Anti-spasmodics such as oxybutynin chloride (Ditropan™) or propantheline bromide may be prescribed to control the spasms. Anti-depressants may help prevent involuntary loss of urine. In more severe cases, intermittent catheterisation may have to be performed. Sometimes a fixed catheterisation device is more desirable.

Bowel dysfunction—Bowel problems are more common and more serious in patients with a progressive sacral nerve root syndrome. Problems begin with loss of function of the sphincter muscle. Constipation is common and there may be problems with constipation for years before the painful spasms begin. Spasms occur in the lower part of the abdomen, they may also occur higher up in the intestine. In the final stage of bowel dysfunction, there is an inability to have a bowel movement. (impaction). Problems may progress until there is complete loss of feeling in the rectum. When impaction and loss of feeling occurs, patients must begin a bowel maintenance program.

Frequently, drinking a glass of prune juice at bedtime will result in successful elimination of the feces. It is also important to drink several glasses of water and other non-carbonated drinks. In more difficult cases, the patient may need to wear a latex glove to manually remove the feces. (Contact your physician or BPAA before doing this. Improper procedures can damage the rectum.) Laxatives such as DulcolaxÒ or glycerine suppositories may be needed. Water enemas should not be used on a daily basis and only in rare instances when feces cannot be removed. Bowel dysfunction can be critical in some cases. The spasms can last hours at a time and they can become severe enough to cause extreme weight loss. Severe spasms can cause nausea and vomiting and a feeling of intense warmth. It is important to cool the head and body with cool cloths. If the spasms persist, emergency care may be required. (15).

Sexual dysfunction—Pain in the back and legs may make it difficult to engage in sex. Pain in the vagina or testicles may also interfere with sexual function. The inability to maintain an erection is common in men with clinically significant arachnoiditis. There are now many devices, procedures and medications prescribed for impotence that may make sexual relations possible. A urologist who specializes in neurogenic bladder problems should be able to help or refer you to someone who can.

*Hypersensitivity of the skin and muscles—Skin and muscles may be extremely sensitive to touch. Beginning a program of gentle massage may help to relax the muscles. Anti-depressants may help both the muscle spasms and skin sensitivity. Relaxation techniques and self-hypnotism may be beneficial as well.

Spasticity—Loss of muscle control (jerking and uncontrollable movements) in the legs and arms usually occur in the later stages of the disease. Some patients may require anti-spasmodic medications such as Baclofen.

Allergy to shellfish and iodized products and substances—Retained iophendylate contains iodine. Some people experience problems after eating shellfish, iodized salt, or products containing a large amount of iodized salt (listed as sodium in the ingredients). Symptoms may include diarrhea, vomiting, headaches and sometimes fever.

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