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Urology (Expert Forum)
Facial Blushing with Nuerogenic Bladder
Answered by
Kevin Pho, MD - Internal Medicine
Kevin, M.D.
Boston - MA
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
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Facial Blushing with Nuerogenic Bladder
by reaton, Apr 06, 2003 12:00AM
Hello Doc,
Due to a diving accident I had 25 years ago I am a C-6 complete
spinal cord injured quadraplegic. I have a nuerogenic bladder which
means when my bladder gets to a certain volume it will contract and
then I void. I cath myself once every morning to drain any residual
or sludge and throughout the day I wear an external
catheter..............other then a few UTI's and one kidney stone
this system has worked fine for 25 years.
My problem is that over the past year I have noticed that when my
bladder 'kicks off' and I void, about 2 minutes later my face
flushes and turns very red. This has become a social embarrassment
with comments like "Ronnie, you don't have to turn so red over it".
I can't really explain to the "able-bodied" community that I just
urinated into my leg bag and that causes me to flush, so I usually
make up some absurd excuse.
Anyway, I went to my urologist whom I have been seeing for 20 years
and he explained that the nerve that controls the contraction of the
bladder also controls the heart. So, when my bladder contracts my
heart rate goes up for a minute or so and it pumps blood to my face
causing the red face.
He prescribed Ditropan to relax the bladder to no avail and then he
put me on Detrol LA to no avail. I will go back and see him next
week, but would like a second opinion from you on what could be
causing this and what drug or procedure should be prescribed ?
Thanks,
Ronnie Eaton
***@****
Due to a diving accident I had 25 years ago I am a C-6 complete
spinal cord injured quadraplegic. I have a nuerogenic bladder which
means when my bladder gets to a certain volume it will contract and
then I void. I cath myself once every morning to drain any residual
or sludge and throughout the day I wear an external
catheter..............other then a few UTI's and one kidney stone
this system has worked fine for 25 years.
My problem is that over the past year I have noticed that when my
bladder 'kicks off' and I void, about 2 minutes later my face
flushes and turns very red. This has become a social embarrassment
with comments like "Ronnie, you don't have to turn so red over it".
I can't really explain to the "able-bodied" community that I just
urinated into my leg bag and that causes me to flush, so I usually
make up some absurd excuse.
Anyway, I went to my urologist whom I have been seeing for 20 years
and he explained that the nerve that controls the contraction of the
bladder also controls the heart. So, when my bladder contracts my
heart rate goes up for a minute or so and it pumps blood to my face
causing the red face.
He prescribed Ditropan to relax the bladder to no avail and then he
put me on Detrol LA to no avail. I will go back and see him next
week, but would like a second opinion from you on what could be
causing this and what drug or procedure should be prescribed ?
Thanks,
Ronnie Eaton
***@****
Doctor's Answer
by Kevin Pho, MD, Apr 07, 2003 12:00AM
, Apr 07, 2003 12:00AM
Hello - thanks for asking your question.
Your symptoms are likely due to autonomic dysreflexia. Autonomic dysreflexia is a syndrome characterized by abrupt onset of excessively high blood pressure caused by uncontrolled sympathetic nervous system discharge in persons with spinal cord injury. Persons at risk for this problem generally have injury levels above T-6.
Facial flushing is a sign of dysreflexia. A bladder etiology is the most common precipitant for dysreflexia due to overstretch or irritation of bladder wall. Specific causes include:
- Urinary tract infection
- Urinary retention
- Blocked catheter
- Overfilled collection bag
- Non-compliance with intermittent catheterization program
Your urologist is correct in trying the reduce the bladder spasm. Ditropan and Detrol LA are appropriate medications.
One option would be a more frequent straight catheterization schedule - this will lower the urine volume and reduce the amount of bladder spasm. Another option may be a superpubic catheter. Discuss these options with your urologist.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
Your symptoms are likely due to autonomic dysreflexia. Autonomic dysreflexia is a syndrome characterized by abrupt onset of excessively high blood pressure caused by uncontrolled sympathetic nervous system discharge in persons with spinal cord injury. Persons at risk for this problem generally have injury levels above T-6.
Facial flushing is a sign of dysreflexia. A bladder etiology is the most common precipitant for dysreflexia due to overstretch or irritation of bladder wall. Specific causes include:
- Urinary tract infection
- Urinary retention
- Blocked catheter
- Overfilled collection bag
- Non-compliance with intermittent catheterization program
Your urologist is correct in trying the reduce the bladder spasm. Ditropan and Detrol LA are appropriate medications.
One option would be a more frequent straight catheterization schedule - this will lower the urine volume and reduce the amount of bladder spasm. Another option may be a superpubic catheter. Discuss these options with your urologist.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
