A few years ago, despite my happy circumstances, I was enveloped in a cloud. A lovely family, loving husband, yet where was my joy? Why was I anxious? My body ached. When I ate food, I felt full and unsatisfied. I had other tell-tale signs, of course, but they crept up so gradually, I did not notice them. I prided myself on not needing to use the restroom as frequently as my friends when we were out and about. In my youth, I could ‘pee like a racehorse.’ In fact, now I was pressing my urine out.
I had been sharing my symptoms with my doctor for years at this point. He suggested that I might have fibromyalgia or irritable bowel. It was not until I had a bladder infection that I was diagnosed with a neurogenic bladder. I was told that my bladder was not contracting properly; it was “underactive” and I would need to use intermittent catheterization to urinate for the rest of my life.
I was numb with shock and overcome with a myriad of emotions including humiliation, depression, and pure shame. How could I fess up to the fact that my problems were due to my bladder? Who talks about bladders? They are a forbidden topic. Never in my wildest dreams would I have equated my physical and emotional symptoms with my bladder and its deficient state.
New medical diagnoses affect each of us differently, but the reality of dealing with a chronic health condition is wearing at best – and devastating for most. It is not going to heal; it won’t get better.
After receiving a neurogenic bladder diagnosis, I dealt with a daily change in routine. I was manually emptying my bladder using clean-intermittent catheterization (CIC). A bedridden or paraplegic might use an indwelling catheter (or Foley). Regardless, the very real challenge is avoiding chronic urinary tract infections (UTI). Why? Emptying the bladder manually inadvertently introduces bacteria into the urethra (neck of the bladder), which can migrate into the bladder itself. These bacteria then start to multiply and result in an infection. Chronic bladder infections can result in kidney damage or even septicemia.1 Long-term catherization ensures you will have recurrent UTIs.2
Many times, feelings of despair, anxiety and mood swings are the result of bladder infections. It is a constant battle that wears on the nerves: many times you are suffering a low-grade infection from bacteria that have now colonized your urethra; only once symptoms appear and it is raging can you begin treatment. Will the antibiotic work? Will the bacteria become resistant to my current antibiotic and will there be a time when the infections can’t be controlled? Emotionally, you can be caught unaware.
A 2015 study drew a relationship between a percentage of patients with UTI and various neuropsychiatric disorders,3 including mood disorders. Dramatic mood swings (ranging anywhere from sudden lethargy to uncharacteristic yelling) are well documented among multiple sclerosis patients who experience a myriad of medical problems, including neurogenic/underactive bladder.4 A study conducted on roughly 100 patients with spinal cord injury (SCI) showed that emotional and neurological symptoms, including depression, are more likely in women over men (3.8 fold), as well as those unable to successfully catheterize themselves (4.6 times)5 compared to those able to maintain their independence by performing self-catheterization. A smaller study of people with urinary tract infections found twice as many women as men experience extreme mood swings.6
I think it’s crucial to recognize the possibility of associated mental-state changes when dealing with a neurogenic bladder and UTI. If you have been diagnosed, watch for symptoms. Be ready to deal with them, rather than allow them to overtake and rob you further. The state of health care today demands that we be proactive; being our own advocate allows us to maintain our own best possible health.
JoAnne Lake is the author of Beyond Embarrassment: Reclaiming Your Life with Neurogenic Bladder and Bowel, together with Julia Parker, MS, MLIS. She can be reached at www.trudytriumph.com.
References: 1) Feneley RC, Hopley IB, Wells PN. Urinary catheters: history, current status, adverse events and research agenda. J Med Eng Technol. 2015;39(8):459-70. doi:10.3109/03091902.2015.1085600. Epub 2015 Sep 18. Review. PubMed PMID: 26383168; PubMed Central PMCID: PMC4673556 2) Vigil HR, Hickling DR. Urinary tract infection in the neurogenic bladder. Transl Androl Urol. 2016 Feb;5(1):72-87. doi: 10.3978/j.issn.2223-4683.2016.01.06. Review. PubMed PMID: 26904414; PubMed Central PMCID: PMC4739987 3)Chae JH, Miller BJ. Beyond Urinary Tract Infections (UTIs) and Delirium: A Systematic Review of UTIs and Neuropsychiatric Disorders. J Psychiatr Pract. 2015 Nov;21(6):402-11. doi: 10.1097/PRA.0000000000000105. Review. PubMed PMID: 26554322; 4) Kes VB, Cengić L, Cesarik M, Tomas AJ, Zavoreo I, Matovina LZ, Corić L, Drnasin S, Demarin V. Quality of life in patients with multiple sclerosis. Acta Clin Croat. 2013 Mar;52(1):107-11. Review. PubMed PMID: 23837280; 5) Oh SJ, Shin HI, Paik NJ, Yoo T, Ku JH. Depressive symptoms of patients using clean intermittent catheterization for neurogenic bladder secondary to spinal cord injury. Spinal Cord. 2006 Dec;44(12):757-62. PubMed PMID: 16432529; 6) Urinary tract infection and Mood swings – from FDA reports; https://www.ehealthme.com/cs/urinary-tract-infection/mood-swings/ visited Nov. 17, 2017
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