LOW-BACK-PAIN AND URINARY-INCONTINENCE - A HYPOTHETICAL RELATIONSHIP

Study Design. An apparent association of low back pain with urinary in continence was observed. Sixteen patients were investigated for organi c neurologic and genito-urinary disease or deficit, which could provid e a conventional explanation for the incontinence. Objectives. The unu sual association of low back pain alone, with urinary incontinence, sh ould be brought to the attention of clinicians, in the search for neur ologic mechanisms to explain the phenomenon. Summary of Background Dat a. Over 5 years, a spinal practice reviewed 5000 new patients, most pr esenting with low back pain. Sixteen low back pain patients had urgenc y incontinence of urine, of varying severity but sufficient in all cas es to cause daily distress and disruption of routine. Twelve of the si xteen patients had surgery (spinal fusion in 11 and total hip replacem ent in one), and four are awaiting surgery. Follow-up ranged from 1 to 4 years. Methods. Plain radiography, detailed neurologic examination, myelography, or computed tomography scanning of lumbar spine, urine c ulture, and urodynamic studies were the investigations used, with a fe w exceptions relating to those patients whose urinary symptoms were re vealed retrospectively. Results. When surgery reduced low back pain su ccessfully (11 of 12 patients), the urgency incontinence was cured or improved. In one patient, the low back pain continued, associated with a pseudarthrosis in the fusion mass, and the urinary symptoms were un changed. In the four patients awaiting surgery, the urinary symptoms a re unchanged. The investigations did not reveal any neurologic or geni to-urinary pathology in any patient. Conclusion. A rare association be tween severe low back pain and urgency incontinence of urine, not expl ained on the basis of any conventional neurologic or genito-urinary pa thology, should be recognized.