Loss of bowel and bladder control

[JanM]

Hi - I'm interested in information about how severe lumbar curves can cause loss of bowel and bladder control. What is the cause and what are the symptoms? I understand that once it happens, it's irreversible. Is that true? Any information or a place you can direct me to information would be much appreciated. Thanks

[CHRIS WBS]

Hi Jan,

I have a severe lumbar curve and quite honestly I've not had one surgeon tell me that that's something I need to think about if I elect to forego surgery. I've had other forebodings such as inability to walk and nerve impairment. On the other hand, surgery can unfortunately cause loss of bowel and bladder control. I don't know what the stats are on that. One surgeon did tell me that dribbling is oftentimes a consequence of surgery that requires fusion to the sacrum.

Chris

[Karen Ocker]

One surgeon did tell me that dribbling is oftentimes a consequence of surgery that requires fusion to the sacrum.

ChrisWBS

Oftentimes???? That seems pretty drastic and I have NOT seen that as an often complication to fusion to the sacrum. Who said that???

In any case I have never had contact with a person who was fused to the sacrum and had problems with bladder and bowel. If that happened so often then I would have heard it on the revision forum where the surgeries are more complicated.

I just did a search-not exhaustive-in the National Library of Medicine on-line and couldn't find anything about loss of bowel/bladder control fusion to the sacrum for scoliosis surgery nowdays. There were many articles about persons with scoliosis and cerebral palsy, spinal cord abnormalities, fractured spines, spinal bifida and syryngomelia which might have had such problems pre-op.

Maybe this happened in the past but with the usual neurological monitoring of the spinal cord/nerves during surgery I suspect this is rather remote.

Maybe someone else on the forum wants to delve further; they can go to that site and look around.

[CHRIS WBS]

One of the surgeons I saw in Chicago mentioned that to me at my second appointment with him. At that time I felt that he was trying to do his best to dissuade me from surgery, because every time I brought up something positive about surgery, he would turn it around into something negative. My gut feeling is he just did not want to do my surgery. Quite frankly, I don’t know where you people are finding all these encouraging doctors. After the last one telling me I’m at high risk for paralysis, I found myself wondering why anyone would consent to such risky surgery. Perhaps my case is unusually complex.

Chris

[Singer]

Chris, I SO wish you could have a consultation with Dr. Boachie. I know it's very impractical for you and difficult logistically to consider, but I wish you could see someone who is completely used to especially challenging cases.

Just thinking out loud.

Best,

[Janet]

Chris,

I agree completely with Singer's suggestion to have a consultation with Dr. Boachie. Originally I set up my appointment with him just to get a third opinion, but the minute he started the conversation I knew he would be the surgeon for me.

Yes, there was the extra expense and time for me to go to NYC, but I feel it was, and will be, worth every penny and then some.

Best wishes,
Janet

[Houston Curves]

The Cauda Equina is the part of the spine where the spinal cord splits out into individual nerves - it's the end of the actual spinal cord. However, there is a Cauda Equina syndrome. I found the following on the American Academy of Orthopedic Surgeons' website (THANKS for putting a name to it Cathydownunder! That made it a lot easier to find):

Cauda Equina Syndrome
Low back pain is common and usually goes away without surgery. But a rare disorder affecting the bundle of nerve roots (cauda equina) at the lower (lumbar) end of the spinal cord is a surgical emergency. An extension of the brain, the nerve roots send and receive messages to and from the pelvic organs and lower limbs. Cauda equina syndrome (CES) occurs when the nerve roots are compressed and paralyzed, cutting off sensation and movement. Nerve roots that control the function of the bladder and bowel are especially vulnerable to damage.


If you don't get fast treatment to relieve the pressure, CES may cause permanent paralysis, impaired bladder and/or bowel control, loss of sexual sensation and other problems. Even if the problem gets treatment right away, you may not recover complete function.

Causes

CES may be caused by a ruptured disk, tumor, infection, fracture or narrowing of the spinal canal. It may also happen because of a violent impact such as a car crash, fall from significant height or penetrating (i.e., gunshot, stab) injury. Children may be born with abnormalities that cause CES.

Diagnosis and treatment

Although you need early treatment to prevent permanent problems, CES may be difficult to diagnose. Symptoms vary in intensity and may evolve slowly over time. See your doctor immediately if you have:


Bladder and/or bowel dysfunction, causing you to retain waste or be unable to hold it.

Severe or progressive problems in the lower extremities including loss of or altered sensation between the legs, over the buttocks, inner thighs and back of legs (saddle area), and feet/heels.

Pain, numbness or weakness spreading to one or both legs that may cause you to stumble or have difficulty getting up from a chair.

To diagnose CES, the doctor will probably evaluate your medical history, give you a physical examination and order multiple imaging studies.

Medical history: Describe your overall health, when the symptoms of CES began and how they impact your activities.

Physical exam: The doctor assesses stability, sensation, strength, reflexes, alignment and motion. He or she may ask you to stand, sit, walk on your heels and toes, bend forward, backward and to the sides, and lift your legs while lying down. The doctor might check the tone and numbness of anal muscles. You may need blood tests.

Imaging: You may get X-rays, MRIs (magnetic resonance imaging) and CAT scans (computerized tomography) to help the doctor see the problem.

Surgery

If you have CES, you may need urgent surgery to remove the material that is pressing on the nerves. The surgery may prevent pressure on the nerves from reaching the point at which damage is irreversible.

Living with CES

Surgery won't help if you already have permanent nerve damage. In this case, you can learn how to make living with CES more tolerable. Some suggestions:


In addition to medical personnel, you may want to get help from an occupational therapist, social worker, continence advisor or sex therapist.

Involve your family in your care.

To learn all you can about managing the condition, you may want to join a CES support group.

Managing bladder and bowel

Some bladder and bowel function is automatic, but the parts under voluntary control may be lost if you have CES. This means you may not know when you need to urinate or move your bowels, and/or you may not be able to eliminate waste normally. Some general recommendations for managing bladder and bowel dysfunction:

Bladder: Empty the bladder completely with a catheter 3-4 times each day. Drink plenty of fluids and practice regular personal hygiene to prevent urinary tract infection.

Bowel: Check for the presence of waste regularly and clear the bowels with gloved hands. You may want to use glycerin suppositories or enemas to help empty the bowels. Use protective pads and pants to prevent leaks.


June 2001

[CHRIS WBS]

The fact of the matter is that a good many of us will suffer from bladder and/or bowel incontinence at some point in our lives, scoliosis or not. Just visit a nursing home and see all the residents in diapers. I have an aunt who has suffered from fecal incontinence for years and she does not have scoliosis.

Chris