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(cell phone 240-506-1556)

To: All veterans

Date: Jan 2015
Topic: Bladder Incontinence
Male and Female

Craig N. Bash, M.D.

Independent Veteran Medical Opinion (IMO)

Veteran Medical Nexus Opinion (VMNO)
Pages: 2

NPI or UPIN-1225123318- lic #--D43471

4938 Hampden lane, Bethesda, MD 20814
Phone: (301) 767-9525 Fax: (301) 365-2589

Bladder Incontinence
Bladder function is often thought to be automatic by most patients- until it does not work. The need to
void occurs several times a day and without normal function (inc9nitnce) patients are be very debilitated
form the psychological and physiologic loss of this normally automatic function. Patients can end up with
balder volumes of over 2 liters and/or the need to void 2 or more time an hour or with chronic infections.
The reasons for bladder dysfunction are numerous but basically they can be broken down into neurologic
and anatomic dysfunction (with over lap of the two) as follows;
Due to interruption in the neural circuits that have to control both detrussor function and urethra sphincter
activation in an alternating fashion. If the balder contracts against a tight sphincter no urine is released
and the bladder pressure increases and the kidney can be fatally damaged due to the reflux nephropathy
( AKA hydraulic pressure on the kidneys form the increase ladder pressure)
Common etiologies (nexus medical cause):
Male and female spinal cord injuries
Male and female Multiple sclerosis
Male and female neurologic disease
Male and female toxic/radiation effects to the bladder or nerves

Anatomic changes to the bladder urethra sphincter are pelvic floor can cause incontinence. In these
causes the bladder or sphincter normally floor is scared open or the pelvic floor structures do not provide
the needed support.
Common etiology (nexus medical cause):
Male female bladder surgery or sphincter surgery or pelvic floor surgery
Male prostate surgery
Female child birth
1. Since any bladder dysfunction is abnormal - all veterans should be fully evaluated with a urologist to
include veterans medical nexuses opinions for imaging, urologic and neurologic testing.
2. Bladder dysfunction often leads to kidney dysfunction this all of these patient should put in veteran
medical nexus opinions for secondary kidney dysfunction and should be tested for kidney dysfunction.
Since kidney dysfunction leads to other secondary dysfunction such as blood pressure control, chronic
infections and bone metabolism all secondary dysfunctions should be evaluated and added to the VA
benefits veterans.
3. Often these conditions are treated surgical or with catheters thus any secondary complications form
these treatment should be included in the veteran nexus medical opinions.
4. All veterans should make and keep all medical appointments because these are important for diagnosis
and veteran medical nexus opinions
5. All medical evidence should be forwarded to the VA well prior to any decisions.
6. All veteran should have high quality independent veteran medical opinions and veteran medical nexus
oninions examinations in their claims files prior to their decision because these cases often hinge on the
medical opinions and examinations,
Craig Bash M.D.
Associate Professor cell 240-506-1556

Independent Veteran Medical Opinion (IMO)

Veteran Medical Nexus Opinion (VMNO)
based on Veterans medical records