Bladder symptoms sometimes arise with other functional symptoms, especially back pain. Common symptoms include:
As with all functional symptoms, it is essential that such symptoms are properly assessed. It will often be necessary for a urologist to assess bladder symptoms in conjunction with a neurologist to assess whether there is any evidence of a structural problem or other neurological disease causing the symptoms.
Nonetheless, it is not that unusual for someone to find that they do have bladder symptoms which are arising from a functional disorder explanation.
Often, investigations suggest a condition called detrusor instability, overactive bladder syndrome or irritable bladder syndrome. This is when the muscle of the bladder is unusually active leading to a desire to pass urine frequently and in a hurry.
This problem is the bladder’s equivalent to irritable bowel syndrome. It is a genuine condition related to the nervous control of the bladder.
It is perhaps not hard to see why detrusor instability / irritable bladder symptoms are sometimes seen along with functional neurological symptoms in the legs.
Chronic Urinary Retention is when your bladder fills up and you can’t pass urine at all, or you can only do a little, leaving a lot of urine behind in the bladder.
There are many causes of chronic urinary retention such as problems with the prostate gland in men or narrowing of the urethra, both of which restrict the outflow of urine from the bladder. In addition, neurological diseases affecting the spinal cord may cause paralysis of the bladder.
In some specialist centres, some women with chronic urinary retention where there isnt a structural or other neurological condition found are diagnosed with Fowler’s syndrome. Its likely that Fowlers syndrome and what is called ‘Chronic Idiopathic Urinary Retention’ are the same or strongly overlapping conditions. The charity Fowler’s Syndrome UK is the first in the world to support women suffering from this condition. Their information is also relevant to women who have been diagnosed with chronic idiopathic urinary retention. Note that ‘idiopathic’ is a medical term meaning ‘unknown’.
We are still learning a lot about chronic urinary retention, but in some people, it seems to go along with FND and other functional disorders.
There is a lot of information about this area in this fact sheet which you can also download by clicking below
One situation in which bladder symptoms are commonly seen without any clear evidence of a structural or other condition seen on tests or scans is in patients admitted to hospital with suspected slipped disc in the back. Patients with severe back pain sometimes develop weakness of their legs, numbness in their bottom and bladder symptoms, which can look, clinically, very suspicious of a slipped disc. This can be a serious condition called cauda equina syndrome requiring urgent surgery to the back to prevent nerve damage.
But when patients in this situation have a scan, around a third of them have nothing on it to explain the symptoms and another third have some trapping of nerve roots in the back which doesnt explain the whole clinical picture. Sometimes, there is another neurological condition cause which must be found using other means In many cases, it seems that severe back pain itself can be enough to lead to leg weakness, numbness and bladder symptoms. WHen there is leg weakness then its often functional leg weakness of the type seen in FND.
The fact sheet was developed from research led by Dr Ingrid Hoeritzauer, Consultant Neurologist, in Edinburgh which helped us learn more about this problem.
Irritable bladder symptoms can often be quite effectively treated with medicines that relax the bladder wall.
It may be helpful to understand, if you do have detrusor instability / irritable bladder symptoms along with other symptoms like back pain and leg weakness (and your investigations are normal) that they may be all related to each other.
You may benefit from seeing a continence nurse specialist in addition to help from a urologist if you have this symptom.
Pelvic physiotherapy can be very helpful for some women with functional bladder disorders.
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