Bladder spasm/blood pressure spike

Dr.Strangelove · 09-09-2007, 04:03 PM

Hello all, Glad to be here and join in.

Couple of questions: Your feedback (especially SCI nurse or Dr. Wise) is greatly appreciated.

Background:

I'm 49 y/old male 25 year postinjury C5/6 incomplete. (Brown's sequard/hemiplegia). "patchy" r/side paralysis (minimal "patchy" paralysis l/side). Sensation better on right side than left. Walk with a cane and use a scooter for long haul.

I have been spontaneously voiding urine post-injury and have ALWAYS had bladder spasms with urgency. In other words, when my bladder spasms, I need to get the the restroom fast (thank god for urinals! have one bedside, in my car LOL!), when I can't get to the restroom in time (w/in minutes, there's leakage--sometimes a little, sometimes a lot. I wear absorbent pads to catch the leakage.

When my bladder spasms, I sweat (upper body/forehead) and get runny or stuffy nose. I also notice however, that my bowels gurgle quite a bit--as I think this is an automomic/reflexive response. When urinating, I use the "tapping/triggering" method, which helps me void. Only one UTI in the last 10+ years.

Last week I bought an automatic blood pressure monitor and checked my blood pressures when sitting, standing, laying down, etc. My blood pressure is actually somewhat low around 85-110/70 most of the time, but I noticed when my bladder spasms--my pressure will temporarily kick up to 150/90 or sometimes even higher* (while I hold it until I get to the restroom)--until I void, then it drops back down immediately. NOTE: I do have to "tap" my bladder to get a good stream going.

[*This is nowhere near the effect of AD as I've had temporary autonomic dysreflexia before (genital/sex related), i.e., the dysreflexia gave me a severe pounding headache, anxiety, well, those of you who've had it know how nasty it feels.]

Question one: I urinate quite a few times day and night (3-5 day/3-5 night) around 6-8 ounces (200cc) at a time. Voiding is almost always proceeded by bladder contracting/spasm. I can feel when my bladder is filling and getting close to the "spasm stage". I've become used to the frustration of urgency and really don't want to take any meds, nevertheless--it's still frustrating--and I was wondering if Ditropan XL might help deal with the spasm and frequency issues and/or lower my blood pressure spikes by relaxing my bladder?

Question two: Are there any other walking quads/spontaneous voiders out there that use the "trigger method" with problems similar to mine who have tried Ditropan and/or other therapies? Has anyone out there found that Ditropan increased urine retention/voulume and decreased spasms? Were you still able to get the "reflex/trigger" response to work?

Question three: Does anyone else hypothesize that during the bladder spasm episode (when the autonomic response goes haywire, i.e., blood pressure kicks up and the bowels jump/gurgle) that food passes through the small intestines/bowels too quickly--negatively effecting absorbtion and/or contributing to gas, diarrhea, bloating, etc.? I've used a morning digital stim bowel program to try and avoid the diarrhea issue--and was thinking Ditropan my actually help slow down my bowels, BUT, does Ditropan also reduce gastric juices negatively affecting digestion (I heard it reduces saliva that is important for pre-digesting carbs while chewing).

Sorry for the long rant! Smiles!

Any responses are greatly appreciated. The Nurse Practitiners through my HMO medical plan don't seem to have a real grasp of all the nuances of SCI care/rehab issues.

John, California

SCI-Nurse · 09-09-2007, 09:25 PM

You need to see a good neurologic urologist (not a nurse practitioner) and get urodyanmics. It sounds like you are voiding with high (possibly dangerous) pressures, and are getting autonomic dysreflexia.

Voiding by reflex and trigger is outdated, as we know now that this nearly always results in voiding with high resistance and high pressures. Ditropan can decrease pressures and leakage, but the pay-back is that it also increases retention, and may increase it to the point where you no longer void at all if taken in sufficient amounts. This may mean needing to do intermittent cath or use an indwelling catheter.

Insist that you get a consultation with a neurologic urologist and that you get a full urodynamics work up.

(KLD)

09-09-2007, 04:03 PM	#1
Dr.Strangelove Junior Member Join Date: Sep 2006 Posts: 7	Bladder spasm/blood pressure spike Hello all, Glad to be here and join in. Couple of questions: Your feedback (especially SCI nurse or Dr. Wise) is greatly appreciated. Background: I'm 49 y/old male 25 year postinjury C5/6 incomplete. (Brown's sequard/hemiplegia). "patchy" r/side paralysis (minimal "patchy" paralysis l/side). Sensation better on right side than left. Walk with a cane and use a scooter for long haul. I have been spontaneously voiding urine post-injury and have ALWAYS had bladder spasms with urgency. In other words, when my bladder spasms, I need to get the the restroom fast (thank god for urinals! have one bedside, in my car LOL!), when I can't get to the restroom in time (w/in minutes, there's leakage--sometimes a little, sometimes a lot. I wear absorbent pads to catch the leakage. When my bladder spasms, I sweat (upper body/forehead) and get runny or stuffy nose. I also notice however, that my bowels gurgle quite a bit--as I think this is an automomic/reflexive response. When urinating, I use the "tapping/triggering" method, which helps me void. Only one UTI in the last 10+ years. Last week I bought an automatic blood pressure monitor and checked my blood pressures when sitting, standing, laying down, etc. My blood pressure is actually somewhat low around 85-110/70 most of the time, but I noticed when my bladder spasms--my pressure will temporarily kick up to 150/90 or sometimes even higher* (while I hold it until I get to the restroom)--until I void, then it drops back down immediately. NOTE: I do have to "tap" my bladder to get a good stream going. [*This is nowhere near the effect of AD as I've had temporary autonomic dysreflexia before (genital/sex related), i.e., the dysreflexia gave me a severe pounding headache, anxiety, well, those of you who've had it know how nasty it feels.] Question one: I urinate quite a few times day and night (3-5 day/3-5 night) around 6-8 ounces (200cc) at a time. Voiding is almost always proceeded by bladder contracting/spasm. I can feel when my bladder is filling and getting close to the "spasm stage". I've become used to the frustration of urgency and really don't want to take any meds, nevertheless--it's still frustrating--and I was wondering if Ditropan XL might help deal with the spasm and frequency issues and/or lower my blood pressure spikes by relaxing my bladder? Question two: Are there any other walking quads/spontaneous voiders out there that use the "trigger method" with problems similar to mine who have tried Ditropan and/or other therapies? Has anyone out there found that Ditropan increased urine retention/voulume and decreased spasms? Were you still able to get the "reflex/trigger" response to work? Question three: Does anyone else hypothesize that during the bladder spasm episode (when the autonomic response goes haywire, i.e., blood pressure kicks up and the bowels jump/gurgle) that food passes through the small intestines/bowels too quickly--negatively effecting absorbtion and/or contributing to gas, diarrhea, bloating, etc.? I've used a morning digital stim bowel program to try and avoid the diarrhea issue--and was thinking Ditropan my actually help slow down my bowels, BUT, does Ditropan also reduce gastric juices negatively affecting digestion (I heard it reduces saliva that is important for pre-digesting carbs while chewing). Sorry for the long rant! Smiles! Any responses are greatly appreciated. The Nurse Practitiners through my HMO medical plan don't seem to have a real grasp of all the nuances of SCI care/rehab issues. John, California

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09-09-2007, 09:25 PM	#2
SCI-Nurse Moderator Join Date: Jul 2001 Location: USA Posts: 41,354	You need to see a good neurologic urologist (not a nurse practitioner) and get urodyanmics. It sounds like you are voiding with high (possibly dangerous) pressures, and are getting autonomic dysreflexia. Voiding by reflex and trigger is outdated, as we know now that this nearly always results in voiding with high resistance and high pressures. Ditropan can decrease pressures and leakage, but the pay-back is that it also increases retention, and may increase it to the point where you no longer void at all if taken in sufficient amounts. This may mean needing to do intermittent cath or use an indwelling catheter. Insist that you get a consultation with a neurologic urologist and that you get a full urodynamics work up. (KLD)