Trudy Triumph's Neurogenic Bladder Blog

Questions from a Reader of neurogenicbladder.me – The Diagnostic Process

We have a disability that is not easy to talk about.  One of the primary purposes of this blog is to allow us to talk freely about a topic that is in most circles unspeakable.

Not long ago I received some questions on the "Ask a Question" part of this blog. Below, you will find questions excerpted from Mark’s letter and our responses. 

Thank you for your questions, Mark!

 


 

Hello Trudy,

 I get your fantastic blog. Wondering if you might help me. My doctor has said that my urine problem could be Neurogenic bladder. I SOON WILL BE HAVING TESTS.

1. What are the tests like?

Mark, there are so many tests that can be ordered to help determine the exact nature of your specific bladder issue. "Urodynamic testing" actually refers to a panel of tests that a urologist uses to better understand any pathology present in the urinary tract.  Here are some of the parameters that your urologist may be testing . . . 

There are tests that look at:

  • Frequency of urination
  • The flow of urine
  • Volume and speed of urine voiding
  • Nerve impulses

Quality:

  • The amount of liquid your bladder can even hold and at what point the urge to pee sets in
  • The pressure point of any leakage that occurs. [Does coughing or sneezing affect this? — Stress Incontinence]

 There are many types of urodynamic tests and procedures that your urologist can choose to administer. Each test may involve different types of imaging equipment, such as x-ray, videos, and ultrasound. The doctor utilizes different urodynamic procedures customized for their patient’s needs, based on your symptoms and the preliminary patient consult. To obtain the best diagnosis it is important that you are completely honest with your doctor when answering questions about your condition, so that the right procedures can be ordered and ultimately the best assessment will be made.

Two common procedures that are performed are the "Filling Cystometry" test and "Pressure-Flow" studies, but we will also briefly touch on some of the other tests that your urologist may wish to perform.

 Pressure-Flow studies – simultaneously measure bladder pressure and the flow-rate during the voiding phase of urination, “the micturition cycle”. The test is used to assess the process of bladder-emptying. For example, obstruction of urine outflow can be diagnosed if there is a low urinary flow rate in conjunction with a raised pressure of the bladder (the "detrusor" muscle) during voiding.

 Filling Cystometry – the part of urodynamic testing in which the bladder is slowly filled with liquid while pressure and volume measurements are taken in order to assess bladder function.

Other Tests:  

  • Post-void residual volume test: Most tests begin with the insertion of a urinary catheter/transducer into the bladder neck following complete emptying of the bladder by the patient. The remaining urine volume is measured to demonstrate how efficiently the bladder empties. High volumes (180 ml) may be associated with urinary tract infections [Truzzi JC, 2008] and they are often associated with patients who experience overflow incontinence.
  • Multichannel Cystometry or Cystometrogram (CMG): measures the pressure in the rectum and in the bladder, using two pressure catheters, to deduce the presence of contractions of the bladder wall, during bladder filling, or during other provocative maneuvers. The strength of the urethra can also be tested using a cough or “Valsalva maneuver”, to confirm genuine "stress incontinence". By understanding how hard the bladder muscle is squeezing, the urologist can determine whether the bladder puts undue strain on the kidneys.
  • Urethral pressure profilometry: measures the strength of sphincter contraction by measuring how tightly the sphincter (control muscle) can squeeze.
  • Electromyography (EMG) is the measurement of the electrical activity in the bladder neck, or at the base of the bladder, that empties into the urethra.
    • Assessment of the "tightness" along the length of the urethra (where the urine drains from the bladder.
    • Fluoroscopy (moving video x-rays) of the bladder and bladder neck can be taken while the bladder empties.
    • Ultrasonography is an imaging tool that often reveals congenital abnormalities, for instance, in the ureters, which connect (drain into) the bladder and the kidneys above them which process and concentrate urine.

Above are just some of the many tests that your urologist may consider ordering when making a complete diagnosis.

Biosleuth helped pull this information together for us. Thank you Biosleuth . . . .

 



2. How uncomfortable are they — pain level — how sore is it?

I did not find the procedures that occurred in the Urologist/s office to be painful at all.

3. Do the tests make you have a urine accident?

No. Because I have urinary retention, the only time I have urinary accidents is when I have a bladder infection. I do have bowel accidents if I am on a non-constipated day.  During the work week I eat so I am mildly constipated so I do not have accidents but on the weekends it can be a free-for-all of sorts.

4. How do you cope and deal with it?

I try to keep a positive attitude.  Don’t get me wrong; I have my bad days but mostly I want to get out and live my life. I do not talk about my physical disability much but I am free to write and write.  

 5. How uncomfortable is life with neurogenic bladder — pain/how sore is it?

The worst part of it for me is reoccurring bladder infections. They can be horrible to my inner core.  I get crabby and at times very tired feeling.

 6.  What helps you the most?

I try to keep what I need on me at all times.  For instance, I keep a stash of catheters in my car and at work.  I always keep a plastic bag and extra underwear with me in case of an accident.  If I have what I need on hand, I can roll with the punches.  

 7. How many accidents a DAY/Night-time DO YOU HAVE?

I rarely have accidents because I keep organized with my food and stool supplement schedule.  That helps me a lot, but it has taken me a while to figure out what works best.

 8. I do wear adult nappies; also have Bowel Problems — anything you can help  me with/say?

I do not need to use nappies most of the time.  I only do when I plan to be gone from home or away from a toilet for a vey long time.

If you would like to ask me anything please do! If a person does not ask, how can they understand or help? 

Mark, I just want to thank you for your questions because if you are wondering these things it is possible that others are too.  God Bless you and have a great day!

Trudy

 

For More Information:

Urodynamics (Wikipedia): 

http://en.wikipedia.org/wiki/Urodynamics

Truzzi JC, Almeida FM, Nunes EC, Sadi MV.  Residual urinary volume and urinary tract infection–when are they linked?   J Urol. 2008 Jul;180(1):182-5. doi: 10.1016/j.juro.2008.03.044. Epub 2008 May 21.     PubMed PMID: 18499191

http://www.jurology.com/article/S0022-5347(08)00601-0/pdf

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