Can't Urinate -- a new symptom -- help?
 

Well, I saw a urologist and he thinks I have some neurogenic bladder problems going on. I guess it is called dyssynergia. Essentially, the spincter muscle is in a spasm and I am unable to urinate well--hesitation, not emptying bladder completely, interrupted stream. What a bummer. Now I have a new MS symptom to add to the bunch. I've had it for months but it seems worse now.....have had UTI's here and there and thought that might be it but now I have a clean bill of health on the UTI and the problem remains or has really gotten a little worse.

Needless to say I'm a little freaked out by this. It seems that there are a lot more treatments and solutions for incontinence then there are for this problem. He said roughly 70% of MS patients have the incontinence and 30% tend to have dyssynergia.

Does anyone struggle with this? Have you found any useful treatments? I know the ugly word "catheter" has come up. I'm not at that stage yet but petrified, of course. :(

The other thing I wonder is, does this mean I have a spinal lesion now? When I first got diagnosed in Sept. 2007 they did brain and spine MRIs. Nothing showed on the spine. Should I now ask my neuro for a spine MRI?

Thanks all.

I also have that problem for years now. A Female Neurologist told me to squeeze my bladder and that works to help me empty my bladder to avoid the horrible UTIs.

When I went to the hospital, after my fall, they had to catherize me, but just once, then they wanted me to go on my own. This was a real problem for the first few days in the hospital.:eek:

When I go and I think I'm finished, I squeeze my bladder and more comes out, so I have a constant tendancy to retain.:(

I hope you can do this and won't have to cathiterize.:hug::hug:

Thanks for that info Sal - I too find that I have to press on my bladder quite often (and quite hard) to start urinating - I know I have to go and I feel lots of discomfort in my bladder but I just can't do it - and I often do the start-stop-start again thing.

This is in direct contrast to the times when I can barely make it in time. It varies.

Cheers

Lyn

VINPOCETINE for lower urinary tract dysfunctions
 

VINPOCETINE is a PDE-1 Phosphodiesterase inhibitor TYPE 1 that when taken in the CORRECT AMOUNT will help. I find that 10 mg two or three times a day greatly helps.

jackD

p.s It also cures MS, but that is another story.



World J Urol. 2000 Dec;18(6):439-43.

Initial clinical experience with the selective phosphodiesterase-I isoenzyme inhibitor vinpocetine in the treatment of urge incontinence and low compliance bladder.

Truss MC, Stief CG, Uckert S, Becker AJ, Schultheiss D, Machtens S, Jonas U.
SourceDepartment of Urology, Medizinische Hochschule Hannover, Germany.

Abstract
Current pharmacological treatment modalities for urge incontinence and low compliance bladder are limited by a low clinical efficacy and the significant side effects of the standard drugs available. Previous in vitro studies indicated a possible functional relevance of the intracellular phosphodiesterase (PDE)-1 isoenzyme in the regulation of human detrusor smooth muscle contractility.

We therefore investigated the effect of the PDE-1 inhibitor vinpocetine in nonresponders to standard pharmacological therapy. In 11/19 patients (57.9%) clinical symptoms and/or urodynamic parameters were improved. Although these initial data are preliminary, they represent the first evidence that isoenzyme-selective PDE inhibition may be a novel approach to the treatment of lower urinary tract disorders.

PMID:11204266[PubMed - indexed for MEDLINE]


World J Urol. 2001 Nov;19(5):344-50.

Phosphodiesterase 1 inhibition in the treatment of lower urinary tract dysfunction: from bench to bedside.

Truss MC, Stief CG, Uckert S, Becker AJ, Wefer J, Schultheiss D, Jonas U.
SourceUrologische Klinik, Medizinische Hochschule, Hannover, Germany.

Abstract
Anticholinergic drugs are currently the therapy of choice to treat urgency and urge incontinence. However, muscarinergic receptor blockers with adequate selectivity for detrusor smooth muscle are not available.

Also, in contrast to the normal detrusor, the unstable detrusor neurotransmission seems to be at least partially regulated by non-cholinergic (NANC) pathways. These factors may explain the common side effects and the limited clinical efficacy of these compounds. Specific modulation of intracellular second messenger pathways offers the possibility of organ selective manipulation of tissue function, specifically contraction and relaxation of smooth musculature.

Because of their central role in the intracellular regulation of smooth muscle tone phosphodiesterases (PDEs) are an attractive pharmacological targets.

The PDE 5 specific inhibitor sildenafil (Viagra) has revolutionized the treatment of patients with erectile dysfunction.

Numerous other PDE inhibitors are currently under investigation for the treatment of various disorders.

We investigated the role of PDEs in human detrusor smooth muscle. Our data demonstrate the presence of five PDE isoenzymes in human detrusor and suggest, for the first time, that the cAMP pathway and the calcium/calmodulin-stimulated PDE (PDE 1) are of functional importance in the intracellular regulation in this tissue in vitro.

In addition. initial clinical data with the PDE 1 inhibitor vinpocetine in patients not responding to standard anticholinergic therapy indicate a possible role for vinpocetine in the treatment of urgency, urge incontinence and, possibly, low compliance bladder and interstitial cystitis. The results of a larger randomized, double-blind, placebo-controlled, multicenter trial with vinpocetine show a tendency in favor of vinpocetine over placebo; however, statistically significant results were documented for one parameter only. This might be due to the rather low dosage chosen and the small sample size. Further studies are necessary and currently underway to delineate the optimal dosage, indications and patient population. Modulation of intracellular key enzymes effecting second messenger metabolism, i.e. isoenzyme-selective PDE inhibition is a novel approach which possibly avoids the limitations of anticholinergic therapy in patients with lower urinary tract dysfunction.

PMID:11760783[PubMed - indexed for MEDLINE]

RATS WITH THE SAME PROBLEMS -LOVE THE STUFF!!!!


Urol Res. 2001 Dec;29(6):388-92.

Identification and functional study of phosphodiesterases in rat urinary bladder.
Qiu Y, Kraft P, Craig EC, Liu X, Haynes-Johnson D.

SourceR.W. Johnson Pharmaceutical Research Institute, Raritan, NJ 08869, USA.

Abstract
Abstract Cyclic nucleotides are important secondary messengers involved in modulating the contractility of various smooth muscles.

Phosphodiesterases (PDE) play important roles in this process by modulating the levels of cyclic nucleotides and their duration of action.

This study was designed to identify and characterize the PDE isoenzymes in rat urinary bladder and to evaluate their roles in regulating bladder smooth muscle tone.

The involvement of cAMP and cGMP pathways in this process was also assessed. The studies were carried out with tissues from male and female rats and no significant sex-related difference was found in the results. Utilizing the unique pharmacological properties of different isoenzymes, PDE1, 2, 3, 4, and 5 were identified in rat bladder. Organ bath experiments showed that forskolin was most potent in relaxing pre-contracted rat bladder strips while sodium nitroprusside was moderately effective, suggesting the relaxation was mainly mediated by the cAMP pathway and that the cGMP pathway is moderately involved. For PDE inhibitors, the non-specific inhibitor papaverine was most effective in relaxing pre-contracted bladder strips.

Among isoenzyme-selective inhibitors, vinpocetine, EHNA, and sildenafil induced more relaxation than milrinone and rolipram.

PMID:11828991[PubMed - indexed for MEDLINE]

It sounds like Retention more than anything else. Not uncommon with MS. The Best Solution is Cathing, makes sure you empty completely and it is not difficult.

Natalie - :hug: I have retention too. It's not bad enough where I need medication. It was offered to me by my urologist but I opted out at this point. I am not getting UTIs and it is not bad enough to justify medication and subsequent side effects from the medication. Anyhow, I know how you feel.

There are times when I have to go. I hurry to the bathroom only to sit and wait and wait and wait. Sometimes I get frustrated and just get up and leave. It is so annoying. I know this sounds weird but other times I just tell my brain and bladder to get with the program and work together. haha

November, I had that sphincter sliced to stay open (i'm already a paraplegic, worn condom caths for 22yrs) and for past 2 yrs would SWEAT, not pass urine unless I lay down or get on couch or go in pool, or lift myself up in wheelchair, or cath 1000cc's. Anyway, procedure didn't help. Been using foley cath since procedure & probably will for a long time till bladder shrinks or forever. Nice not gluing condom on 2x/day but foley cath's a pain in it's own respect.

I got to watch the procedure, as dr spoke what he was doing & showing me on screen. That was the coolest part & experience i've had with this medical bologna. My blood psi med is Prazosin which I took for 20 yrs & less then 1/2 that time ago, was found to help pass urine in guys anyway. Didn't do it for me.

edit - uro said mine was spasming which was causing my problem. Well, guess that wasn't it. Have them look at it to see if it's really spasming FIRST.

hi natalie,

i have a neurogenic bladder also. i was dx'd when i had problems going.
i went to an MS urologist who did bladder studies and a bladder ultrasound.

i've been on several meds but am currently on vesicare. i havn't had any further problems for a long time. i start restricting my fluids about 7pm because i can have trouble not making it to the bathroom during the nite.

don't freak. it's treatable. i'd also talk to your neuro about it.
not sure about the mri. when i had mine 9 yrs ago i did have a couple of c-spine lesions they thought were causing this.

I also have a neurogenic bladder. In years past I would try to hurry when using the restroom but I know now that it just does not work. I have to sit and let my bladder relax so that I can empty.

I work in a retail store with 14 employees and one shared restroom. This is a real challenge for me but I make sure that I have time to sit at least one extra minute for emptying. :o

Thanks for all the useful commentary and encouragement. Sometimes I forget how great this place is! :hug:

I got results back from a renal sonogram and they were normal. I did the urodynamic testing a year ago with a different practice and it was the most traumatic/stressful procedure I have ever had. The woman was running behind so she rushed with me, she was not friendly, jammed the catheter in (which I had never had before) and filled me up with water and then said PEE! While leaving the blinds wide open. I was so stressed out I just couldn't release. Thus, all they could tell me was that my pelvic floor was very tight (basically clenched up). DUH!

I did bio feedback which was very interesting--learning how to squeeze the pelvic floor and release over and over. But the urologist said that doesn't help with anything if the true problem is the spincter (which definitely means neurogenic). Anyhow I know what you mean about sitting on the toilet and trying to relax enough to urinate. I feel like I should be zen meditating on the toilet!:D

Anyhow the plan is watch and wait, try not to get worked up over it and go back in 3 months for a follow up. I also had kidney stones a few years ago and of course there were the endless UTIs on Tysabri until I switched to every 8 weeks. And a personal question for the ladies: are you finding this killing your sex life because you are paranoid you will get a UTI after intercourse so you have no sex urge?

Cheers and thanks!