Although many people know the common symptoms of pain and altered mobility that spine problems can cause, what is often less well-known is the potential impact on the bladder. This effect can range from mild to a medical emergency and in this article we look at what can cause this, what signs to look for, what treatments are available and when to seek medical advice.
The term spinal dysfunction refers to any abnormality or impairment in the normal functioning of our spine, which is a very complex and critical structure in the human body. The spine (also known as the vertebral column or backbone) consists of a series of vertebrae stacked on top of each other. Between each backbone is a disc that acts like a shock absorber to help protect our back from impacts and stress. These vertebrae encase and protect the spinal cord, which is a key part of our central nervous system. The spine provides structural support, allows for us to move, and the nerves that run down it transmit signals between the brain and the rest of our body.
Spinal dysfunction can involve structural, mechanical, or neurological causes. Common causes include:
• Trauma. Accidents, falls, or injuries can cause fractures, dislocations, or other damage to the spine that lead to dysfunction.
• Degenerative changes. The natural ageing process can result in degenerative changes in the spine, such as disc degeneration, osteoarthritis, and spinal stenosis.
• Abnormalities of the spine. Structural abnormalities, such as scoliosis (sideways curvature of the spine), kyphosis (excessive forward curvature of the upper spine), or lordosis (excessive inward curvature of the lower spine), can all contribute to dysfunction.
• Disorders of the spinal cord. Diseases affecting the spinal cord, such as multiple sclerosis, transverse myelitis, or syringomyelia, can disrupt normal spinal cord function.
• Tumours. Tumours - either cancerous or benign - in or around the spine can compress it, affecting nerve function and leading to dysfunction. (Compression of spinal nerves can also be caused by conditions such as spinal stenosis or herniated discs).
These vary widely depending on the underlying cause and its location. Common symptoms may include pain, stiffness, numbness, tingling, weakness, changes in posture, and difficulties with movement.
Spinal dysfunction can potentially affect the bladder by impacting the nerves and structures that control bladder function. Our spinal cord plays a crucial role in transmitting signals between our brain and bladder, regulating the storage and release of urine. If there is any disruption or dysfunction in the spinal cord or surrounding structures, this can impact on our bladder control. Some of the most commonly seen spinal dysfunction conditions that may be associated with bladder problems include:
Damage to the spinal cord, such as may occur from the injuries resulting from accidents or falls, can disrupt the communication between the brain and the bladder. SCI at or above the lower section of the spinal cord can lead to neurogenic bladder dysfunction, affecting the ability to control bladder emptying and storage of urine.
This is a narrowing of the spinal canal that can compress the spinal cord or nerve roots. If the stenosis occurs in the lower back (lumbar spine), it may affect the nerves that control bladder function and cause difficulty starting to urinate, a weak urine stream, or incomplete emptying of the bladder.
A herniated disc in the lumbar (lower) spine can press on the nerves there, potentially affecting the ones that supply the bladder. Symptoms may include urinary urgency, frequency, or difficulty in starting or stopping the urine stream.
This is a rare but serious medical condition that occurs when the bundle of nerves below the spinal cord, called the cauda equina, is compressed - usually from a large herniated disc, spinal stenosis, or other spinal abnormality. Cauda equina syndrome is a medical emergency that requires prompt medical attention as it can lead to neurological deficits and complications, including bladder and bowel dysfunction. Symptoms may include urinary retention, incontinence, and loss of sensation in the pelvic region.
Tumours that affect the spinal cord or nearby structures can cause neurological symptoms, including bladder dysfunction. The symptoms may vary depending on the location and size of the tumour but may include changes in urinary habits.
This is a neurological condition that can cause demyelination of nerve fibres (where the outer protective coating of a nerve becomes thin, patchy or absent), affecting communication between the brain and various organs, including the bladder. People with MS may experience urinary symptoms such as urgency, frequency, and incontinence. There are also other neurological disorders - such as syringomyelia or transverse myelitis - that can result in spinal cord dysfunction and affect bladder control in the same way.
It's important to say that not all cases of spinal dysfunction lead to bladder problems, and the specific impact can vary depending on the location and severity of the dysfunction. If you have any change in bladder function, urinary symptoms, or signs of neurological impairment, always seek prompt medical evaluation as a thorough assessment is crucial for an accurate diagnosis and appropriate management. Symptoms that should always be assessed urgently include:
• Urinary incontinence - an inability to control the release of urine, leading to involuntary leakage (‘wetting yourself’).
• Urinary retention - difficulty or inability to empty your bladder completely.
• Loss of bladder sensation - a reduced or absent sensation of a full bladder.
• Bowel dysfunction - changes in bowel habits or difficulty in controlling your bowel movements.
• Numbness or weakness in the lower extremities.
Treatment very much depends on the specific diagnosis rather than being the same for everyone. It may involve a combination of measures such as:
• Physical or occupational therapy
• Lifestyle and activity modifications
• In some cases, surgery
The early diagnosis and appropriate management are crucial for optimising outcomes and preventing longer-term complications. Anyone experiencing symptoms of spinal dysfunction should seek prompt evaluation and guidance from healthcare professionals, including orthopaedic specialists, neurologists, or spine specialists.
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