Asked by Sierraskier
Can L5-s1 Fusion Cause Frequent Urinary Tract Infections, And Alternating Constipation And Diarrhea?
My question is regarding bowel and bladder problems resulting from lower spine/nerve problems. I wasn't sure where to place it, but I saw several spinal fusion people on this board so thought I'd ask here. I had a spinal fusion L5-S1 when I was 14 years old. I'm 40 now. I had a 2-3 spondylolisthesis, myelogram says a 14mm forward slippage. Pre-fusion I had severe sciatica and the outer half of my calves, ankle and small toes were completely numb. I couldn't feel pressure or pinpricks at all. The fusion was successful and I was able to return to most activites except I've always had to be careful about lifting, not standing or sitting too long or over-doing physical activity. I've had back pain al all my life, but its usually controlled with ibuprofin and sometimes vicodin and flexeril. However as I'm getting older, I've been having more and more pain and stiffness and some of the scitica has returned. I saw a dr last year who said the disc between L4 and L5 is causing me problems now (common with old fusions) and I will need another fusion in a few years but that its not quite bad enough yet. In the last couple of weeks I have lost sensation on the outside of my 2 little toes and the bottom of the right foot at the base of the toes. I can still feel touch but not pain from pinprick and there is a very distinct difference in sensation from the rest of the foot. I've had frequent urinary tract infections my whole life,anywhere from 2-3 a year to 8 or 9. I had testing and imaging done when I was 4 and they said everthing was normal. When I was pregnant at 21 I was hospitalized for UTI that I didn't even feel any symptoms for. In 2000, I had 8 or 9 infections in a year so they did an IV Pyelogram which came back normal with the exception of abnormalities in the infundibulum of the kidneys. It was decided that it was scarring from repeated infections. This past year, I had 5 infections between Thanksgiving and Valentine's Day (2 were the same infection that the 1st round of antibiotics didn't work on). I was given levaquin then immediately placed on a 90 day course of macrobid starting Fed 21st. I had another UTI on July 22. I wonder if this is because of my spine issues even though they did decompression during the surgery. Maybe the nerves were damaged? When I go in for UTIs the drs always dismiss it saying if it were from my spine then I would have trouble starting to urinate or incontinence, which I don't have. Just frequent UTIs. I also have frequent constipation and diarrhea. Often in a single bowel movement it starts with constipation and immediately followed by watery diarrhea. Then I'll have several more trips to the bathroom with watery diarrhea, severe enough to dehydrate me....by afternoon it will stop, only to wake up the next day and start all over with constipation again, followed by diahhrea. This has been going on for YEARS and again the doctors are dismissive. Do you think these are all separate issues or is it actually my spine again?
Thank you for your detailed question that helps.
I have seen similar situations particularily in those who have spinal cord injuries (actually at the sacral level the "cord" has actually become the cauda equina). Partial or full damage to the nerves that control the bladder (S1-4) can result in incomplete emptying of the bladder. When a spinal cord injuried patient needs to be evaluated because of frequent UTI's, the first thing to note is what the post void residual (PVR) is, any rehabiliation nurse or doctor can check that with a catheter or ultrasound after the patient voids. You and your doctor need to know what your PVR is.
If the PVR is above 50cc (not normal), then frequent UTI's are very likely UNLESS the patient self-catheters at least twice per day, maybe more depending on the bladder function. The catheter completely drains the bladder. Sometimes, a patient can get by with "double voiding" (if you think your done, try to go some more), but self-cath are the only way to keep most neurogenic bladders safe from infections.
You see... if urine sits in the bladder, it becomes a happy little swimming pool for bacteria to multiply. Draining the bladder completely keeps the bacteria from settling in and making a home.
I am suprised that you did not mention that anyone has done a urodynamic study which is very common, routine procedure done by a urologist who has a good understanding about neurogenic bladders.
I would stongly recommend that you see a physiatrist like me who understands spinal injuries and bladder function. UC Davis has a good program.
Your bowel problems are probably also neurologically related to your bladder and the spinal injury. A neurogenic bowel usually requires regular digital stimulation (yes, by hand) and/or laxative protocol to keep the bowels moving. Diarrehea can be a sign of a neurogenic bowel, like a flood after the dam breaks loose. The regular peristalsis that propels the stool down the bowel just does not run very well without some additional stimulation.
Again, you should be evaluated by a specialty clinic for those with spinal cord injuries (trauma and birth related are all included).
I hope my answer is detailed enough to get you pointed in the right direction.
BTW, I like to ski in the Sierras too!
Dr. Christina Lasich, MD