Could urinary symptoms be an early sign of neurological disorders?

This study reviewed symptoms of urinary dysfunction as early predictors of neurological disorders.

Researchers concluded that an increased awareness of the signs and symptoms which require further neurological evaluation is needed.

Urinary symptoms may have various causes, including neurological disorders of the central nervous system. Some studies have suggested that urinary symptoms are often the first sign of an undiagnosed neurological condition. The aim of this study was to provide an overview of the relationship between urinary symptoms and neurological disorders. 

A number of neurological disorders were found to have urinary symptoms as an early feature. Parkinson’s disease is one of the most common age-related neurological disorders. About 57 to 83% of patients with Parkinson’s disease have been found to experience urinary incontinence. Among patients with normal pressure hydrocephalus (a treatable central nervous condition), about 90% of patients report symptoms of urge urinary incontinence. About 50 to 90% of patients with multiple sclerosis (MS; a progressive neurological condition caused by damaged nerve fibers) experience urinary incontinence. However, urinary symptoms in MS patients rarely occur early in the disease (only in about 2 to 12%).

The signs and symptoms that may indicate an underlying neurological condition in patients with urinary symptoms include:

·       abnormal changes in blood pressure

·       resting tremor (usually in hands, legs and jaw)

·       abnormal gait (abnormal posture when walking; such as shuffling or reduced arm swing) or poor movement coordination

·       abnormal speech or abnormal breathing sounds

·       muscle rigidity

·       memory or cognitive difficulties

Conditions of the spinal cord (including injury, inflammation and infection) also frequently affect bladder control. Urinary symptoms associated with conditions of the spinal cord often include incomplete emptying of the bladder, slow or dribbling urine stream, fainting after urination, urinary retention, urge and stress incontinence. The signs and symptoms that may indicate an underlying spinal cord condition in patients with urinary symptoms include:

·       abnormal changes in blood pressure

·       abnormal gait (abnormal posture when walking; such as shuffling or reduced arm swing) or poor movement coordination

·       numbness or sensory changes in the genital and rectal area

·       weakness of the leg muscles

·       fecal incontinence

·       retrograde ejaculation in men (dry orgasm)

Researchers concluded that, although rare, urinary symptoms may be an early sign of an underlying neurological condition. Patients and physicians should be aware of any additional signs and symptoms which may indicate the need for further neurological evaluation.

This study evaluated urinary symptoms among patients with neurological conditions, but did not properly assess the predictive value of urinary symptoms for such conditions.