Recurrent UTI's, recent onset of urinary incontinence and now sudden back pain: What to do?!

[Cymraes84]

Hi.

I could really do with some advice or any input regarding my current situation. I am a 32yo female, have a normal BMI and in relative good health other than some issues with my back and a diagnosis of pernicious anemia.

I'm currently waiting for an appointment to see a Urology Consultant having had repeated lower UTI's after a nasty kidney infection back in April which required hospitalisation. I only managed to see a GP last Tuesday, but have had a private referral so it hopefully wont take too long to come through.

My main concern at the moment (hence the private referral to speed things up) is the development of urinary incontinence (seems to be overflow type, not stress or urge) since around a fortnight. This happened pretty much overnight - one day I was fine, the next day, not so fine! I also have pubic pain and some mild grumbling pain in the region of my kidneys, which is becoming more frequent. Kidney or bladder stones are a possible cause, however fairly unlikely as the pain isn't severe enough. I've not had children so it can't be anything to do with childbirth. I had an ultrasound in April which revealed that my bladder is not emptying fully, with around 50ml residual urine (at the time) present after voiding. And, having had previous spinal surgery in May 2014 (Discectomy) and February (Laminectomy) of this year, my GP an I are concerned about nerve damage being a cause.

With this in mind, I'm a little bit worried at the moment as I have started getting some localised back pain without sciatica. It's reminiscent of a disc herniation or similar as it's a sort of jabbing pain upon particular movements, and otherwise a dull ache. The pain is not at all severe, but enough to notice, plus is new and different to my 'usual' pain these days. Some pain is to be expected after surgery as it is not a cure all, but I'm fretting a tad about this given its emergence with sudden incontinence along side it. I did develop continence issues prior to my latest surgery and got assessed at my local A&E for Cauda Equina Syndrome, however was told it was nothing to do with my spinal cord being compressed. Lo and behold though, surgery cured the incontinence and I have been fine ever since. Well, until now that is.

I'm just not too sure whether I am overreacting, and don't want to create a fuss over nothing. My pain threshold is quite high, and I am used to being in pain too so it's somewhat difficult for me to judge whether this is of significance or not. I'm thinking of just keeping an eye on the back pain and waiting for my urology appointment to come around (I would not consult a Doctor over the back pain alone), but would be really grateful if anyone could offer their thoughts on this, or share a similar experience with me.

If I need to get assessed then I will do so, however don't want to be a drama queen! Plus the fact the last time I was assessed at A&E I wasn't overly convinced by their conclusion, so I don't know what to do for the best really. They don't have a neurosurgical team at my local hospital, so the last time the Junior Doctor who assessed me just liaised with an Orthopedic Surgeon, whom I assume would not have been a spine specialist, as this is not something they can offer at the hospital either. I have thought of calling NHS Direct, however thought they might err on the side of caution and recommend getting it checked out so as not to get sued!

Many thanks for reading this - I appreciate it's lengthy!

[MumofSam]

Hi

If I were you I'd ring your surgery now and go through it all with them. No-one on here's a doctor and it sounds as though you really do need some professional advice. I suffer from sciatica and had major surgery on my back a year ago. I was told that if I experienced any changes in bladder function etc, particularly numbness in that area, to get down to A&E immediately. So I think the least you should do is seek professional advice immediately.

Good luck, and I hope you get it sorted.

[marcia200]

Have you been checked for diabetes. Thats how my uti`s started

[pupsqueak]

hi, im new to posting on here, (not actually a new member) so I apologise if I end up repeating what someone else may have already told you. But, I can totally relate to your case - I recently developed cauda equina symptoms, although in more of a chronic way than really acute. Scans showed damaged vertebra, but they were too high to damage the CE part of spinal cord. The orthopaedic doctor thought symptoms might be stemming from gynaecological cause. I was due a hysterectomy anyway, which was super handy haha, and they discovered I had a retroverted womb. It was basically sitting the complete wrong way, and so pushing into my bowels, which in turn put pressure onto the nerves behind them. It's been nearly 5 weeks since I had the operation, and although I am still getting some symptoms, most seem less intense and I am hoping that once everything settles, the CE symptoms will have gone (they told me to give it a few months before I would be getting results anyway) I know there's a chance that they will be permanently affected, and some of the bladder symptoms have actually got worse (the pain) but I am glad that the pressure has been taken off the nerves. Perhaps you could ask for a scan to see if there's a similar cause in your situation? Im 36, so not too different from you, and being relatively young, my womb was still 'active' and pretty bulky, which also added extra pressure. I think its worth you checking out, and if nothing else, its something that can be crossed off the list if it proves fruitless. Good luck with everything xx

[Neldine]

Please see a doctor now! Don't wait, straight to A&E.

[Cymraes84]

Thanks so much to you all for the replies, you have given me some food for thought with regard to a potential cause for my UTI/bladder problems, and I will bear these in mind when I see the Consultant. Hopefully this wont take too long now as I am finding the incontinence difficult to deal with, especially given my age.

Concerning the emergence of back pain alongside the urinary incontinence/retention issues I'm having, I skipped A&E and made an appointment to see a GP today. I was seen by a nurse practitioner instead, and have to say I'm not feeling tremendously convinced or reassured.

I explained the nature of the pain I'm experiencing, and how it feels virtually identical to the type of pain I had pre-surgery on both occasions (a sort of jabbing pain, not muscular, and it bites when you twist or bend a certain way. It feels as though something is poking into your spinal cord and/or adjacent structures). I didn't have any reflexes or anything checked, and she told me it in no uncertain terms that it is my sacroiliac joint playing up. To be fair, I do fully understand why she might think that is the problem as the pain does emanate from that region, and I don't have any numbness in the saddle region either which I assume would arouse greater concern. But I know my body, I understand what the different kinds of pain indicate, and I just feel in my gut that something is askew. She mentioned that they could refer me to the orthopedic and physio team at my local hospital (whom I've heard are not that great) but I have a private physiotherapist and therefore declined. I would appreciate a Neurosurgical opinion, however, but this doesn't seem to be an option.

By today the back pain is a bit worse (though not excruciating) and I have now developed sciatica, too. I have chronic insomnia anyway, but the discomfort kept me awake for most of last night, despite taking some painkillers before bed. The pain on its own, though a little disconcerting given my history, does not concern me too greatly at present, and it is something I would quite happily deal with and monitor on my own for a while, and perhaps consult my physio should it not improve.

BUT, with the presence of bladder dysfunction, I can't help but think that the nerves are perhaps being compressed - maybe by a small disc re-herniation or something? Or maybe the development of further stenosis at the S5/L1 level? I wholly appreciate that I may well be overreacting, but I was fobbed off for a year by a GP when I in actual fact needed surgery (hence I'm also concerned about the possibility of permanent nerve damage), so I'm just worried that I haven't perhaps been taken that seriously, again. I mean, I'm not expecting them to send for an emergency air ambulance or anything, but surely it's not beyond the realms of possibility that my bladder problems are being caused by some kind of nerve compression? The GP I saw for my referral to the Urologist cited nerve damage as a potential cause (for the bladder problems), so, I can't be completely barking up the wrong tree.

The nurse did say that she would have a chat with the GP on my behalf to gain his opinion, and mentioned that he might give me a call to discuss it further. So I guess I'll just wait and see for a bit now. Frankly, the only person I feel as though I can really trust on this matter is my Neurosurgeon. I am tempted to contact his secretary to see if he would be willing to have a consultation over the phone (as he is a fair distance away from me) as I really would value his opinion. I'm a private patient of his so it will cost, but I'd be willing to pay for his opinion and the reassurance that would bring. I'll hang fire on that for a bit though, and see if I can get anywhere with the GP, and wait and see what the Urologist thinks, too. I guess it wouldn't be a bad idea to check in with my physio either. It was her who got the ball rolling for me with regard to getting an MRI scan and then a neurosurgery referral for my most recent surgery (GP kept insisting that intervention was unnecessary, as mentioned above), so maybe I'll book myself in for a session if things don't improve.

Thanks so much again everyone, and I hope you guys are all keeping well.

[MumofSam]

I think I might be experiencing something similar, as I notice sometimes when I get up during the night and go to the loo, I think I've emptied my bladder etc, but on my way back to bed it feels as though urine is trickling slightly down my leg - very disconcerting! So if I have a similar history to you - stenosis, prolapsed and crushed discs, sciatica etc - it certainly sounds as though nerve damage is at play here. At one time I was repeatedly getting UTIs too. It's horrible when you're really suffering to hear a doctor dismiss you out of hand saying that it's very common! So was the plague once, but it still killed millions! (Wish I'd said that at the time!) Thankfully I've not had a UTI for over a year now. However, this slight night-time incontinence is horrible, and since I had a fall at the end of August my back and sciatica have been much worse. I'm sure they all must be linked.

Next time I have to visit my GP I might mention it, but at the moment it's not too much of a problem as it's only occasionally and at night. Plus I hate going to the doctors. Ah well.

Hope you hear back from your GP or neurosurgeon. It would be interesting to know what they say.

[Cymraes84]

That sounds virtually identical to the continence problems I developed prior to my most recent surgery. Just a little dribble after going to the loo and thinking you're all done. I was advised to visit A&E to be assessed for Cauda Equina Syndrome as I was on a waiting list for surgery at the time, and my diagnostic MRI had revealed compression of the spinal cord. They advised me that the post void dribble (as they call it) was unrelated to my spinal condition. However, I switched over from the NHS and had my operation done privately after this incident, as it was quite worrisome and I had been waiting for a good few months by then too. The surgery cured the problem, so I'm not too trusting of anyone who casually brushes off my symptoms by now. Plus the fact I had a delay of about a year in getting any investigations done and gaining a diagnosis, as my GP didn't deem any further investigation necessary. I had to fork out to see my physiotherapist in the end, who thankfully took it far more seriously.

I just don't feel as though I can trust much of anyone by now. I'm actually feeling a bit angry today. I'm probably being irrational, and I really don't expect them to treat it as an emergency, but I would prefer it if they didn't discount symptoms that are clearly bothering me as something wholly insignificant. I've been here before and suffered as a consequence - physically, mentally and financially through having to pay for private treatments to address the problem.

The nurse I saw yesterday kindly pointed out obvious parts of my anatomy such as my pelvis as though I'm some kind of simpleton who doesn't have an understanding of basic human anatomy. She also explained to me that the pain in my leg is called sciatica which was a true revelation... I mean, seriously, I've had back pain since I was a teenager and two spinal surgeries, I'm aware of what sciatica is. I may not be a doctor, but that doesn't render me an imbecile. It's quite funny though, in a way, as she mentioned the cause of said sciatica is likely to be something pressing against the spinal cord, and this is the exact concern which led me to consult a her in the first place, because I have that familiar jabbing pain again.

Again, I'm probably overreacting and being harsh, but I just think that with my history they could have taken my concerns more seriously. I consider myself to be well informed on the subject, and wont consult a medical professional over nothing. Heck, I've even told that by an actual GP at the practice, so there must be some truth in it!

Sorry, completely waffling on now! Have you had any investigations and treatment for your back at all? Or have you been left to it?! Personally I would mention the night-time incontinence to a Doctor if it doesn't relent, as it's probably worth trying to get it addressed with your history. In the meantime - I was advised by a spinal nurse to get up off the loo, and then sit back down and try and pee again, as this sort of straightens out your urethra and allows some of the residual urine to come out. I don't know if this will be of any help to you, but it might be worth a try. You have my sympathy though, as it is really quite unpleasant.

I think the cause of my UTI's and new onset incontinence is due to the fact that my bladder is not emptying fully. Bacteria then grows in the residual urine and causes an UTI, but the urine also dribbles out involuntarily. I'm just hoping the reason why it isn't emptying properly can be ascertained, and that it isn't a case of management as opposed to cure. This new incontinence is worse than it was before - it's like overflow type, so just dribbles out fairly frequently, especially when walking which sucks as I have a dog, love hiking and live in a fantastic area for doing so. Thankfully it's not too bad at all during the day at work and at night, but I've actually had to resort to using pads (which resemble something you'd find in a nursing home) while I'm out walking, which I hate.

Issues pertaining to dignity and esteem are at play here, so I'm just a bit miffed by the apparent nonchalance I encountered yesterday. Credit where it's due, the GP I saw was quite sympathetic and acknowledged that it's not something somebody of my age would find at all pleasant, so they're not all bad! Hopefully I should get to see the Urologist quite soon and I am eager to find out what he thinks, especially as my back is now playing up too. I'm going to make an appointment with my physiotherapist too, but will try and wait until after I've seen the Urologist so that I can bring his opinion along with me. It's early days to be getting in touch with my Neurosurgeon I suppose, but I might do so if things don't improve and my physio thinks it would be a good idea.

Thanks so much for taking the time to reply and sharing your experience. I hope you're doing well otherwise, and feel free to rant about delinquent spines!

[MumofSam]

My history is that I'm 54 but have suffered from back pain since I had my son, over 13 years ago. Just thought it was one of those things, until a year ago February, when two out of control dogs charged into me from behind while I was at walking, sending me crashing to the ground, landing on my knees. To cut a long story short, I then started to suffer from sciatica badly, all the time, so went through the process. First had physio, but it didn't work so they referred me for an MRI scan. That showed that I had spinal stenosis at the base of my spine, three crushed discs and a prolapsed one, plus arthritis of the spine, thrown in for good measure! I had surgery at the end of the following September which really helped with the sciatica. However, the consultant had told me there was nothing he could do for my spine and the back pain.

Unfortunately I returned to work full-time too soon (the consultant was so vague I thought it was okay to come back full time after 7 weeks). So I ended up in a lot of pain again, went back to see the consultant, who said I should have been part-time for a further 2 months. So, got signed off for that. Had injections in my spine too at that time, but they didn't help.

So have carried on struggling with sciatica and back pain. I've been taking Tramadol, Pregabalin and Naproxen, and to be honest I think without them I wouldn't be able to walk. However, with all those meds I've been able to put up with it as some days it was better than others .

Unfortunately at the end of August, when out walking, my right ankle went over and I fell very heavily, onto my left knee. Excruciatingly painful for my knee, and it set off the sciatica to be even more painful, and since then back pain and sciatica have become permanent. I've had to up my dosage of Tramadol, but am still in a lot of pain.

I have quite a high pain threshold. I found out back in July that the reason I'd had so much pain in my right foot for months on end is 'cos I'd broken a bone in the foot. Couldn't even remember how I'd done it! So that's still painful too.

There - that's my rant over now! I know I need to go back to see my GP - I hate getting fobbed off with the practice nurse too, as they don't know what they're doing - but at the moment I can't be bothered. That might sound strange, but I think you'll understand. It's probably only a matter of time, however, until the frequency of my request for Tramadol on repeat prescription is picked up and I get told I need to see the GP if I want any more. We'll see.

Today is a bad day for pain, and it doesn't help that I'm sat at a desk most of the day, which is really bad for the spine.

I've got a dog too, and love taking her out for walks. She looks like a Shih-zu but is actually a cross between a Cavalier King Charles Spaniel and a Yorkshire Terrier.

[Cymraes84]

Gosh, you've been through the mill with your back! Sounds like a frustrating struggle, and it must be pretty disheartening to be told by your consultant that there isn't a great deal they can do for the back pain. I do understand that back surgery tends to have more favourable outcomes for sciatic pain rather than back pain, but I'm wondering whether you could possibly be a candidate for spinal cord stimulation or something like that? I think the criteria is very strict because of the cost, but it could be worth enquiring about? Or perhaps you could request a repeat scan to see what's going on? I don't think it would be at all unreasonable to ask for some sort of investigation given your history and re-emergence of sciatica. I definitely do understand why you feel as though you can't be bothered with it all mind you, it does get pretty tiresome, and it can get frustrating if you get fobbed off and what have you.

Well, the GP called me earlier on, and contrary to the opinion of the nurse is more concerned about what might be going on, and reckons it would be wise to gain the opinion of my Neurosurgeon therefore is going to sort a referral for me. Something of a surprising relief to be honest! He made a fair point about post-op scarring being a possible cause of the pain, but said that it does sound as though something is irritating the nerve root so is keen for me to be assessed. I'm not used to seeing this GP on a regular basis but have heard that he is quite thorough, so I'm glad I pressed the nurse a little yesterday, as I don't think she would have spoken to the GP if I had of just accepted her opinion and walked out. As I am ridiculously impatient I've made an appointment to see my Physiotherapist next week too, and if she suggests getting an MRI done (she can refer) I might do that before seeing the surgeon, at least that way I won't have to pay to see him twice! He's a very good surgeon though so gaining his opinion will be of great reassurance.

Sorry to hear you're not having a great day pain wise. I sit behind a desk all day too, but my pain hasn't been too bad at all since I had surgery so I've been getting away with it for a while. Have you tried any heat patches or those wheat bags or whatever they're called? I find heat really soothing, but also get up and do some basic stretches during the day too, it does help loosen the muscles a bit and relieve any tension.

Your dog sounds really cute! I have a (thankfully non-yapping) Jack Russell, he's a dude! They make great companions don't they

[stokebones]

I read the first few posts, and then had to skip - apologies - lack of time.

I'm not convinced by the nurses impression, especially with the possibility of nerve impingement - personally I would be contacting your surgeons secretary - and asking for an appointment. I appreciate it isn't close, but one can't truly be examined over the telephone - and this is his speciality not the nurses or GP's.

[Cymraes84 in reply to stokebones]

I'm glad that you agree with my stance re: the nurses opinion. The GP did give me call after all though, and in stark contrast deems a referral back to my neurosurgeon necessary to correctly diagnose the problem.

I wasn't at all reassured following the appointment with the nurse, she was pretty dismissive (though to be fair not at all unpleasant) which is somewhat concerning when taking into consideration my history and current symptoms. To even diagnose sacroiliac joint dysfunction I'm pretty sure that you need to be a little more thorough than simply asking a patient to point to the area of discomfort, then making an instant diagnosis based upon that! I'm quite well informed on the subject, and reckon it's a good thing I was visibly and verbally unconvinced by her opinion as I don't think she would have offered to consult a GP on my behalf otherwise. She gave the distinct impression that this measure was not entirely necessary mind you, so I will admit to deriving some kind of childish satisfaction out of the situation being proved to the contrary.

I'm feeling more content now that the issue is being taken seriously and addressed appropriately. I have also made an appointment with my physiotherapist and am looking forward to gaining her opinion on the matter tomorrow. It shouldn't take too long at all to get in with my neurosurgeon, which is good as I know he will give me the reassurance that I need - good news or bad. I should imagine he'll recommend getting an MRI scan done, and if so, it will be interesting to see what this reveals.

Many thanks for taking the time to reply, much appreciated

[stokebones in reply to Cymraes84]

SI joint pain is difficult to diagnose and easy to misdiagnose. Usually diagnosed following sPecific tests which stress the joint but also an injection with significant pain relief.

[Cymraes84 in reply to stokebones]

Well, this nurse has clearly had some super advanced training to be able to diagnose me without any of the above haha! Bless her, I'm being a bit mean, but I don't think it's at all appropriate to try and send someone packing with a blatantly vague and uncertain diagnosis.

I have to say that it does feel like either a small disc re-herniation or recurrent stenosis. My previous problems have all originated at the L4/L5 level, so perhaps something is going on at the S5/L1 level this time given that there is pain in that region? But it could be a number of things. Am very much looking forward to seeing my physio this evening for a more expert evaluation of the problem.