When your nerves let you down
Before we go to the actual subject of urinary incontinence due to nerve damage, it is important to appreciate a few basic concepts. Your nerves can be compared to the electrical wiring that forms the complex linkages between your brain and the rest of your body. No part of your body can be devoid of nerves and continue to survive. Nerves are of two major types: one, sensory nerves that carry messages from the various body organs (sensations of pain, heat and cold, pressure, smell, sight, etc.) and two, motor nerves, which carry instructions from the brain to every part of the body.
This circuitry also exists in the bladder, urinary passage, the penis and other related organs, and enables you to feel the urge to pass urine, to sense that you are truly passing urine, that your bladder is now empty and so on. It stands to reason that if these nerves are affected in any way, whether due to disease or injury, the entire mechanism will go out of sync. There are many reasons why this might happen, the common ones being as follows:
This is by far the most common, and with upwards of 70 million people in India living with diabetes, the number can only increase with time. When someone has lived with uncontrolled diabetes for several years, the excess sugar damages most organs of the body including the kidneys, the eyes, the reproductive organs and the nerves. The precise mechanism by which diabetes inflicts such widespread injury to the network of nerves is beyond the scope of this article, for we are more concerned with its impact. Also, since nerve damage in diabetes happens slowly, it often remains unnoticed until fairly advanced. Or it may get overshadowed by numerous other signs such as difficulty in walking (due to loss of sensation in the feet), or even a silent heart attack (without any chest pain).
If you don’t feel the urge to pass urine strongly enough, you may not visit the toilet until the urinary bladder is too full and it would be no surprise to see a few drops spill over. Equally common is to not feel the urge till there is insufficient time to reach the toilet.
The problem in diabetes is a bit more complicated because one tends to pass urine more frequently and in greater quantities than normal, much before nerve damage sets in. It is therefore quite common for people to confuse the two aspects, and accept the increased frequency as part and parcel of diabetes.
Impact of Surgery:
Any surgical operation in the lower abdomen or pelvic region, involving the urinary, kidneys, the the lowermost part of the intestine, uterus, and ovaries (in women) can at least, in theory, affect the nerves in that part of the body. This includes the extensive operations that are often for the treatment of cancer in these organs. Even in the hands of very competent surgeons, prostate surgery in men can result in temporary loss of urine control. This last for two to four weeks and can be remedied by special exercises.
Spinal injuries due to traffic accidents, gunshot wounds, surgical treatment for slipped disc (unless performed with great caution) are common reasons for loss of bladder control. The extent may vary, depending on the severity of damage to the spinal nerves, but remedial measures are often not very effective. A condom catheter than enables the urine to flow into a urine bag might the only way to solve the problem.