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Painless Urinary Retention

When cauda equina syndrome (CES) is complete, a patient will have painless urinary retention. In this article we explore urinary retention and cauda equina syndrome in more detail.

Categories of cauda equina syndrome

There are two broad categories of CES:

1. Incomplete cauda equina syndrome (CES-I): there is a degree of voiding and bladder function is retained.

2. Complete cauda equina syndrome (CES-R): there is complete retention of urine as a consequence of complete loss of bladder contractile function.

Complete cauda equina syndrome

Complete cauda equina syndrome is defined as:

a) The loss of bladder control, with ‘control’ referring to the two critical aspects of bladder function – firstly, the function of the bladder as a reservoir of urine, and secondly the function of the bladder as an organ capable of contracting, when so desired, to allow bladder emptying.

b) The loss of bladder sensation

c) Complete loss of the ability to empty the bowels

Patients who are in retention will therefore lose the ability to voluntarily contract the bladder in order to void urine, and will lose the ability to prevent involuntary loss of urine.

Painless urinary retention

Retention of urine in CES-R is painless. A patient with CES-R will be unable to pass urine and will be unaware of the need to do so. Thus, urinary retention in CES-R is distinct from the common causes of urinary retention (such as a benign enlargement of the prostate in an older man) where the patient is distressed by the painful inability to pass urine. This is because with CES-R, bladder sensation is not preserved.

Despite a patient feeling no pain, CES-R will be evident due to the fact a patient has not voided urine for a considerable amount of time. On abdominal scanning or ultrasound the patient will have a distended bladder. Passage of a catheter will result in the drainage of a substantial volume of urine from the bladder. A volume of urine between 500 to 800mls represents acute retention.

Delayed diagnosis of urinary retention

As the bladder of a patient with CES-R fills up, a point is reached at which bladder pressure will becomes greater than the external sphincter pressure (the external sphincter is the valve which maintains urinary continence). Leakage of urine may thus occur and this is called overflow incontinence.

An inexperienced doctor may take these episodes of urine leakage as an indication that the patient is still able to void urine and may conclude that the patient does not therefore have CES-R. This is very problematic as cauda equina syndrome must be treated before complete retention occurs or bladder dysfunction may be permanent.

Have you suffered a delay?

If your cauda equina syndrome was not diagnosed before you reached CES-R, you could be entitled to claim compensation. Contact us for more information.

Please call us free on 0800 234 3300, from a mobile click to call 01275 334030 or complete our Free Online Enquiry for a no cost, no obligation opinion.

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