Functional Neurological Disorder (FND) : a patient's guide
including Functional/Dissociative (non-epileptic) Seizures, Functional Movement Disorder and other functional symptoms
Bladder symptoms sometimes arise with other functional symptoms, especially back pain. Common symptoms include:
•Unrinary frequency (going a lot to the toilet)
•Urinary urgency (having to rush to get there)
•Voiding dysfunction (having trouble starting to pee or being unable to pee at all)
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 for which there is no clear disease explanation.
Often, investigations suggest a condition called detrusor instability, overactive bladder syndrome or irritable bladder syndrome. This is when the muscle of the bladdder is unusually active leading 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 but not one that is due to a definable pathology. Instead there seems to be a problem to do with 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 symptoms in the legs. If someone has functional weakness of their legs then that too is a problem with nervous control.
Chronic Urinary Retention
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.
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 opposite.
Acute Back and Leg Pain with Bladder Symptoms (Scan negative cauda equina syndrome)
One situation in which bladder symptoms are commonly seen without any clear evidence of neurological disease 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 requiring urgent surgery to the back to prevent nerve damage.
But when patients in this situation have a scan, around half of them have nothing on it to explain the symptoms. Sometimes, there is another neurological disease cause which must be found using other means, but often there is no identifiable cause. In many cases, it seems that severe back pain itself can be enough to lead to leg weakness, numbness and bladder symptoms.
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 normal 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