09 Spinal Cord Intoxication by Encephalins

This is really complicated!

What seems to be the case is that the abnormal sphincter EMG activity (cause remains unknown) probably causes an effect in the spinal cord which is brought about by the effect of naturally occurring opiates – the body’s endorphins or enkephalins. Endorphins are known to be important neural signally molecules in the nervous system and have been known to play a part in bladder control for many years (Murray and Feneley 1982). I now hypothesise that Fowler’s syndrome is the result of spinal cord intoxication by enkephalins.  These have the effect of suppressing sensations from the bladder and stopping the bladder contract. In fact the bladder of a woman with Fowler’s syndrome is very like that of someone who has developed urinary retention as a result of taking opiates.

So against that background problem a women is given a prescription for an opiate pain killer and she goes into complete urinary retention. Sometimes bladder function comes back when she stops the opiates – but sometimes it does not. It is difficult to understand how something such as surgery or taking a pain killer can result in urinary retention which does not then go away when the opiate is stopped. More research is needed to find out why this should be and if taking some sort of opiate blocker helps the situation.

Figure (A) & (B)

Figure (A) shows what happens back in the spinal cord when you squeeze your sphincter and pelvic floor if you feel you might be going to leak. Impulses which come from the sphincter have an inhibitory effect on impulses coming from (bladder afferents) and impulses going to (bladder efferents) in the spinal cord.

Figure (B) shows how in Fowler’s Syndrome those inhibitory effects are chronically switched on and overactive, so that no sensation reaches consciousness and the bladder does not contract.

Figure (C)

The chemical messenger in the spinal cord which produces the normal inhibitory effect in health, as seen in Figure (A) and excessively in Fowler’s Syndrome as in Figure (B), may well be an encephalin, a naturally occurring opiate like compound.

If a girl with FS’s takes on opiate this appears to make the abnormality worse, either causing retention in someone who could previously manage to pass urine or making existing retention worse.