Some questions on urinary muscles?

[carld]

Maybe Webslave or Kevin814 can help with this question, but the start and stopping or hesitancy in urinating which is a classic CP symptom and comes and goes with me along with reduced flow on and off or wax an wane...

My question is which muscles in the pelvis control this function? Since I have no obstruction, my cystoscopy was normal, I would like to know the name of the muscles that control this function . I told my urologist this today and he said it's a muscle that's causing this, so is this is a functional problem that's causing my issues with CP/ inflammation?

Is this considered part of pelvic myoneuropathy? The nomenclature can be confusing.

Is the LUTS aspect of CP related to muscle/pelvic myoneuropathy? or some functional problem if no physical problem exists? If my internal work recreates my complaint of a frequent urge to urinate and discomfort in the perineum, then I should be on the right path of continuing internal PT to stretch those muscles out, right?

[kevin]

Good question; the answer varies depending on the individual, though usually these symptoms have both muscular and neurological causes. Your urologist was probably referring to the external urinary sphincter, which is the most common culprit for these symptoms. Tightness of the surrounding muscles can surely contribute as well; Webslave can probably elaborate on which ones.

However, the causes of external urinary sphincter dysfunction can be both muscle- and nerve- related, or both. The muscle itself could be tight, just as any other muscle in your pelvis could be, or there could be a problem with the pudendal nerve, which relays messages to and from the sphincter (there are many pudendal nerve problems that are far more common than entrapment, which is very rare), or there could be a problem with the sacral spinal cord center that controls synergy of the sphincter (Onuf's nucleus). These can all result in what is called "dyssynergic" voiding.

Furthermore, the external urinary sphincter is not always the culprit. In addition to anatomic obstruction, these symptoms can also be caused by tightness of the internal urinary sphincter and weak contractility of the bladder's detrusor muscle (i.e. your bladder isn't contracting with enough force to push urine out with a strong stream), among other things.

So, yes, this is all part of pelvic myoneuropathy, since it results from dysfunction of the muscles and the nerves, both of which contribute to each other. Each individual will have a different balance of muscle and nerve dysfunction (some will be primarily nerve-related, some primarily muscle-related). If PT helps you, you definitely have a muscular component. The beauty of physical therapy is that it is safe and non-invasive. Everybody should give it a try, even if they think their problems are neurological in nature.

Here's a rough rule of thumb: If you have a lot of LUTS/voiding dysfunction/storage dysfunction, e.g. hesitancy, starting and stopping, weak stream, dribbling, and to a certain extent frequency, you should get yourself checked out by a neuro-urologist or specialist in urodynamics, who can determine more precisely what is causing your condition and decide which of an array of treatments (typically a medication that acts on your autonomic nerves) to use for you. If your sole symptom is pain, a neuro-urologist is not likely to be of much help. The urological community does not know what to do with pain, but it does know what to do with voiding dysfunction.

What is a neuro-urologist, and how can you find one? A neuro-urologist is a specialist in neurology and urology, who typically uses a bunch of different tests all under the umbrella of urodynamics to assess urinary function in patients. Here's a good way to find one: go to PubMed (http://www.pubmed.gov) and search for someone in your area who's got publications in the journal "Neurourology and Urodynamics". Here's an example that searches for people in Philadelphia:

Code: Select all

"neurourology and urodynamics"[ta] "Philadelphia"[ad]

Find the authors of papers, and then check if these doctors also have clinical practice.

Hope that answers your question.

[carld]

Thank you Kevin, I knew you would have some intelligent answers, between Webslave and You the knowledge and research you guys have done is amazing to me!!! Kudos to you both.

Your symptoms are the same as mine, I do not have any pain, except a few shots of pain in my perineum from time to time from spasms that I have felt and then the shooting pain after the spasm. I was wondering if you were able to see a neuro-urologist and what was found with your situation. I'm sure you have posted this, so forgive me if you repeat this? or you can PM me if you would like. Best regards, Carl...