Dura mater is one of three membranes that are woven around the length of your spine and continue up and around your skull. It is the outermost of three layers and responsible for protecting your central nervous system (CNS). During back surgeries, there is some risk of nerves getting damaged and interrupting the CNS. This means your brain may have a hard time communicating with your bowels and bladder, causing urinary incontinence. 

Back Surgery and its Effects on the Bladder

Back pain is a common medical problem that has a range of symptoms and causes. It can be the result of sudden trauma, like a car accident; occur as we age due to bone and tissue degeneration; or be a side effect of other medical conditions like arthritis. Regardless of how it started, back pain can cause debilitating discomfort.

Types of back surgery

Your doctor will do a physical exam, take x-rays, and evaluate your medical history and symptoms before determining a diagnosis. Additionally, they may suggest doing exercises, stretches, or prescribe other medical treatments like epidural injections to relieve the pain. If the pain persists, surgery may be the next viable option.

• Spinal fusion involves the use of devices such as metal plates and screws to connect two vertebrae together.  Over time they will fuse together, acting as one bone. This will intentionally limit the mobility of the vertebrae that’s causing pain when it’s in use.
• Laminectomy is the removal of vertebrae or bone spurs to relieve pressure on the nerves.
• Discectomy is the removal of the parts of the disc that are causing pain to relieve pressure on the nerves.
• Foraminotomy is where the surgeon enlarges the hole in the bone where the nerve root opening is, relieving pressure on the nerves caused by the narrowing of the spine.

Potential Bladder Issues After Spinal Surgery

As long as the neural pathways along your spine still exist, recovery is possible, but it doesn’t hurt to understand the characteristics and different types of post-surgical incontinence.

• Stress incontinence happens when pressure is put on the bladder. Symptoms might include leaking urine when you make sudden or harsh movements, sneeze, cough, or lift something heavy.
• Urge incontinence is an involuntary squeeze or spasm of the bladder that causes an immediate urge to urinate. Sometimes it’s a feeling of having to go or actual leakage may occur.
• Mixed incontinence both the feeling of an overactive bladder and stress factors may be experienced by the patient.

Prevalence and Risk Factors for Post-Surgical Incontinence

Spinal surgery is related to lower urinary tract dysfunction in 38%–60% of patients. The nerves along your spinal cord may get impinged or damaged and can hinder your body’s neuronal circuit. Your neuronal circuit is essentially the network of nerves that communicate with your brain to deliver functions to the body, i.e., your bladder and urethra.

Risk factors include but are not limited to:

• Body Mass Index
• Age
• The type of surgery performed
• Overall health
• Medical history
• Management of symptoms post-surgery

Post-surgical incontinence can be a disheartening experience. It’s uncomfortable and leaves patients feeling embarrassed and vulnerable. Fortunately, there are options for relieving symptoms and regaining control. The first step is to take a quick assessment and seek professional help.

Management and Treatment Options

After consulting with a doctor and determining which type of incontinence you have, they may take additional steps to help formulate a treatment plan. This includes a urinalysis to check for infection, bladder journal to identify patterns and amount of incontinence episodes, and other urine tests to check for any obstructions.

Non-surgical approaches to manage incontinence after back surgery

• Pelvic floor exercises and physical therapy will help strengthen the muscles around your bladder.
• Lifestyle modifications such as quitting tobacco, exercising more, and avoiding liquids that have more trouble being processed by your bladder.
• Planning scheduled times to use the restroom so your bladder doesn’t get too full.
• Dietary modification such as eating a diet rich in fiber so as to prevent getting constipated and having bowels press against your bladder.

Medical interventions for incontinence

• Supplements and herbs will help fight off infection and give your body the nutrients it needs, specifically for urge and stress incontinence.
• Nerve stimulation techniques such as sacral neuromodulation involves devices that are implanted below the skin and above the muscle in your back. It delivers electric impulses to the nerves that control the muscles around the pelvic floor.

Surgical options for incontinence after back surgery

• Sling procedures treat stress incontinence by surgically connecting a sling to your abdominal wall and lifting the urethra to it’s normal position.

Post-Surgical Incontinence Relief in Middle Tennessee

At the Incontinence Institute, we understand the indignity that urinary incontinence brings to both men and women. Our mission is to help patients understand what it is, decide on a treatment plan through a variety of methods, and to be a resource for the 33 million American adults who suffer from incontinence. Contact us today to get started!