Why do people with CRPS and Chronic Pain so Frequently Suffer Bowel and Bladder Problems?
It’s something that nobody likes to talk about, but suffering chronic pain very often goes hand in hand with gastrointestinal and/or urinary problems.
For people with CRPS the statistics are stark, with in excess of 90% of sufferers reporting a variety of ongoing gastric issues including constipation, diarrhoea, gastroesophageal reflux disease (GERD), dysphagia and even faecal incontinence.
Urinary problems are also reported frequently by people suffering chronic pain. Urinary voiding dysfunction can cause urgency and even urinary incontinence. Around 25% of people suffering CRPS report urinary problems.
On top of already disabling chronic pain, gastrointestinal and urinary issues can result in a person’s outlook on the world becoming very limited indeed.
What is the cause?
Given the frequency with which these problems occur in tandem with chronic pain, it is surprising that there is so little research on a possible relationship between the two. However, it is thought that there may be a number of causes, often interacting with or exacerbating each other.
One factor that is likely playing a role is medication. Constipation is one of the most widely experienced side effects of taking opioid-based medications of which a number, for example Tramadol, Fentanyl, Oramorph and Codeine, are commonly taken by people suffering chronic pain. We have come across a number of cases among clients prescribed opioid-based medication where constant straining has ultimately led to permanent physical damage of rectal nerves and muscles, resulting in faecal incontinence.
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However, it’s not just opioids that can be problematic. Many people suffering chronic pain are prescribed antidepressants such as Venlafaxine and Sertraline. In themselves they can cause gastro-type side effects, but in conjunction with an opioid, those side effects can be heightened. This is just one of the problems of living life as a pharmacological cocktail shaker!
It’s well known that psychological changes, including anxiety and depression, can be associated with a change in bowel function, in particular the onset of irritable bowel syndrome (IBS), of which faecal urgency is a symptom.
Such factors can also play a role in urinary symptoms such as urgency and an increased need to urinate both at night time (nocturia) and during the day.
The symptoms of CRPS rarely occur in isolation. More commonly sufferers end up with a diversity of symptoms. This is almost certainly because CRPS affects the various systems within the body which are part of the sympathetic nervous system (SNS). The SNS is part of the autonomic nervous system (ANS) which is responsible for unconsciously regulating bodily functions including bowel and bladder function. There is no proven link, but it is possible that there is a direct relationship via the autonomic system between CRPS and bowel and bladder dysfunction.
In her excellent article, “CRPS and Thyroid Problems”, Libby Parfitt highlights the fact that around one third of people suffering CRPS also have an underactive thyroid, a condition known as hypothyroidism. Currently, the reason for this is not understood.
Symptoms of hypothyroidism can include anxiety and depression and from that perspective we come back to the psychological factors discussed above. However, constipation is in itself a common symptom of hypothyroidism and whilst there is not currently an established link, it is not uncommon for people with hypothyroidism to also report urinary issues.
A lawyer’s perspective
For people suffering chronic pain conditions who find themselves in litigation, their lawyer must be alert to the possibility of gastro and urinary symptoms. At the very least they should ask their client the right questions.
Depending on the nature of those symptoms, it may be necessary to obtain expert evidence from a colorectal surgeon and/or a urologist. Not only is this crucial to establishing the likely cause of those symptoms (ie the direct or indirect link to the primary pain condition), but specific treatment options must to be considered.
Ultimately, if a claimant is likely to have longstanding problems then the associated financial costs (eg clothing, laundry, absorbent pads, bed mats) need to be factored into the claim.
Currently there is no specific test that can confirm CRPS. Its diagnosis is based on a person’s medical history, and signs and symptoms that match the definition. Since other conditions can cause similar symptoms, careful examination is important. As most people improve gradually over time, the diagnosis may be more difficult later in the course of the disorder.