Caring Medical - Where the world comes for ProlotherapyThe evidence cervical neck problems can cause urinary incontinence

Ross Hauser, MD  | Caring Medical Regenerative Medicine Clinics, Fort Myers, Florida
David N. Woznica, MD | Caring Medical Regenerative Medicine Clinics, Oak Park, Illinois
Katherine L. Worsnick, MPAS, PA-C  | Caring Medical Regenerative Medicine Clinics, Fort Myers, Florida
Danielle R. Steilen-Matias, MMS, PA-C | Caring Medical Regenerative Medicine Clinics, Oak Park, Illinois

The evidence Cervical neck problems can cause urinary incontinence

In this article we will present the evidence that connects urinary incontinence with cervical neck pain and instability and that when you treat the neck problems, often the bladder control problems are alleviated.

Many patients come to us with a myriad of symptoms related to their cervical neck instability. Some symptoms are clearly related to their neck problems. These would be, for example, the challenges of vertigo, vision problems, headaches, and swallowing difficulties. Some symptoms, which have no seemingly obvious connection as being related to cervical neck pain are usually categorized as “these other things that are wrong with me.”

This can be the case when it comes to urinary incontinence.

Here we may have a patient, whose cervical neck instability is causing pressure on their nervous symptom which can unsurprisingly to us, lead to the problems of urinary incontinence. For those who do not make a connection between cervical neck instability and urinary incontinence, this patient may be sent to a urology specialist who may find it challenging to help this patient, or, as we will see in the research be looking for a diagnosis that is not there.

Patients we are treating for cervical spine pain and instability will start revealing that they HAVE urinary challenges and their urinary challenges treatment as mostly or wholly unsuccessful.

Typically, a patient we are treating for cervical spine pain and instability will start revealing that they HAVE urinary challenges and their urinary challenges treatment as mostly or wholly unsuccessful. They, in the past they admit, have been given the standard set of guidelines and urinary management suggestions: Dietary changes mostly, avoidance of caffeine (which many cervical neck patients cannot tolerate and do not take) as a primary lifestyle change along with healthier diet are recommended. There is usually nothing wrong with these recommendations but they are not working for this patient. Other recommendations were equally not helpful, such as “holding it in as long as you can,” to retrain your bladder to be able to hold it in. Of course wearing some type of protective undergarments is always an option.

While these recommendations may be helpful to many, cervical spine and neck instability patients are dealing with multiple symptoms that they are not able to control. It is at this point the medications for urinary incontinence may be added to their treatments.

Neurogenic Bladder Disorder is this only a problem of the lumbar spine? Is your cervical spine the cause?

It is not easy to find research connecting cervical spine instability with urinary incontinence. We are going to see this below. The great weight of research centers on the problems of the lumbar spine and the neurologiocal defects herniated lumbar discs may cause. But, as we will suggest and demonstrate, there is a connection between the cervical spine and urinary incontinence.

People getting cervical spine surgery already have urinary and bladder problems

In April 2019, doctors at the Department of Orthopaedics and Rehabilitation, Oregon Health & Science University published their research findings that made a connection between lower urinary tract symptoms and urinary bother in patients who underwent elective cervical spine surgery. The research was published in the journal Clinical orthopaedics and related research. (1)

The researchers record that the purpose of this study was to:

  1. Examine and determine the prevalence of moderate-to-severe lower urinary tract symptoms (LUTS) and clinically relevant urinary bother among patients undergoing elective cervical spine surgery
  2. Does the presence of myelopathy (spinal cord compression from cervical instability, herniated disc, or stenosis) affect frequency of moderate-to-severe LUTS or clinically relevant urinary bother among patients undergoing elective cervical spine surgery?
  3. Do MRI findings of spinal cord injury or compression correlate with presence and severity of LUTS?

The research:

  • 242 patients (youngest 34 to oldest 83 years – average group age 58
  • There were 108 males (45%) and 134 females (55%).
  • Patients were grouped into a myelopathy group (spinal cord pressure) and a non-myelopathy group based on diagnosis as assigned by the operating surgeon.

Nearly half of all patients undergoing elective cervical spine surgery had moderate-to-severe LUTS (lower urinary tract symptoms)

Numbers:

  • The prevalence of moderate LUTS in the patient sample was 40%
  • The prevalence of severe LUTS in the patient sample was 8%
  • Clinically relevant urinary bother was reported in 18% of patients
  • The odds of moderate-to-severe LUTS among patients with myelopathy was greater than that observed in patients without myelopathy
  • The prevalence of clinically relevant urinary bother was higher in patients with myelopathy (30% [26 of 88]) compared with those with no myelopathy (11% [15 of 140]

Nearly half of all patients undergoing elective cervical spine surgery had moderate-to-severe LUTS. This is more than double the prevalence that has been reported in a community-dwelling adult population. These symptoms can impair quality of life, lead to surgical complications (urinary retention or incontinence), and may be mistaken for cauda equina (lumbar nerve disorder), prompting potentially unnecessary imaging and studies.

Patients had urinary problems before their cervical neck surgeries – and – these patient’s urinary problems should not be mistaken for low back complications but should be traced back to the neck

Here, we see that patients had urinary problems before their cervical neck surgeries and that these patient’s problems should not be mistaken for low back complications.

There have been previous studies to make a connection between urinary incontinence and cervical neck instability and in fact in some instances where a successful surgery did cure the patient if their urinary symptoms.

A 2005 study in the Journal of spinal disorders and techniques (2) came from Japanese researchers at the Shinshu University School of Medicine. Here the researchers found that:

  • In 56 patients examined in this study, 29 (52%) had some urinary subjective complaints, whereas the remaining 27 (48%) had none.
  • Urologic examination indicated that 8 of these 29 (28%) patients with urinary complaints had urologic disorders other than neurogenic bladder (the urinary problems was not suspected of coming from the neck).
  • Of the remaining 21 patients, 6 (25%) were judged to have neurogenic bladder on urodynamic study. However Urodynamic study may be of limited value in diagnosing urinary disturbance in cervical myelopathy.
  • Patients with urinary complaints had significantly longer durations of myelopathy and delayed motor evoked potential latencies (neurologic complaints) than those without urinary complaints.
  • After surgery, 19 of the 21 (90%) patients with urinary complaints showed recovery from urinary disturbance. Operations in patients with cervical myelopathy were also effective against urinary disturbance. Urinary complaints may be an indication for surgical treatment despite the results of urodynamic study.

What do we make of all this?

If you have been suffering from urinary problems that the urologist and the cervical surgeon disagree on what is causing it – the surgeon comes out on top here because 90% of cervical neck patients who had a surgery and had previous urinary dysfunction, were basically cured of that problem.

Degenerative cervical myelopathy

Degenerative cervical myelopathy is cervical spine degeneration that causes pressure or compression on the spinal cord. While typically classified as a a wear and tear disorder caused by aging, the problems and symptoms can be much more complex.

Our website is filled with detailed articles on the problems of cervical spine instability. A list is provided below. In the many patients we see, Degenerative cervical myelopathy or cervical spine instability does not cause one problem in isolation. A patient will have neck pain, perhaps numbness, some will have headaches, some will have vision problems, some will have swallowing difficulties, some will have fainting spells or blackouts, some will have ringing in the ears, some will have 3 or 4 or 5 or more of these and other problems concurrently. Some will also have urinary incontinence and bladder problems and some of those people, as we have mentioned above, will be sent to a urologist and be given treatments that will be ineffective if the patient’s or your problem is coming from the cervical spine. A urologist does not work on neck pain.

Research lead by doctors at the Academic neurosurgery unit, Department of Clinical Neurosurgery, University of Cambridge and published in the British Medical Journal (3) (February 2018) describes the problems of Degenerative cervical myelopathy in a category of articles titled: “Easily Missed.” What did the Cambridge doctors suggest was easily missed? Symptoms coming from the neck. This is quoted from the research:

  • “Consider degenerative cervical myelopathy in patients over 50 with progressive neurological symptoms, such as pain and stiffness in the neck or limbs, imbalance, numbness, loss of dexterity, frequent falls, and/or incontinence.”
  • Consider degenerative cervical myelopathy in “Autonomic symptoms such as bowel or bladder incontinence, erectile dysfunction, or difficulty passing urine.”

    So patients with bladder problems and neck pain should be examined for neck pain.

    We would also like to point out the guidelines the researchers gave their fellow physicians in regard to recommendations to surgery

    • “It is not possible to predict the long term outcome of surgery. Maximal recovery occurs at around 6-12 months. Residual symptoms beyond this are likely to be permanent and should be managed appropriately. Functional deficits are common, and include falls and reduced mobility, incontinence, depression, sleep deficits, and struggles with self-care, and often the most troublesome symptom is pain. Discuss with your patient that complete resolution of pain is unlikely. Neuropathic analgesia and anti-spasticity medication can be offered to manage the pain. Early referral to specialist pain clinics is often helpful.”

    Surgery, as is generally recommended should be the last option.

    In our practice, we continue to see a large number of patients with a myriad of symptoms related to cervical neck instability including seemingly unrelated problems of the bladder and urinary difficulties. As we have demonstrated in our own research, which we discuss below, and that of other researchers, problems of the neck can be far reaching

    Cluster headache treatment - cervical ligament instability and the trigeminal and vagus nerves

    There is a connection between urinary problems and cervical neck pain, the Vagus Nerve and blood pressure

    If you look at the illustration above you will see where the Vagus nerve is closely related to the C1 – C2 – C3 vertebrae. While doctors usually discuss the vagus nerve in singular sense, there are two vagus nerves, one on each side of the neck and in combination they are referred to as the vagal nerves. This means that the degenerative damage in your neck can significantly impact the function of one or both vagus nerves.

    There has been some degree of controversy as to whether of not the vagus nerves do provide nerve impulses and function to the bladder. It should not be far fetched to think they do. The vagus helps regulate your heartbeat, the vagus helps regulate your breathing, your vagus regulates functions of your digestive tract. Wouldn’t it be within the realm of possibility that the vagus could also regulate the bladder? Let’s get to the science so we may be able to explain how treating your neck pain can, among other things, help regulate your bladder.

    We are going to go back to a 1987 study performed on dogs, that makes a connection to neck area pain, the heart, and urinary bladder problems. If your neck pain includes problems of regulating heartbeat, you may find a long sought answer to some of your problems.

    Let’s point out that this study is not coming from cervical spine specialists or urologists, it is coming from the Department of Cardiovascular Studies, University of Leeds in the United Kingdom. It was published in Quarterly journal of experimental physiology. (4)

    Here are the highlights:

    • The researchers anaesthetized dogs and filled up their urinary bladders with saline. This began the experiment to see if the bladder and the vagal nerves talked to each other. How would the researchers know? By filling up the dog’s bladder they could measure the activity of the efferent (furthest from the bladder) vagal nerves. This would create changes in blood pressure and variation of heart activity. As we mention the Vagus nerves impact coronary function.

    What did the researchers find?

    • It is concluded that distension of the urinary bladder results in the response of a decrease in activity in efferent cardiac vagal nerve fibres (the dog’s body has responded to a filled bladder by trying to reduce heart rate and blood pressure to calm the dog down. The vagal nerves also blocked the stimulating receptors in the carotid region (that part of the neck where the common left and right carotid arteries pass along with the carotid sinus, where they merge above the aorta,  and the somatic nerves (the voluntary controls that help you control your bladder).

    What does this mean to you? 

    Urinary problems, heart rate, blood pressure, seemingly all have a common neck component.

    The vagal nerves, blood pressure regulation, heartbeat regulation, urinary incontinence problems, could all trace a common source to the neck.

    Two years later a different set of researchers from the Department of Cardiovascular Studies, University of Leeds in the United Kingdom published a follow up study in the Quarterly journal of experimental physiology. (5) They found: “inhibition of vagus nerve activity caused by bladder distension was affected by the level of carotid sinus pressure.” The filled bladder and the nerve impulses it was creating were being regulated by the carotid sinus in the neck. The vagal nerves, blood pressure regulation, heartbeat regulation, urinary incontinence problems, could all trace a common source to the neck.

    Now you would think research like this would get neurologists, urologists, and cardiologists talking. This was not the case. Let’s fast forward some 25 years later to 2012.

    In a published study in the Polish medical journal Folia medica Cracoviensia, (6) doctors at the Department of Pathophysiology, Jagiellonian University Medical College, Kraków, Poland opened their study with this sentence:

    “There is no evidence that vagal nerve innervate the urinary bladder.” They closed their research investigation with this sentance: “The modulation of vagal nerve activity affect the urinary bladder function in naive (normal) conditions, as well as in case of (damaged or degenerative tissue disease). These data implies the integrative action of visceral vagal nerve innervation in urinary bladder function.” There is a connection.

    As you can there is controversy when it comes to urinary and bladder problems and cervical neck pain.

    Vagus nerve compression

    Vagus nerve compression has been implicated in many problems. See the list below. In the video below and the articles below, we will explain our ways of treating vagus nerve compression to help treat the long list of symptoms patients experience including urinary incontinence.

    In our examination, we too are looking for compression.

    In our clinical and research observations, we have documented that Prolotherapy can offer answers for sufferers of cervical instability, as it treats the problem at its source. Prolotherapy to the various structures of the neck eliminates the instability and the sympathetic symptoms such as urinary problems without many of the short-term and long-term risks of cervical fusion. We concluded that in many cases of chronic neck pain, the cause may be underlying joint instability and capsular ligament laxity. Furthermore, we contend that the use of comprehensive Prolotherapy appears to be an effective treatment for chronic neck pain and cervical instability, especially when due to ligament laxity. The technique is safe and relatively non-invasive as well as efficacious in relieving chronic neck pain and its associated symptoms.

    Medical research validating the use of Comprehensive Prolotherapy, from simple dextrose injections to stem cell prolotherapy injections is not new. There is 55 years of research supporting the use of Prolotherapy for problems of the neck and head.(7)

    Urinary incontinence is not a symptom in isolation of cervical neck instability patients. Please learn about how we can help you with these symptoms:

    Questions about Cervical Neck Pain and Instability?
    Get help and information from our Caring Medical Staff

    Prolotherapy Specialists Cervical Neck Pain and Instability

    1 Lieberman EG, Radoslovich S, Marshall LM, Yoo JU. Lower urinary tract symptoms and urinary bother are common in patients undergoing elective cervical spine surgery. Clinical Orthopaedics and Related Research®. 2019 Apr 1;477(4):872-8. [Google Scholar]

    2 Misawa T, Kamimura M, Kinoshita T, Itoh H, Yuzawa Y, Kitahara J. Neurogenic bladder in patients with cervical compressive myelopathy. Clinical Spine Surgery. 2005 Aug 1;18(4):315-20. [Google Scholar]

    3. Davies BM, Mowforth OD, Smith EK, Kotter MR. Degenerative cervical myelopathy. Bmj. 2018 Feb 22;360:k186. [Google Scholar]

    4 Hassan AA, Hicks MN, Walters GE, Mary DA. Effect on efferent cardiac vagal nerve fibres of distension of the urinary bladder in the dog. Quarterly Journal of Experimental Physiology: Translation and Integration. 1987 Oct 10;72(4):473-81. [Google Scholar]

    5 Ramadan MR, Drinkhill MJ, Mary DA. The effect of distension of the urinary bladder on activity in efferent vagal fibres in anaesthetized dogs. Quarterly Journal of Experimental Physiology: Translation and Integration. 1989 Jul 10;74(4):493-501. [Google Scholar]

    6 Juszczak K, Thor PJ. The integrative function of vagal nerves in urinary bladder activity in rats with and without intravesical noxious stimulation. Folia Medica Cracoviensia. 2012. [Google Scholar]

    7 Steilen D, Hauser R, Woldin B, Sawyer S. Chronic neck pain: making the connection between capsular ligament laxity and cervical instability. The open orthopaedics journal. 2014;8:326.  [Google Scholar]

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