulses it was creating were being regulated by the carotid sinus in the neck. The vagal nerves, blood pressure regulation, heartbeat regulation, urinary incontinence problems, could all trace a common source to the neck.

Now you would think research like this would get neurologists, urologists, and cardiologists talking. This was not the case. Lets fast forward some 25 years later to 2012.

In a published study in the Polish medical journal Folia Medica Cracoviensia, doctors at the Department of Pathophysiology, Jagiellonian University Medical College, Kraków, Poland opened their study with this sentence:

There is no evidence that vagal nerve innervates the urinary bladder. They closed their research investigation with this sentence: The modulation of vagal nerve activity affect the urinary bladder function in naive conditions, as well as in case of . These data implies the integrative action of visceral vagal nerve innervation in urinary bladder function.There is a connection.

As you can there is controversy when it comes to urinary and bladder problems and cervical neck pain.

Spinal Disorders And Neurogenic Bladder Dysfunction

Often times spinal disorders associated with injuries that result in nerve damage are linked to Neurogenic Bladder Disorder , which refers to urination issues. Neurogenic is a term for the nerve tissues that stimulate an organ or muscle to properly function.

With NBD the nerves that control the bladder and other muscles involved with urination may cause the bladder to be under or overactive.

When the nerves for bladder sensation or function become irritated, inflamed, or compressed, dysfunctions such as frequent urination, the sudden overwhelming urge to urinate, or involuntarily voiding the bladder may occur.

NBD is commonly caused by spinal cord injuries . Accidents that cause bruising or constrict blood flow along the spinal cord can damage the ability to transmit nerve signals.

Herniated discs, infections, lesions, lumbar tumors, and fractures along the spine can also cause back pain and damage to the spinal nerves leading to bladder dysfunction. These conditions may also cause Cauda Equina Syndrome , a serious medical issue requiring immediate attention.

Grading The Strength Of Evidence For Individual Comparisons And Outcomes

The overall strength of evidence for select clinical outcomes within each comparison will be evaluated based on four required domains: study limitations directness consistency and precision .13 A fifth domain, reporting bias, will be assessed when the strength of evidence is moderate or high based on the first four domains.13 Risk of bias will be rated as low, medium, or high according to study design and conduct. Consistency will be rated as consistent, inconsistent, or unknown/not applicable . Directness will be rated as either direct or indirect. Precision will be rated as precise or imprecise. Other factors that may be considered in assessing strength of evidence include dose-response relationship, the presence of confounders, and strength of association. Based on these factors, the overall evidence for each outcome will be rated as:13

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Enhancing Healthcare Team Outcomes

Postoperative urinary retention is not an uncommon problem, and it should have management from an interprofessional healthcare team. Its diagnosis and treatment rely on an interprofessional approach through all perioperative stages. Surgeons should identify patients preoperatively who are at the highest risk of developing POUR, educate them on their increased potential of developing POUR, and consider prescribing a prophylactic alpha-blocker . Intraoperatively, the anesthesia team should keep in mind that POUR correlates with the volume of intravenous fluids given, and the surgeon should keep in mind that the length of operation has a link to the development of POUR.

A trial without a catheter can then follow in 1 to 3 days by the floor nurse at the order of the surgeon/hospitalist. It is essential after removal of a foley to closely monitor the patient’s ability to void to avoid a second episode of extreme bladder retention and confirm a low postvoid residual bladder scan before considering the trial without catheter a success. If a patient does fail a trial without a catheter, the patient should receive an outpatient urology consultation. These interprofessional measures can ensure the best possible patient outcomes with POUR.

Back Pain And Incontinence In Women

Post

Depending on the cause of back pain or incontinence, symptoms may vary. Women often struggle with stress incontinence after giving birth and leak while participating in activities that add stress to the bladder, such as laughing, sneezing, or lifting a heavy object. However, kidney problems such as stones can also cause frequent urination or urge incontinence when the urge to urinate suddenly strikes.

While studies show that in some patients the cause of back pain and incontinence is linked to weight gain or sedentary lifestyles, both conditions can also be caused by chronic illnesses like type 2 diabetes and arthritis.

When it comes to giving birth, 50% of women report stress urinary incontinence. Postpartum back pain and incontinence may impact moms for up to twelve months after their babies are delivered due to pelvic floor weakness.

Pelvic floor muscles often become weakened due to the added stress of supporting a growing infant and from supporting the body during labor. Once weakened, pelvic floor muscles are less able to function under increased pressure from the abdominal muscles during physical activities, leading to leaks. Pelvic floor muscles also play a role in spinal stability.

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Spine Disorders With Potential To Cause Nbd

  • is a common cause of neurogenic bladder dysfunction. The spinal cord need not be severed to cause paralysis below the injured level of the spine . Bruising of the spinal cord or inadequate blood flow can damage the cord’s ability to transmit nerve signals.

  • occurs when the spinal nerve roots in the lower back are compressed. Although cauda equina syndrome is a rare occurrence, it is a serious medical situation requiring urgent care.

Causes of CES include:

Nearly Half Of All Patients Undergoing Elective Cervical Spine Surgery Had Moderate

Numbers:

  • The prevalence of moderate lower urinary tract symptoms in the patient sample was 40%
  • The prevalence of severe lower urinary tract symptoms in the patient sample was 8%
  • Clinically relevant urinary bother was reported in 18% of patients
  • The odds of moderate-to-severe lower urinary tract symptoms among patients with myelopathy was greater than that observed in patients without myelopathy
  • The prevalence of clinically relevant urinary bother was higher in patients with myelopathy compared with those with no myelopathy .

Nearly half of all patients undergoing elective cervical spine surgery had moderate-to-severe lower urinary tract symptoms. This is more than double the prevalence that has been reported in a community-dwelling adult population. These symptoms can impair quality of life, lead to surgical complications , and may be mistaken for cauda equina , prompting potentially unnecessary imaging and studies.

Dr. Albert also suggested:

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How Is A Diagnosis Made

A careful medical exam will confirm or rule out a suspected diagnosis of cauda equina. Evaluation includes a medical history and physical exam. A loss of sensation in the anal area is a clear finding. A patient who complains of severe leg weakness, numbness in the genital area, or loss of bladder or bowel function will undergo an MRI scan to reveal the extent to which the herniation is compressing the spinal nerves. The doctor may also order a CT scan or a myelogram.

Common Symptoms For These People *:

Trabeculated bladder with ureteral stenosis at ureterovesical junction, & loss of renal function.
  • Weight Increased: 1 person, 50.00%
  • Mental Status Changes , loss of alertness, loss of orientation): 1 person, 50.00%
  • Back Pain: 1 person, 50.00%
  • Body Height Decreased: 1 person, 50.00%
  • Carpal Tunnel Syndrome : 1 person, 50.00%
  • Chest Pain: 1 person, 50.00%
  • Complex Regional Pain Syndrome ): 1 person, 50.00%
  • Compression Fracture : 1 person, 50.00%
  • Deafness Unilateral: 1 person, 50.00%
  • Fall: 1 person, 50.00%
  • * Approximation only. Some reports may have incomplete information.

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    When Should To Call My Healthcare Provider

    Lumbar spinal stenosis can cause cauda equine syndrome, which needs medical attention right away. Call your healthcare provider if you have:

    • Loss of bowel or bladder control
    • Severe or increasing numbness between your legs, inner thighs, or back of your legs
    • Severe pain and weakness that spreads into one or both legs, making it hard to walk or get out of a chair

    Who Gets Spinal Stenosis

    Just about everyone has some narrowing of the spinal canal by the age of 60, but very few people develop troubling symptoms of the disease. Spinal stenosis due to aging seldom appears before the age of 50. The condition is somewhat more common in people of Asian heritage. Lumbar spinal stenosis is more common in men than in women. Occasionally congenital spinal stenosis is a problem for children and teens.

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    How Can A Lumbar Laminectomy Treat Spinal Stenosis

    Lumbar laminectomy, also called open decompression, is a surgical procedure performed to treat the symptoms of central spinal stenosis or narrowing of the spinal canal. The surgery involves removal of all or part of the lamina to provide more space for the compressed spinal cord and/or nerve roots .

    What Can My Chiropractor In Edmonds Do To Help With Spinal Stenosis

    Acute urinary retention

    A report from the United States Agency for Healthcare Research and Quality reveals that 13 to 14 percent of people who have lower back pain also have some degree of spinal stenosis. Your chiropractor is an expert not just in treating but also in recognizing diseases of the spine. You’ll get early detection and treatment at your chiropractor.

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    Typical Symptoms Of Lumbar Spinal Stenosis

    The characteristic symptom of lumbar spinal stenosis is increased pain in the legs with walking , which can markedly diminish one’s activity level. People with lumbar spinal stenosis are typically comfortable at rest but cannot walk far without developing leg pain. Pain relief is achieved within 5 to 10 minutes when they sit down or lean forward.4 Spinal nerve root involvement may cause a more sharp, shooting type of pain in the leg.

    The symptoms of lumbar spinal stenosis develop slowly. As the condition progresses, the symptoms may worsen and become quite debilitating. For each person, the severity and duration of lumbar stenosis symptoms are different and based on the affected neural tissue. Common symptoms may include one or more of the following:

    • Radicular pain: Nerve root compression or irritation that results in leg pain, which typically travels down from the lower back into the buttock and leg on one sidecommonly called sciatica.
    • Lumbar radiculopathy: Nerve root compression or irritation that results in tingling, weakness, and/or numbness that radiates from the lower back into the buttock and leg on one side.
    • Neurogenic claudication: Spinal cord compression that causes a symmetrical pattern of pain affecting both legs while walking or standing for a long period of time. Neurologic deficits, such as loss of coordination, gait imbalance, numbness, and weakness affecting both legs may also occur.

    Read more about Lumbar Spinal Stenosis Symptoms

    Patients Had Urinary Problems Before Their Cervical Neck Surgeries And These Patients Urinary Problems Should Not Be Mistaken For Low Back Complications But Should Be Traced Back To The Neck

    Here, we see that patients had urinary problems before their cervical neck surgeries and that these patients problems should not be mistaken for low back complications.

    There have been previous studies to make a connection between urinary incontinence and cervical neck instability and in fact in some instances where a successful surgery did cure the patient if their urinary symptoms.

    A 2005 study in the Journal of spinal disorders and techniques came from Japanese researchers at the Shinshu University School of Medicine. Here the researchers found that:

    • In 56 patients examined in this study, 29 had some urinary subjective complaints, whereas the remaining 27 had none.
    • Urologic examination indicated that 8 of these 29 patients with urinary complaints had urologic disorders other than neurogenic bladder .
    • Of the remaining 21 patients, 6 were judged to have neurogenic bladder on urodynamic study. However Urodynamic study may be of limited value in diagnosing urinary disturbance in cervical myelopathy.
    • Patients with urinary complaints had significantly longer durations of myelopathy and delayed motor evoked potential latencies than those without urinary complaints.
    • After surgery, 19 of the 21 patients with urinary complaints showed recovery from urinary disturbance. Operations in patients with cervical myelopathy were also effective against urinary disturbance. Urinary complaints may be an indication for surgical treatment despite the results of the urodynamic study.

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    How Is Lumbar Spinal Stenosis Treated

    If you have lumbar spinal stenosis, many types of healthcare professionals can help you, such as arthritis specialists, nerve specialists, surgeons, and physical therapists. Treatment can include physical therapy, medicine, and sometimes surgery. Except in emergencies, such as cauda equina syndrome, surgery is usually the last resort.

    • Physical therapy may include exercises to strengthen your back, stomach, and leg muscles. Learning how to do activities safely, using braces to support your back, stretching, and massage may also be helpful.
    • Medicines may include nonsteroidal, anti-inflammatory medicines that relieve pain and swelling, and steroid injections that reduce swelling.
    • Surgical treatments include removing bone spurs and widening the space between vertebrae. The lower back may also be stabilized by fusing together some of the vertebrae.
    • Acupuncture and chiropractic care may also be helpful for some people.

    Searching For The Evidence: Literature Search Strategies For Identification Of Relevant Studies To Answer The Key Questions

    Cervical Spinal Stenosis – Mayo Clinic

    We will utilize bibliographic database searching to identify previous systematic reviews, randomized controlled trials, and observational studies published from 1946 to the present for studies enrolling adults based on a diagnosis of CUR. Relevant bibliographic databases for this topic include MEDLINE® and the Cochrane Central Register of Controlled Trials . Our preliminary search strategy appears in Appendix A. This search strategy searches on only one concept, CUR, and employs relevant Medical Subject Headings and natural language terms to find studies on the topic. The concept search is supplemented with filters designed to select experimental designs. Bibliographic database searches will be supplemented with backward citation searches of highly relevant systematic reviews. We will update searches while the draft report is under public/peer review.

    We will conduct additional grey literature searching to identify relevant completed and ongoing studies. Relevant grey literature resources include trial registries and U.S. Food and Drug Administration databases. We will search ClinicalTrials.gov and the International Controlled Trials Registry Platform . We will also review Scientific Information Packets sent by manufacturers of relevant interventions. Grey literature search results will be used to identify studies, outcomes, and analyses not reported in the published literature to assess publication and reporting bias.

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    Data Abstraction And Data Management

    We will review bibliographic database search results for studies relevant to our PICOTS framework and study-specific criteria. The use of previous systematic reviews to replace the de novo process will be explored when relevant or partially relevant systematic reviews are identified and judged to be of fair or good quality by using modified AMSTAR criteria.9 Search dates may be altered in the presence of high-quality systematic reviews for specific populations and/or interventions.

    Review of bibliographic database searches will occur in two stages. First, titles and abstracts will be reviewed by two independent investigators to identify studies meeting the criteria in the PICOTS framework and study-specific criteria. At this stage we plan to include all interventions identified in the literature. At completion of this stage, we will consult with our Technical Expert Panel to ensure that we capture only studies examining relevant interventions . All studies identified as relevant by either investigator will undergo full-text screening. Two independent investigators will screen the full text to determine if our inclusion criteria are met. Differences in screening decisions will be resolved by consultation between investigators and a third investigator if necessary. We will document the inclusion and exclusion status of citations undergoing full-text screening.

    Approach To Patients With Urinary Retention

    The evaluation of the patient with suspected urinary retention should begin with a detailed history to elucidate the precise etiology, as summarized in Table 4.5 Initial evaluation should also include a thorough medication history, including use of over-the-counter medications and herbal supplements. The American Urological Association Symptom Index is a validated questionnaire that aims to quantify lower urinary tract symptoms in men relative to obstructive uropathy, often secondary to prostatic enlargement .27

    History and Physical Examination Findings That Suggest Etiologies of Urinary Retention

    Adapted with permission from Selius BA, Subedi R. Urinary retention in adults: diagnosis and initial management. Am Fam Physician. 2008 77:647.

    History and Physical Examination Findings That Suggest Etiologies of Urinary Retention

    Adapted with permission from Selius BA, Subedi R. Urinary retention in adults: diagnosis and initial management. Am Fam Physician. 2008 77:647.

    Physical examination should include a complete abdominal assessment, including palpation and percussion of the bladder and abdominal/pelvic organs evaluation for flank tenderness a digital rectal examination in men to assess prostate size with or without nodularity and the presence or absence of rectal masses a complete pelvic examination in women and a neurologic evaluation to assess strength, sensation, muscle tone, and reflexes relative to lower thoracic, lumbar, and sacral spinal levels.5

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    What Are The Symptoms Of Lumbar Spinal Stenosis

    Early lumbar spinal stenosis may have no symptoms. In most people, symptoms develop gradually over time. Symptoms may include:

    • Pain in the back
    • Burning pain going into the buttocks and down into the legs
    • Numbness, tingling, cramping, or weakness in the legs
    • Loss of sensation in the feet
    • A weakness in a foot that causes the foot to slap down when walking
    • Loss of sexual ability

    Pressure on nerves in the lumbar region can also cause more serious symptoms known as cauda equine syndrome. If you have any of these symptoms, you need to get medical attention right away:

    • Loss of bowel or bladder control
    • Severe or increasing numbness between your legs, inner thighs, and back of the legs
    • Severe pain and weakness that spreads into one or both legs. This makes it hard to walk or get out of a chair

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