Urinary Issues After Severe Injury: A Patient's Journey

Urinary problems

Hello, doctor.
On April 17 of this year, I accidentally fell from the fourth floor to the first floor and was taken to E-Da Hospital's emergency department.
I had a urinary catheter inserted until September 28, during which it was removed a total of five times.
The first three times, my bladder was very distended, but I was unable to urinate.
The last two times, I had to apply significant pressure to my bladder to urinate, but the residual urine was over 200 cc.
After the last removal, I no longer need to apply pressure to my bladder, but I have to push hard to urinate, and I can only do so while sitting.
I cannot urinate as easily as I could before the injury, as standing to urinate is inconvenient due to my right leg fracture.
I will provide more details about the diagnosis of my injuries later.

My penis is partially split; the left side feels completely normal, while the right side has some sensation but no pain when pinched (the same goes for my right thigh).
Additionally, the urge to urinate feels very weak, and I need to monitor how much water I drink and how long it has been to know when to go to the bathroom.
The urologist I consulted prescribed Urinary Retention Tablets (to be taken three times a day) and Uroselect 4 mg (to be taken in the morning and evening).
I would like to ask the doctor if this is due to nerve damage that requires time to heal.
By the way, in July, I returned to the hospital's emergency department due to a fever from a urinary tract infection.

My diagnoses are as follows:
1.
Right acetabular fracture
2.
Pelvic fracture with lumbar and sacral nerve injury
3.
Coccygeal fracture and transverse process fractures of the third, fourth, and fifth lumbar vertebrae
4.
Open fracture of the right tibia and fibula with infection
5.
Pressure ulcer on the arm.

Ali, 20~29 year old female. Ask Date: 2021/10/02

Dr. Fu Shizhang reply Urology

It may be related to nerve injury.
The medication prescribed to assist with urination has shown good results, but recovery will take time.
Online consultations cannot replace an in-person examination and physical assessment by a physician.
It is still recommended to seek medical attention at a healthcare facility when there are health issues.

Reply Date: 2021/10/02

More Info

It sounds like you have been through a very challenging and painful journey following your fall and subsequent injuries. The urinary issues you are experiencing are likely related to the significant trauma you sustained, particularly the pelvic and spinal injuries, which can affect the nerves that control bladder function.

When you experience a severe injury, especially to the pelvic region and lower spine, it can lead to nerve damage. The bladder is controlled by a complex network of nerves, and any disruption to this system can result in symptoms such as urinary retention, urgency, and difficulty in initiating urination. In your case, the fact that you have to exert pressure to urinate and that you experience a weak sensation of bladder fullness suggests that there may be some degree of neurogenic bladder dysfunction.

Neurogenic bladder can manifest in various ways, including:
1. Urinary Retention: This occurs when the bladder does not empty completely, leading to residual urine. This can be due to a lack of nerve signals that trigger the bladder to contract.

2. Increased Urgency and Frequency: Some individuals may experience a strong urge to urinate frequently, which can be distressing and disruptive to daily life.

3. Difficulty Initiating Urination: As you mentioned, you may find it challenging to start urination without applying pressure to the bladder.

The medications prescribed to you, such as the urinary antispasmodics, are intended to help manage these symptoms by relaxing the bladder and improving its function. However, it is essential to understand that recovery from nerve injuries can take time. The nerves may heal gradually, and with appropriate rehabilitation and management, you may see improvement in your bladder function.

In addition to medication, it may be beneficial to engage in pelvic floor rehabilitation. A physical therapist specializing in pelvic health can provide exercises and techniques to help strengthen the pelvic floor muscles, improve bladder control, and enhance overall urinary function. This type of therapy can be particularly helpful in cases of neurogenic bladder.

It is also crucial to maintain regular follow-ups with your urologist to monitor your progress and adjust your treatment plan as needed. If you continue to experience urinary infections or other complications, further evaluation may be necessary to ensure that there are no underlying issues that need to be addressed.

Lastly, it is important to take care of your mental health during this recovery process. The physical limitations and challenges you are facing can understandably lead to feelings of frustration or despair. Seeking support from mental health professionals, support groups, or counseling can be beneficial as you navigate this difficult time.

In summary, your urinary issues are likely related to the nerve damage from your injuries. Recovery may take time, and it is essential to work closely with your healthcare team to manage your symptoms and support your healing process. Engaging in pelvic floor therapy and maintaining open communication with your urologist will be key components of your recovery journey.

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