Spine problems and UTI's

[mmglobal]

A client I'm working with said something very interesting to me last week. In the years leading up to her ADR surgery, she had frequent bladder and/or urinary tract infections. In six months since her ADR surgery, she's had none.

I asked Dr. Andrea Fenk-Mayer of Pro-Spine about the releationship between spine problem and UTI's. Her reply generated some very interesting discussion.

Originally Posted by Dr. A F-M

She did not have a cord compression sufficient to compromise bladder emptying – residual urine in the bladder is always a core for infection. Relevant in many spine patients, but expectedly not in her

She does not think that there is a direct relationship for this patient, but the issue of cord compression with a potentially unnoticeable symptom that could cause bladder infections is something we should know about.

Originally Posted by Dr. A F-M

Might be due to changed medication - many meds alter the immune system some, many change the chemical consistency of urin (e.g. ph), and thus foster bladder infections. Which are frequent anyway in females.

... a very interesting indirect relationship between spine problems and potential UTI's

While this patient did not have spine cord compression, in the past she did have a serious lumbar herniation that might give concern for symptoms more advanced than typical sciatica. It may be the case that there was some issue that had not been adequately decompressed until her ADR surgery. It may also be the case that this all has nothing to do with her spine or treatments... but she cannot ignore the dramatic difference pre and post-op.

I'll be asking more questions about this. Next:

"If you are suffering from UTI's that may be related to spine issues... is there anything you can do to improve the situation (other than surgery?)

From the patient community... any relevant experience that may be helpful here?

All the best,

Mark

[dshobbies]

Frequent UTIs in women can be caused by lifestyle choices. Two related factors are infrequent urination and not drinking enough fluids. Often bathrooms aren't readily available and/or inconvenient, not to mention the inevitable long lines. We therefore don't drink because of this and 'hold it' even if we have to go.

One possible fix is of course to drink a lot of fluids and urinate as often as possible. One doctor told me if your urine has color or odor, you waited too long. As long as I know I'll have access to a bathroom, this is not a problem but too often the access is the problem, therefore you have a catch 22 situation.

Flushing out the infection by drowning it might be a solution if caught quickly but if it's caused by other factors, the solution might not be that simple.

[Maria]

It sounds as though we are talking specifically about females so then we consider what age group, sexually active and if so, monogamous, using protection, anal, gential penetration, oral sex, post coital urination, meds utilized such as oral contraception, antibiotics, other meds and so forth plus the overall spinal condition as well as overall health condition of the person and other considerations.

Prior to my first spine surgery yet also before my first documented spine injury, I had numerous UTIs. I was catheterized quite often and seemed that even if I didn't have a bladder infection there was irritation of the urethra that was problematic enough to make me feel like I was having a UTI thus treated in this manner. On hospitalization for first spine surgery when male nurse trying to cath me w/o anesthesia I crawled up to the head of the bed.. wasn't happening. I remember telling the nurses to knock me out if they were going to cath me so they waited until I was under to do so. Was later told I had a urethral stricture likely caused from either multiple infections and/or multiple caths.

After my first documented spinal injury and prior to my first surgery I experienced not only frequent UTIs (was monogamous and on oral contraception but no other meds) I experienced something akin to stress incontinence without the stress. Just leaking. Urologist thought it related to my spinal condition at L5S1. Neurosurgeon wasn't sure but thought perhaps it would be relieved with surgery at L5S1.

Had some very sophistocated urodynamic testing (editing prior post as recalling more on this) and was recommended to go under general anesthesia and fill the bladder up completely and have it empty under general anesthesia because it was difficult in an awake state with a catheter in my bladder, and one in the rectum (for pressure) over more than several hours of testing to get an accurate dx re emptying (neurogenic bladder). Was told that with multiple UTIs the bladder wall was much less elastic and under general anesthesia while the bladder capacity was being tested, there were treatments to stretch out the bladder wall and injections.

I do remember speaking to few patients that had undergone the treatment to stretch the bladder wall and not being impressed with what they had to report. The Neurosurgeon I was seeing made sure to get a Uro (one of his choice) consult while I was catherized/hospitalized and the testing he performed was much simpler and I was prescribed Ditropan for frequency.

After my first discectomy I no longer had the incontinence. The Neuro didn't take credit for this as I recall only asked about recurrence and I saw the Uro several more times but didn't want to take the Ditropan on a regular basis. Not until after my 2nd discectomy which was at L4 and failed did I experience a similar but slighter level of leakage (incontinence) and for a very short period of time. I was advised to come in immediately to r/o Cauda Equina as I recall.

Ok suggestions to avoid routine UTIs
Stay hydrated, drink enough water
As mentioned before, void when needed, wipe front to back.
Precautions re relations/intimacy w/new partners
Perineal hygine
Undergarments w/o dye, clean

See your doctor when you've urinary complaints such as burning, frequency, urgency, pelvic or back pain of unknown origin, leaking or incontinence and just general malaise, temp.101 or greater (even low grade increase), nausea... just best to check it out.

I've edited this post because there was too much info there but suffice to say of course one should get a diagnosis re UTI (urinary tract infection vs. other such as neurogenic bladder).

Wondering which came first the chicken or the egg in terms of bladder probs again I have to say throw into the mix all the reasons one might have frequents UTIs as well as incontinence and the best I can say is if you are symptomatic with any urinary complaint, don't wait too long to see if it's going away on it's own (I think most people are seen again with acute complaints such as burning, frequency and urgency. I didn't go right right away for the incontinence as I was *embarrassed* and had no other symptoms. Make an appt. with your PCP. I've seen some nasty consequences of undiagnosed bladder infections/urinary complaints gone unchecked, let alone something that might or might be related to the spine.

I have to think that somehow the incontinence I had was related to my disc bulge just because it stopped so dramatcally post my 1rst L5S1 discectomy. The UTIs.. while I've only had one since in the last 25 plus years and I can't say that I can give my L5S1 discectomy credit for that though perhaps partial credit?

[Maria]

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