SP Tube,Rectal Muscles and lower abdomen pain?

Carl R · 04-27-2003, 05:08 PM

I have been having a severe amount of pain around my lower abdomen and lower back area, particularly around where my SP tube enters. It comes and goes, but seems to be related to return of function of what I guess are rectal muscles or lower abdomen muscles being flexed. Since late last year, I have started to be able to push stool during bowel program with some success, but it has become painful over time and sometimes results in pretty high blood pressure. Now just flexing what I call stomach muscles (maybe rectal muscles) or lower abdomen muscles (not supposed to have these) to sit up straight or brace myself causes quite a bit of pain around the tube. I have had to quit standing up in my standing frame and stop exercising because of the pain and blood pressure problems. I also seem to have a lot of what I call shocks and kind of feels like electricity head to toe. Changing the SP tube has become very painful the last two or three times even when using nupracainal to try and deaden the area. Any transfer or movements in my waist area causes blood pressure to rise on average 175 over 110(highs around 215/150), but that has gotten somewhat better. Could I have aggravated the rectal muscles? Or if they are working could the SP cause problems? This has been going on for roughly 3-4 months or so.

** I started taking theophylin (theophylin study)about one year ago and regained the ability to push a few months after taking the drug. It also seems to have helped my lungs significantly. Vital capacity is now 2500 or better, compared to 1700 before. I have had IVP, CT scan ,mri in the last month. I am waiting on MRI results but the others were normal. Any Ideas?

[This message was edited by Carl R on 04-27-03 at 07:49 PM.]

SCI-Nurse · 04-27-2003, 10:07 PM

Have you discussed these problems with your SCI physician and urologist? While this may just be a change in your neuropathic pain pattern, it would be important to check out any other possibilities. A bladder cystoscopy might be indicated to look at the inside of your SP tract.

If you can associate these changes with starting the theophyline, then that should be investigated, and reported as a possible side effect to the investigators.

(KLD)

The Dude · 04-27-2003, 11:35 PM

A lot of times if your SP is pushing into your bladder wall it will cause your bladder to have spasms which might make your whole lower abdomen and lower back squeeze real hard. It happens to me when I change it or push it into my bladder, also if its clogged or not draining properly. I also get a slight raise in bp not severe but a red face and head throb for just a second.

I'd make sure when you change your SP to fill the balloon but not too much and pull it out so its out as far as it can go but still be in there and not being pulled, that way it won't stab into the bladder wall on the opposite side. To me it also seems like my bladder, rectum and lower abdomen are all kinda connected, like if you have bladder spasms you feel it in your rectum too. And I'd make sure you dont have a hemmorhoid cause the pain from it might be causing the same type squeezing.

Also if your having a spasm you can sometimes kinda control it. I don't know if everyone has this but if i hurt my leg or cause it to spasm by stretching or moving a certain way whatever i can move it where I want to while its spasmed, it sounds like you have kinda the same thing in your abdomen where somethings causing you pain and its making your bladder abdomen and stuff to squeeze, you can control it but your squeezing is giving you AD. I dont know just my experience. Since you say when you transfer and stuff it hurts it sounds to me like your SP is stabbing your bladder and causing your abdomen to squeeze.

[This message was edited by The Dude on 04-28-03 at 01:51 AM.]

Carl R · 04-28-2003, 11:14 AM

Still curious though, what is in between where the SP goes in and the bladder? Is this where the rectal muscles are located? Is there any scan or test which could show damage?

Dude, I would believe it to be bladder spasms except that I am taking DitropanXl orally,imipramin,and intravesicular Ditropan to reduce bladder spasms. It does seem like the SP is irritating something, but it seems more muscle related and it feels like I can flex the muscles in the area and that's when it hurts the most. Seems like there has to be a way to figure out what's irritating the tube itself?

I am not in a formal study, but just taking the drug under off label uses? Dr. Young, could the theophylin be generating some axonal growth or regeneration?

Wise Young · 04-29-2003, 12:54 PM

Carl,

I am not sure what is going on with your suprapubic catheter and the source of your pain. Your description suggests that you are having pain induced by changes in the catheter position. This tells me that you are regaining sensation in the area. Are you getting sensory recovery in other areas?

A suprapubic catheter should not be painful. When the catheter is inserted for the first time, it goes right through the skin and muscle of your abdomen, and through the bladder wall. Over a period of a week or so after it is inserted, the passageway is lined with epithelium (skin) and the passageway allows a conduit into your bladder.

Your doctor need to rule out several possibilities:

1. There may be damage to the skin lining the path to the bladder. It might have become infected.

2. The original insertion might have caught some other kind of tissue (although this should not be) such as bowel. I think that this is unlikely or else you would have had trouble a lot sooner (how long have you had the catheter in before you noticed the pain).

3. You may have a bladder infection.

If it is any of the above, you may need to remove the catheter, allow the hole to heal up and then have another one placed after a while. This is a decision that should be discussed with your doctor.

Wise.

Carl R · 04-29-2003, 01:40 PM

I am having some strange sensations, as far as sensory is concerned. Lots of pain in my abdomen area, but some weird shocking sensations as well. For example, if I tap with my finger on my chin, I get a shock down my chest and stomach to my abdomen. If I tap on the side of my head, I get a shock sensation which goes down my spine to the sacral area. This shocks are not necessarily painful but Very intense and strange, and my spasms have increased dramatically. It feels like I can feel everything on the inside, but nothing on the outside. Any guesses? Can someone who has sensation still have a SP or is it too painful?

Curt Leatherbee · 04-29-2003, 03:55 PM

You might also want to have an MRI done of your Spinal Cord looking for a cyst (Syring), it is not a bad idea for everybody to get an MRI done after 5 years or so just to make sure everything looks ok with the cord.

"Life is about how you
respond to not only the
challenges you're dealt but
the challenges you seek...If
you have no goals, no
mountains to climb, your
soul dies".~Liz Fordred

[This message was edited by Curtis on 04-29-03 at 10:20 PM.]

04-27-2003, 05:08 PM	#1
Carl R Senior Member Join Date: Jul 2001 Location: Houston, Tx. USA Posts: 1,888	SP Tube,Rectal Muscles and lower abdomen pain? I have been having a severe amount of pain around my lower abdomen and lower back area, particularly around where my SP tube enters. It comes and goes, but seems to be related to return of function of what I guess are rectal muscles or lower abdomen muscles being flexed. Since late last year, I have started to be able to push stool during bowel program with some success, but it has become painful over time and sometimes results in pretty high blood pressure. Now just flexing what I call stomach muscles (maybe rectal muscles) or lower abdomen muscles (not supposed to have these) to sit up straight or brace myself causes quite a bit of pain around the tube. I have had to quit standing up in my standing frame and stop exercising because of the pain and blood pressure problems. I also seem to have a lot of what I call shocks and kind of feels like electricity head to toe. Changing the SP tube has become very painful the last two or three times even when using nupracainal to try and deaden the area. Any transfer or movements in my waist area causes blood pressure to rise on average 175 over 110(highs around 215/150), but that has gotten somewhat better. Could I have aggravated the rectal muscles? Or if they are working could the SP cause problems? This has been going on for roughly 3-4 months or so. ** I started taking theophylin (theophylin study)about one year ago and regained the ability to push a few months after taking the drug. It also seems to have helped my lungs significantly. Vital capacity is now 2500 or better, compared to 1700 before. I have had IVP, CT scan ,mri in the last month. I am waiting on MRI results but the others were normal. Any Ideas? [This message was edited by Carl R on 04-27-03 at 07:49 PM.]

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04-27-2003, 10:07 PM	#2
SCI-Nurse Moderator Join Date: Jul 2001 Location: USA Posts: 29,465	Have you discussed these problems with your SCI physician and urologist? While this may just be a change in your neuropathic pain pattern, it would be important to check out any other possibilities. A bladder cystoscopy might be indicated to look at the inside of your SP tract. If you can associate these changes with starting the theophyline, then that should be investigated, and reported as a possible side effect to the investigators. (KLD)

04-27-2003, 11:35 PM	#3
The Dude Junior Member Join Date: Apr 2003 Posts: 7	A lot of times if your SP is pushing into your bladder wall it will cause your bladder to have spasms which might make your whole lower abdomen and lower back squeeze real hard. It happens to me when I change it or push it into my bladder, also if its clogged or not draining properly. I also get a slight raise in bp not severe but a red face and head throb for just a second. I'd make sure when you change your SP to fill the balloon but not too much and pull it out so its out as far as it can go but still be in there and not being pulled, that way it won't stab into the bladder wall on the opposite side. To me it also seems like my bladder, rectum and lower abdomen are all kinda connected, like if you have bladder spasms you feel it in your rectum too. And I'd make sure you dont have a hemmorhoid cause the pain from it might be causing the same type squeezing. Also if your having a spasm you can sometimes kinda control it. I don't know if everyone has this but if i hurt my leg or cause it to spasm by stretching or moving a certain way whatever i can move it where I want to while its spasmed, it sounds like you have kinda the same thing in your abdomen where somethings causing you pain and its making your bladder abdomen and stuff to squeeze, you can control it but your squeezing is giving you AD. I dont know just my experience. Since you say when you transfer and stuff it hurts it sounds to me like your SP is stabbing your bladder and causing your abdomen to squeeze. [This message was edited by The Dude on 04-28-03 at 01:51 AM.]

04-28-2003, 11:14 AM	#4
Carl R Senior Member Join Date: Jul 2001 Location: Houston, Tx. USA Posts: 1,888	Still curious though, what is in between where the SP goes in and the bladder? Is this where the rectal muscles are located? Is there any scan or test which could show damage? Dude, I would believe it to be bladder spasms except that I am taking DitropanXl orally,imipramin,and intravesicular Ditropan to reduce bladder spasms. It does seem like the SP is irritating something, but it seems more muscle related and it feels like I can flex the muscles in the area and that's when it hurts the most. Seems like there has to be a way to figure out what's irritating the tube itself? I am not in a formal study, but just taking the drug under off label uses? Dr. Young, could the theophylin be generating some axonal growth or regeneration?

04-29-2003, 12:54 PM	#5
Wise Young Administrator Join Date: Jul 2001 Location: New Brunswick, NJ, USA Posts: 34,097	Carl, I am not sure what is going on with your suprapubic catheter and the source of your pain. Your description suggests that you are having pain induced by changes in the catheter position. This tells me that you are regaining sensation in the area. Are you getting sensory recovery in other areas? A suprapubic catheter should not be painful. When the catheter is inserted for the first time, it goes right through the skin and muscle of your abdomen, and through the bladder wall. Over a period of a week or so after it is inserted, the passageway is lined with epithelium (skin) and the passageway allows a conduit into your bladder. Your doctor need to rule out several possibilities: 1. There may be damage to the skin lining the path to the bladder. It might have become infected. 2. The original insertion might have caught some other kind of tissue (although this should not be) such as bowel. I think that this is unlikely or else you would have had trouble a lot sooner (how long have you had the catheter in before you noticed the pain). 3. You may have a bladder infection. If it is any of the above, you may need to remove the catheter, allow the hole to heal up and then have another one placed after a while. This is a decision that should be discussed with your doctor. Wise.

04-29-2003, 01:40 PM	#6
Carl R Senior Member Join Date: Jul 2001 Location: Houston, Tx. USA Posts: 1,888	I am having some strange sensations, as far as sensory is concerned. Lots of pain in my abdomen area, but some weird shocking sensations as well. For example, if I tap with my finger on my chin, I get a shock down my chest and stomach to my abdomen. If I tap on the side of my head, I get a shock sensation which goes down my spine to the sacral area. This shocks are not necessarily painful but Very intense and strange, and my spasms have increased dramatically. It feels like I can feel everything on the inside, but nothing on the outside. Any guesses? Can someone who has sensation still have a SP or is it too painful?

04-29-2003, 03:55 PM	#7
Curt Leatherbee Moderator Join Date: Jul 2001 Location: Portsmouth, R.I USA Posts: 7,058	You might also want to have an MRI done of your Spinal Cord looking for a cyst (Syring), it is not a bad idea for everybody to get an MRI done after 5 years or so just to make sure everything looks ok with the cord. "Life is about how you respond to not only the challenges you're dealt but the challenges you seek...If you have no goals, no mountains to climb, your soul dies".~Liz Fordred [This message was edited by Curtis on 04-29-03 at 10:20 PM.]