DCS and DIFFICULTY IN URINATION

[knightdiver1]

HI,

I am taking my Dive Master Course.

The question at hand is why DCS cause difficulty in urination? Are the effects for women the same?



Thank you,
Dan

 

[Hemlon]

Welcome to the board!

 

[TSandM]

Coordinated urination requires input from the spinal cord, and DCS can result in spinal cord damage.

 

[DocVikingo]

Are the effects for women the same?

Yes, they are, e.g., difficulty urinating, loss of bowel or bladder control.

Regards,

DocVikingo

 

[Dr Deco]

Hello knightdiver1:

When many people speak of “decompression sickness” [DCS], they are often referring only to joint-pain DCS, commonly called “the bends.” DCS has other manifestations, often much worse than painful joints.

These presentations are the neurological ones where gas bubbles form in the peripheral nerves, spinal cord, or the brain. When in the nerves, a diver might experience difficulty walking, talking, loss of sensation, etc. In some cases, difficulty with urination results from bubbles in the spinal cord.

Difficulty with urination is an indication of neurological DCS and one should seek recompression therapy.


Dr Deco :doctor:


The next class in Decompression Physiology for 2007 is August 18-19. :1book:
This class is at the USC campus in Los Angeles.
http://wrigley.usc.edu/hyperbaric/advdeco.htm

 

[DocVikingo]

Hi Dan,

Based on other contact that we have had, it appears that you are not entirely satisfied with the responses you have received here to date.

As such, allow me to unite, clarify and expand upon what has been said.

First, let's clarify some language and concepts. When nitrogen, and other inert gases such as helium, come out of solution within the tissues and form bubbles they can cause a subcategory of decompression illness (DCI) called decompression sickness(DCS). "The bends" is common, not scientific or medical, terminology for a subcategory of DCS known as Type I, or joint-pain only, DCS. When such bubbles emerge in peripheral nerves, spinal cord or brain, they can cause Type II, or neurological, DCS. The latter frequently is more serious than the former, and sometimes very much more serious.

DCS-related problems with urinary bladder control are considered Type II, or neurological. Without going into detail that exceeds your needs, such problems are the result of inert gas bubbles affecting the spinal cord, a neurological structure which plays an intimate role in the functioning of muscles that control the bladder.

When the bladder become full, nerve endings in the bladder wall send a message to the brain via the spinal cord. The brain sends a message back to the bladder to contract one set of muscles (the detrusor muscles) and relax another (the sphincter muscles) so that one can urinate. If you can't get to an appropriate location to void, the brain delays (within reason) the messages until you can.

Gas bubbles in areas of the sacral level of the spine (http://www.spineabilene.com/images/pop_up/an_column.jpg) can result in the interruption of transmissions between bladder and brain and cause inability to void and uncontrolled voiding (incontinence). The process is the same in males and females and manifests itself similarly.

Helpful?

Regards,

DocVikingo

 

[Narced Shark]

I find this all very interesting. This is my story and question -
About 18 months ago I suffered from a very severe headache. The headache began immediately after a month long period of very active and deep diving. The headache was very intense and I would have to classify it as the worst pain I've ever experienced in my life. I called DAN and they attributed the headache to cold water and sinus pressure. After putting up with this monster for several days I finally gave in and went to the ER in the middle of the night. While at the ER I was given a very strong dose of pain medication and a CAT scan which came back negative for any brain bleeds. Next I was given a Spinal Tap to check for blood in my spinal fluid. Almost from the minute that the needle went into my spine the headache began to disappear and the test came back negative. I was sent home and told to contact my primary care physician who did the normal blood work and such. The tests all came back normal with the exception of one which was slightly off for kidney function. My doctor sent me to have an ultra sound done to have my kidneys checked out. Almost as soon as the examination began the tech began asking me if I had to pee to which I answered no. The tech seemed amazed and went and got another tech who seemed equally amazed that I wasn’t floating away even though I had no urge to urinate. I thought something was wrong with the ultra sound machine because I had just went to the bathroom prior to the examination. I received an urgent call from my physician later that afternoon who had set up an appointment with a urologist. The urologist told me that my bladder was not emptying and that I had quite a bit of urine left in me and I didn’t even know it. He inserted a catheter and to this day I must self-cath myself several times a day in order to drain my bladder.
Prior to the headache I was in excellent health and had no medical issues and I am healthy today. I still dive on a regular basis and have not had a single headache of any type since. I have never heard of a DCS connection to your bladder until recently. But I am still very confused…….Was I bent??

 

[DocVikingo]

Hi Narced Shark,

There is a known relationship between DCS and long periods of very active and deep diving.

Signs and symptoms of neurological DCS can include headache, confusion, memory loss, tremors, visual and hearing disturbances, lack of co-ordination, numbness or altered sensations of the skin, disorders of urination, and unconsciousness. My prior post discusses the mechanism by which spinal DCS can cause urinary retention.

Regarding the history you have provided, it is interesting to note that with spinal cord DCS CAT, MRI and other imaging techniques often yield little or nothing. Ditto for spinal taps.

At this point it cannot definitively be concluded that you sustained neurological DCS with a resultant need for continuing self-catheterization. However, the temporal relationship between the onset of your complaints and a history of provocative scuba, and the fact that no other cause has been identified despite what sounds to be thorough medical evaluation, do make it tempting to connect the dots, don't they?

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual and should not be construed as such.

Regards,

DocVikingo

 

[mello-yellow]

Probably not related, but...

In 2002 I suffered a mild DCS hit. Before entering recompression chamber I did not experience any difficulty urinating, nor anything else unusual in genital area (DCS was in left hand and forearm). Within minutes after "descending" to 60' pure oxygen, I had an annoying (you are in a glass box!) erection. I did not do anything about it, and eventually it went away, but not until I needed to urinate and the said erection was making it impossible. All in all, it was a hassle.

Is that a common response to high PPO2?

 

[DocVikingo]

Hi mello-yellow,

Unintended erection is not a common response to elevated PP02s.

Was there indication of spinal involvement in your hit?

Was the chamber attendant especially attractive?

Regards,

DocVikingo