Dr. Richard Bruno is Chairperson of the International Post-Polio Task Force and Director of The Post-Polio Institute and International Centre for Post-Polio Education and Research at Englewood (NJ) Hospital and Medical Center. His new book, The Polio Paradox: Uncovering the Hidden History of Polio to Understand and Treat "Post-Polio Syndrome" and Chronic Fatigue, will be published by Warner Books in June 2002. Please e-mail questions directly to him at ppsforum@newmobility.com.

Note: This column is for information purposes only and is not intended as a substitute for professional medical advice.

Q: I used to be like a camel, not having to use the bathroom all day. Now in my early 60s I sometimes have trouble making it to the bathroom. A few times I haven't. Are bladder problems due to PPS or are they just what happen to older women?

A: There are only a few studies of bladder problems in polio survivors. A 1949 study found that 2 percent of patients had retention--were unable to urinate--right after they had polio. But anecdotal reports from the 1940s indicated that 65 percent of patients in some epidemics couldn't empty their bladders. A 1988 survey found that 11 percent of 203 polio survivors remembered having retention during the polio attack. More of those who had "bulbar" polio and needed respirators had retention. However, retention was also reported to have occurred even if there was no muscle paralysis.

Bladder problems associated with bulbar damage and "non-paralytic" polio? This sounds like the work of our old friend the vagus nerve. The vagus activates muscles in the throat, esophagus, stomach and intestines. When damaged, it causes the newest post-polio problem: food not moving down the esophagus or through the gut (see PPS Forum, January 2001). The vagus nerve also travels past the gut, all the way down to the bladder, and is responsible for relaxing bladder muscles and allowing urine to flow out. So poliovirus-damage to the vagus nerve and its control center in the brain stem--the bulb of the brain--could very well have caused retention.

So it makes sense that a 1996 survey found that more polio survivors have bladder problems than those who didn't have polio: nearly twice as many women and six times the number of men. Male polio survivors had twice the difficulty women did passing urine, reporting problems reminiscent of those in acute polio patients--hesitancy, decreased force of stream and dribbling after urinating--although not one reported retention. These difficulties are not uncommon in older men and could result from a too-large prostate blocking the flow of urine. But the six-times greater frequency of urinary problems in male polio survivors may be caused by the combination of an oversized prostate and poliovirus-damage to the vagus revealing itself in mid-life.

On the other hand, women polio survivors had nearly five times more difficulty holding urine than did men, reporting urgency, incontinence with a full bladder, stress incontinence and urine leakage. You only have to see commercials for Depends to know that these symptoms are not uncommon in older women who didn't have polio. But again, the higher frequency of urinary problems in women polio survivors may be due to a combination of poliovirus-damage to the vagus nerve and normal--or possibly polio-enhanced--weakening of bladder muscles with aging.

One bladder problem is shared almost equally by a third of men and women polio survivors: nocturia--those frequent, sleep-disturbing nocturnal treks to the bathroom. A study of 584 polio survivors found that nocturia was related to poor sleep quality, daytime sleepiness and napping, as well as sleep apnea (see PPS Forum, May 2002).

Other than nocturia, most Post-Polio Institute patients don't report significant bladder problems. We have only two patients with retention who need to catheterize themselves. (Interestingly, both are women.) Since only a small percentage of our patients have other urinary problems, it can't be said that bladder problems are rampant in polio survivors. However, whether or not bladder problems are caused or made worse by having had polio, they can be treated as they would in those who didn't have polio. Anyone having urinary troubles should see a urologist. Men should have a yearly prostate exam and discuss whether a medication such as Flomax, which increases urine flow through the prostate--or rarely, prostate-opening surgery--would be helpful. For women, emptying the bladder frequently, non-fatiguing Kegel exercises to strengthen pelvic floor muscles and medications that control the activity of the vagus nerve, such as Detrol, are very helpful in preventing leakage. Nocturia is the easiest bladder problem to treat: Limit liquid intake at dinner and don't drink anything afterward.

POST-POLIO ALERT: A New Approach to SSDI Denials. Instead of appealing SSDI denials through the usual procedure, ask your congressperson to request an "administrative review" of your file by Social Security. In 2001 SSA admitted that their own procedure for determining disability in polio survivors is flawed and is in the process of being changed. Asking for a review of "administrative errors" may be more effective and expeditious than an appeal. For more information go to www.postpolioinfo.com.