Dear Dr. Roach: I am 71, and about two weeks ago I came down with shingles in my right lower back, and it also affected my bladder. My doctor put me on Valtrex, which I have now finished, and my bladder function is gradually returning. My questions:
1. Are there any long-term problems with shingles that affect the bladder function, and if so, what should I watch for?
2. The doctor said that when I am over this, I need to get the shingles vaccine. Does this mean once you have had shingles, the possibility of them returning is more than if you never had them? I have a sensitivity (was told it was an allergy years ago) to eggs and have never received the flu, shingles or pneumonia vaccines, and I’m concerned about this.
S.T.
Shingles is caused by the reactivation of the chickenpox virus. Most people get shingles decades after having chickenpox, and when it occurs, it occurs on one side of the body, in one specific area of the body. When it affects the lower back, shingles can rarely affect the bladder. If that’s the case, it can cause several different problems. First, the bladder itself can have the same kind of blister seen on the skin, and these can bleed. Second, shingles can damage the nerve to the bladder, preventing the bladder from emptying properly. This may require a temporary bladder drainage tube. Third, shingles can stimulate the muscle controlling the bladder, causing urgency and even incontinence. Usually, things go back to normal, but nerve damage always has the possibility of residual effects.
As I’ve said before, everyone over 60 should get the shingles vaccine — even if they have had shingles before. Having shingles in the past provides some protection against future shingles, but the protection isn’t perfect, which is why it’s recommended to get the vaccine.
Although a severe egg allergy prevents you from getting the flu vaccine, the pneumonia and shingles vaccines do not contain egg components and are safe for people with egg allergies. No booster shot is recommended if you have already had the shingles vaccine.
Dear Dr. Roach: I had a total knee replacement done 15 months ago and was given hydrocodone/acetaminophen 5-325 for pain. I had to go to the emergency room after being on it for a little over two weeks to get my bladder drained, because I could not urinate. Two days ago I fell and went to an urgent-care facility, where they said I had broken ribs and was given the above-mentioned medication. Is there a chance of my bladder doing the same thing again?
G.K.
Urinary retention is when the bladder is unable to fully empty. Several different classes of medications — including opiates, such as the hydrocodone in the combination tablet you describe — can cause urinary retention. Given that it happened to you before, I would say there definitely is a chance that the same drug would do the same thing. I would avoid using hydrocodone. In my experience, anti-inflammatories such as ibuprofen are as effective or more so than opiates for the pain of broken ribs.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or write him at P.O. Box 536475, Orlando, FL 32853-6475.
