Urinary Incontinence and Voiding Difficulty in a Young Woman

Abstract

A 22-year-old girl visited the urology outpatient clinic with chief complaints of urinary frequency, difficulty in urination, and urge incontinence. Her history revealed that she had experienced acute onset of four-limb/trunk numbness with hiccup, severe swallowing difficulty, hoarseness, and bilateral facial weakness 6 months previously. Magnetic resonance imaging revealed focal edema in the lower dorsal medulla oblongata and a long segment of edema from the lower brain stem to the upper thoracic spinal cord. Difficulty in urination and constipation were associated with the overactive bladder symptoms. She received endotracheal tube with ventilator support because of respiratory failure. The symptoms improved 3 weeks later with neurologic sequelae of mild numbness in the distal fingers after medication and rehabilitation therapy. She recovered to be able to walk slowly without assistance and needed intermittent urinary catheterization twice a day with residual urine amount of 160–180 mL. Multiple sclerosis (MS) was diagnosed by neurologists.