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Hello everyone. I'm a 36 year old male a bit overweight but generally okay in health I guess. Here is my situation. Please bear with my long winded story.

About a 2 months ago I started experiencing chronic urinary symptoms. I urinate and feel like my bladder isn't emptying. I met with my urologist who begun testing. He has currently ruled out Prostatitis and any type of infection via some of the preliminary testing that was done. They are now looking at my bladder. I had a uroflometry study done which revealed that I don't empty my bladder completely.

The pattern of the test appeared to rule out any "obstructions" but now I have to come in for urodynamic testing. I am currently being treated with flomax to help relax my bladder muscle which really isn't helping so of course more panicking.

I've done extensive reading on urodynamic testing and this is basically a test to see how the urinary muscles are working during filling and emptying of urine. Well it turns out this test typically reveals there is some underlying issue with the nervous system that can cause the bladder to over react or under react. Yes it can also detect some type of obstruction but I'm under the impression this has already been ruled out.

Well of course its a very short list. The primary causes of urogenic bladder are MS, Parkinsons, diabetes, spinal bifida or some type of spinal cord injury.

I am under the treament of a neurologist. Last year I had very bad headaches, dizziness, etc. A bunch of neurological tests were performed. These included MRI, EEG, EMG, Nerve Conduction Study and blood work. All tests were normal except for nerve conduction study which revealed I do have peripheral neuropathy. The cause was never really determined. I'm not diabetic

Anyway in panic I called my neurologist and asked if my neurological tests are still "good" after a year. She stated abosulutely and nothing would change in 1 years time. She stated you don't have any demyelinating disorders of the nervous system.

In my online MS research I found that MS can be missed in a brain MRI and can be detected in the spinal cord MRI. I asked my neurologist if my spinal cord was tested. She told me that the testing I had done did look at my spinal cord and it was normal.

Now I'm questioning my normal results from last year. I only recall brain MRI. Maybe that does see the column to some extent and the other tests, EEG, EMG would find something. I don't know.

Fast forward to the past 2 weeks. I'm now experiencing bouts of constipation (2 days of not going or very little and then not going). One one occassion I did start bleeding. I have had hemmorhoids in the past.


I did start going to the gym again and this might have helped a little with my constipation but I still dont' feel "regular" on that front. Urinary symptoms are pretty much the same. I feel like I have to go even when I'm done.

I'm actually freaking out that I have MS and this is how it will start for me. The nerves that control bladder and bowel function are all shared so now I'm convinced this is what I'm going to have to get ready for. My wife feels that maybe my weight gain has something to do with this.

If anyone has had similar experience or can share some advise I would greatly appreciate it. Of course the chronic headaches on the right side of my head have started up again.

Should I go back to my neurologist and insist on a new set of tests?

I do appreciate your time in reading this.

nickt76 wrote:The primary causes of urogenic bladder are MS, Parkinsons, diabetes, spinal bifida or some type of spinal cord injury.

So have you seen any kind of ortho since this started?

I don't know why you are doubting your neuro about the past MRIs, but new sx that might have a spinal cause probably deserve new MRIs, anyway. If you get an ortho to order them you'll get the physically oriented opinion first, and if that's inconclusive you should have your neuro look at them, too.

if your bladder muscle is spastic you could investigate your magnesium status. you may have to push for it b/c it isn't a status quo approach. if you can't get the test from the docs and you happen to be in the us, you can always consider life extension http://www.lef.org/Vitamins-Supplements ... -Test.html

most people have poor magnesium status to some degree, but because it's involved in so many different processes, the manifestations can vary widely from person to person.

serum magnesium is the test. you want your level to be up in the 0.95 to 1.1 mmol/L range, ie the very top of the normal range.

supplementing magnesium has to be done with care. there are plenty of useless products out there on the shelves. find some magnesium glycinate - one example (I use this one) http://www.iherb.com/Kirkman-Labs-Magne ... ules/43215

two particularly dense food sources of magnesium: spinach and swiss chard (white stems not red). eat lots, after 3 mins of boiling to reduce oxalic acid content. 1c serving of either provides roughly 150mg of magnesium.

magnesium is known to be low in ms patients, so if you want to take steps to not match the ms patient profile, optimizing serum magnesium could be a useful first step.

The effect of magnesium oral therapy on spasticity on a patient with multiple sclerosis
http://www.direct-ms.org/sites/default/ ... ticity.pdf
"we found a significant improvement in the spasticity after only 1 week from the onset of the treatment"

magnesium status also tends to be suboptimal in overweight people:

An inverse relationship between cumulating components of the metabolic syndrome and serum magnesium levels
http://www.nrjournal.com/article/S0271-5317(08%2900175-9/abstract
"Metabolic syndrome has been defined as the presence of abdominal obesity combined with 2 of the following factors: hypertension, dyslipidemia, and impaired glucose tolerance, or diabetes mellitus. Magnesium is an essential cofactor for more than 300 enzymes involved in carbohydrate and lipid metabolism. In this study, we enrolled 117 consecutive overweight and obese patients and we measured serum magnesium levels together with fasting serum glucose, high-density lipoprotein cholesterol, and triacylglycerols. A strong inverse relationship between magnesium levels in serum and the presence of metabolic syndrome was noticed. Moreover, magnesium levels decreased as the number of components of metabolic syndrome increased. Also, there is an inverse relationship between serum magnesium levels and high-sensitivity C-reactive protein. We concluded that decreased levels of serum magnesium are associated with increased risk for metabolic syndrome, perhaps by a low-grade inflammation process."

Oral Magnesium Supplementation Improves Insulin Sensitivity and Metabolic Control in Type 2 Diabetic Subjects
http://www.ncbi.nlm.nih.gov/pubmed/12663588
"At the end of the study, subjects who received magnesium supplementation showed significant higher serum magnesium concentration (0.74 0.10 vs. 0.65 0.07 mmol/l, P 0.02) and lower HOMA-IR index (3.8 1.1 vs. 5.0 1.3, P 0.005), fasting glucose levels (8.0 2.4 vs. 10.3 2.1 mmol/l, P 0.01), and HbA1c (8.0 2.4 vs. 10.1 3.3%, P 0.04) than control subjects." note in this study the subjects went from magnesium deficient to barely inside the bottom end of the normal range. not good enough!

by the way I also find I can take magnesium effectively for headache, although in research it is only showing up as effective for migraine, not regular headaches.

No it doesn't sound like MS. I would call the urologist back and ask what infections he tested for? Did he test for CPN (chlamydia pneumonia), Lyme, Mycoplasma Pn., bartonella or babesia? All of these are very hard to identify. Then I would make sure to get a copy of every test he did and the results. Then I would educate myself on the Lyme disease controversy and how the testing is only 30% effective. That means it misses 70%!!! I would find out which Lyme test he gave you? He probably didn't even test for it. I would educate myself on the two tier testing of elisa/western blot. Then I would find a better doctor, one who will prescribe antibiotics. Obviously, the first thing the urologist thought of was an infection...just because a test doesn't show it doesn't mean it's not there. Why even have doctors if all they do is read a test result? You and I can do that. Being a doctor is an art and test results should be used as another tool for diagnosis but shouldn't be the only factor. Initially he thinks infection, why doesn't he treat based on what he thinks? Absence of proof is not proof of absence. check out the antibiotic section of this site. My cousins MS which almost killed him turned out to be 6 infections. Find a LLMD.

nickt76 wrote:I'm a 36 year old male a bit overweight but generally okay in health I guess....

About a 2 months ago I started experiencing chronic urinary symptoms. I urinate and feel like my bladder isn't emptying. I met with my urologist who begun testing. He has currently ruled out Prostatitis and any type of infection via some of the preliminary testing that was done. They are now looking at my bladder. I had a uroflometry study done which revealed that I don't empty my bladder completely.

The pattern of the test appeared to rule out any "obstructions" but now I have to come in for urodynamic testing. I am currently being treated with flomax to help relax my bladder muscle which really isn't helping so of course more panicking.

I've done extensive reading on urodynamic testing and this is basically a test to see how the urinary muscles are working during filling and emptying of urine....

Fast forward to the past 2 weeks. I'm now experiencing bouts of constipation (2 days of not going or very little and then not going). One one occassion I did start bleeding. I have had hemmorhoids in the past.


I did start going to the gym again and this might have helped a little with my constipation but I still dont' feel "regular" on that front. Urinary symptoms are pretty much the same. I feel like I have to go even when I'm done.

...My wife feels that maybe my weight gain has something to do with this.

...

Should I go back to my neurologist and insist on a new set of tests?

Welcome to ThisIsMS, Nick.

We are a diverse group with many, unique opinions – mine centers around insulin.

I suggest you ask your GP for a "fasting blood insulin test" – NOT to be confused with a glucose test. The optimal outcome should be 3 UU/ML or lower. I suspect that yours are higher.

Here is my reasoning: insulin is necessary for weight gain – you describe yourself as "a bit overweight." Later you state, "My wife feels that maybe my weight gain has something to do with this." (Listen to your wife, I think she is right!)

Your initial symptoms concerned the bladder – the muscles involved in emptying the bladder are smooth muscles (the detrusor muscles and sphincter muscle). Excess insulin thickens and stiffens smooth muscles and would affect their function (losing muscle tone, i.e., getting too relaxed – perhaps the reason that Flomax isn't helping?).

You are "now experiencing bouts of constipation" – the muscles around the intestines which move things along are also smooth muscles and would also be affected by excess insulin.

Specialists only find and treat problems in their area of specialty – a neurologist will only find a problem in neurology. A GP or internist might be a better "disease detective" for you.

Thanks everyone for your advice. Just wanted to provide an update.

I had my neurology appointment and based on my bladder and constipation symptoms the neurologist stated that these are not conclusive to indicate MS. She performed a thorough neurological physical exam and said it was perfect. According to the neurologist if I had a spinal cord lesion which results in bladder and bowel issues ,something would have definitely presented itself during the physical exam and it didn't

According to my physical exam there were 0 indications of anything wrong. She advised me that I have an extreme amount of anxiety and advised I get some therapy which I wil. I was prescribed a small dose of zoloft and she told me to start taking a magnesium supplement.

She did feel bad and would love to do nothing more than give me an mri of my spine so I"m at ease, but it isn't warranted. I am getting sent however for an xray of my back because of my extensive lower back pain.

I continued to challenge what I've read regarding on the internet regarding urine retention, constipation and MS. She told me absolutely not from my symptoms. The types of urine retention associated with MS are typically those where you can't empty your bladder at all and the same goes for the constipation.

I guess I'm just going to have to deal with this until I get my urodynamic study done.

The neurologist said even if I do end up having a neurogenic bladder it will more than likely be overractive bladder which is not ms related despite what we read when googling these issues.

I trust my doctor a great deal but I really do still have doubts that something is still there. I did go through a bout of ALS fears last year as well.

Thoughts?

yes magnesium is highly effective against anxiety too.

if you can get a serum magnesium test and ensure HIGH normal levels as specified above, that would be really smart.

as for supplements, refer to the above for preferred form (glycinate) and an option for an online supplier.
(fyi I just used iherb to ship magnesium glycinate via DHL and it was quick. brought it into the UK and it was fine, just a small shipping charge and no import tax b/c the package value was low enough. took 2 business days.).

with magnesium, the supplemental form that you choose is extremely important. magnesium glycinate is way out in front compared to something like magnesium oxide which is a very common form. don't waste your money on a form with high elemental magnesium but poor solubility or absorption. (although.. you may as well get both kinds if you'd like to use the poorly absorbed one as a laxative. magnesium oxide at higher doses, ie say 600-800mg per day or so, should be VERY EFFECTIVE. plan for a day at home if you decide to experiment with that idea).

maximizing magnesium intakes from food is a great foundation, then see how many additional magnesium glycinate pills you can tolerate. for me, it's just one per day. any more and I start to notice mild weakness.
you can also soak up magnesium through your skin via an Epsom salts bath.

Looking back, my 1st "real" symptoms of MS were urinary frequency/urgency...my urologist questioned me about MS but I did not think anything about it. A year later, bladder issues again, was questioned again and once again did not follow up. Ended up with left sided numbness and weakness, thus leading to a MRI. MRI showed numerous lesions, so to Neuro I went and was diagnosed with MS. We all have the same disease, but no 2 of us have the same symptoms. Guess the point to all that is never ignore anything just because someone else who has MS doesn't have that. Most all my MS friends have or have had vision issues and no bladder issues, but I'm the bladder girl with no vision issues