Urinary incontinence after possible DCI II episode - desperate - any hope?

[Cavetecdiver]

Re the ruling out of lung pathology like blebs or bullae: again this is speculation, not suggesting that you need to run out and do this, but you would need a high-resolution CT scan for that.

Good to hear about the negative TCD with bubbles - it's likely that you can rule out shunting then, which would make you being a "bubbler" something of a moot point and obviate the need for further study like transthoracic echocardiography to determine shunt morphology.

Re saturation, if you're talking about pulse oximetry, a low reading following a dive would be an alarming sign, especially in the setting of decompression sickness. A normal reading on room air doesn't really rule out anything but significant respiratory depression or pulmonary pathology.

Exactly where in Europe are you?

Best regards,
DDM

Poland, Wrocław

 

[Ninjapug]

Re the ruling out of lung pathology like blebs or bullae: again this is speculation, not suggesting that you need to run out and do this, but you would need a high-resolution CT scan for that.

Good to hear about the negative TCD with bubbles - it's likely that you can rule out shunting then, which would make you being a "bubbler" something of a moot point and obviate the need for further study like transthoracic echocardiography to determine shunt morphology.

Re saturation, if you're talking about pulse oximetry, a low reading following a dive would be an alarming sign, especially in the setting of decompression sickness. A normal reading on room air doesn't really rule out anything but significant respiratory depression or pulmonary pathology.

Exactly where in Europe are you?

Best regards,
DDM

 

[Ninjapug]

[Neurogenic bladder dysfunction a main disability of decompression sickness: a case report] - PubMed

Half of the cases of neurological decompression involve dysbaric myelitis. Venous ischemia is the most likely cause. Foramen ovale is an important risk factor, but the pathophysiology is obscure. Bladder problems, common in the acute phase of decompression sickness, may be the primary...

pubmed.ncbi.nlm.nih.gov

I hope this helps. I think the TCD was beneficial and with a very high probality of ruling out PFO. We always utilized transesophageal echo, TEE, with bubbles to visualize and assess the FO as well as the anatomy of atrial septum. I have served my sentence as a nurse in the cardiac Cath lab for almost 26 years and seen so many TEE bubble studies. I was totally ignorant of the TCD prior to reading your post I’m sorry to say. No experience with TCD other than reading several articles and case studies from my go to sites ( not WebMd for sure) before posting a reply.Never knew this was an option as TEE is a more invasive study and usually requires deep sedation or IV anesthesia. Complication rates are low but can occur.
Take comfort in Duke Dive Medicine advice. I have personal experience in Duke as an employee and have the utmost respect for the patient care they provide. I only mentioned TEE because while I was reading to the post and replies I didn’t see any reference to this procedure. I would be relieved and would follow their assessment and advice without hesitation.
I hope you can find answers for your issue and can under medical advice resume diving without further issue. I certainly wish you well for a full recovery. Apologies that the article is not a direct link. This article is from 2006 but appeared verbatim in an article published in July 2022.

 

[Duke Dive Medicine]

Poland, Wrocław

The closest hyperbaric unit in Poland I could find is in Gdynia:

Uniwersyteckie Centrum Medycyny Morskiej i Tropikalnej - Klinika medycyny hiperbarycznej i ratownictwa morskiego

I don't speak Polish so couldn't review the site with much detail, but if they treat acute indications like necrotizing infections, then they may have physicians who are qualified to examine divers. At the very least you could contact them and see if there's anyone closer.

Best regards,
DDM

 

[Dsix36]

This is only my personal experience and I am not a doctor. I got DCS and pretty much ended up paralyzed from the waist down. Legs were dead, had very little control over bowels and could not urinate at all. Many chamber rides returned some use of my legs and I could wobble (not stable enough to call it walking) again. Bowels improved but urinating required a catheter. I wore a catheter and a collection bag strapped to my leg for a few weeks until I finally opted to self catheterize 4 times a day. over the course of several months I was able to stop retaining urine and eliminate the need to use catheters. Now I began to have minor accidents and was forced to resort to diapers. I was diagnosed with spinal cord damage and told by the time 6 months was up, it would not improve any further. I began "self training" of holding my urine just as long as I possibly could every single time in an effort to strengthen muscles and/or relearn the function. A couple months of this and I was able discontinue the use of diapers. Things still feel different but functions are pretty much back to normal. I know this is TMI and many people with similar experiences are not apt to share so freely but I hope this offers some insight to what determination and work can do to help.

 

[Trace Malinowski]

I began "self training" of holding my urine just as long as I possibly could every single time in an effort to strengthen muscles and/or relearn the function. A couple months of this and I was able discontinue the use of diapers. Things still feel different but functions are pretty much back to normal. I know this is TMI and many people with similar experiences are not apt to share so freely but I hope this offers some insight to what determination and work can do to help.

I did the same for my eye tracking after DCS. It took two years but my left eye returned to normal. I had surgery to realign the right eye two weeks ago, and I'm now working on the right eye hoping to have both eyes working together as a team in the future.

When it comes to the things doctors cannot fix, you need to become your own lab rat because sometimes only you know how things feel and maybe what you think you need. Persistence, exercise, and applications of heat, cold, or other stimuli might begin to help the brain and body heal.

I planned to commit suicide through VSED, but halted that plan when my body turned a corner and the vertigo I had for 2.5 years went away. Now, I'm back to freediving and shallow scuba diving. I never thought I'd be able to go to a restaurant or a movie again let alone scuba dive.

I just wanted to post that I improved a lot over the course of 4 years to offer some hope.

 

[FabletheRaven]

You should look into Pelvic Floor physical therapy. At this point there seems like there is a certain amount of neurological damage, but you haven't really had a musculoskeletal evaluation. I would also recommend seeking out psychiatric help regarding your level of confidence and misery surrounding your bladder dysfunction as well as the interruption to your diving and social life.

 

[chillyinCanada]

OP hasn't been back to Scubaboard since Nov. 8. We wish him well.

 

[Cavetecdiver]

You should look into Pelvic Floor physical therapy. At this point there seems like there is a certain amount of neurological damage, but you haven't really had a musculoskeletal evaluation. I would also recommend seeking out psychiatric help regarding your level of confidence and misery surrounding your bladder dysfunction as well as the interruption to your diving and social life.

I started pelvic Floor exercises and continue for more than a month. I do 40 repeats of syrenghening musles and relaxing with 12 sec intervals.
There is a big improvement with musle strengh but unfortunetly only medium improvement with incontence and not sure if not caused more by drugs (esp omnic) than exercises. I see that every time I miss omnic pills my urine pressure drops by half and immediately urine starts smelling bad
I believe that shows in my case the primary issue must be with bladder emptying and low urine pressure/retention rather than detrusor strenght.
If that is the case is there any way to check what caused emptying problem?
Is emptying somehow a separate wire/circle in spine cord than stopping urine flow?
Any surgery or exercises dedicated for emptying?
I will continue exercises and going for physioteraphy appointment soon with hope of any further advice and directions.

 

[FabletheRaven]

I started pelvic Floor exercises and continue for more than a month. I do 40 repeats of syrenghening musles and relaxing with 12 sec intervals.
There is a big improvement with musle strengh but unfortunetly only medium improvement with incontence and not sure if not caused more by drugs (esp omnic) than exercises. I see that every time I miss omnic pills my urine pressure drops by half and immediately urine starts smelling bad
I believe that shows in my case the primary issue must be with bladder emptying and low urine pressure/retention rather than detrusor strenght.
If that is the case is there any way to check what caused emptying problem?
Is emptying somehow a separate wire/circle in spine cord than stopping urine flow?
Any surgery or exercises dedicated for emptying?
I will continue exercises and going for physioteraphy appointment soon with hope of any further advice and directions.

So a pelvic floor PT will be able to give you way more information, I only a know a cursory amount as it's not my expertise at all. However they should be able to assess based on your history and physical evaluation what's causing your emptying problem, or if you have an emptying problem. (though based on your original post that you're retaining urine that seems likely).

Muscle strength is great and can help you hold it in, but it's not going to help you volitionally empty the bladder if you have a neurogenic bladder weakening the detrusor muscles. Basically the bladder should be default squeeze it all out like a balloon letting out air. After some injuries, such a certain spinal cord injuries you can have a flaccid bladder and it's like trying to get the air out of a deflated balloon if that makes sense. Generally you can use massage techniques to get it out. I'm not sure if it's applicable but you can give it a try, found this video on youtube that may be helpful.