Unintentional urine leakage (incontinence), a sudden urge to urinate or difficulty emptying the bladder are most commonly caused by urological, gynaecological, neurological or hormonal factors. However, in rarer cases, infection-related nervous system involvement may also play a role.
Bartonella infection can primarily affect the nervous system as well: neuropathy, autonomic nervous system disorders, numbness, burning sensations, cardiac arrhythmia, circulatory complaints or autonomic symptoms may also occur. In theory, if the infection affects the autonomic nervous system or the nerve pathways regulating bladder function, it may lead to a strong urge to urinate, frequent urination or even urinary incontinence. However, this is not considered a typical or diagnostic symptom in itself.
Complaints similar to those of a neurogenic bladder have been described in Lyme disease and co-infections (including Bartonella), particularly when the central or peripheral nervous system is also affected. In such cases, the underlying cause may be neuritis, spinal cord involvement or autonomic dysfunction.
Viral infections may also cause temporary or persistent bladder dysfunction in certain cases:
-Herpes viruses (HSV, VZV): neuritis, sacral radiculitis, difficulty urinating or incontinence
-Epstein–Barr virus (EBV) or Cytomegalovirus (CMV): rarely with neurological complications
-Enteroviruses or other neurotropic viruses
-COVID-19 / Long COVID: autonomic nervous system abnormalities, POTS, increased bladder sensitivity, urge to urinate
However, urinary leakage is much more commonly linked to other causes, such as:
-urinary tract infection or irritation,
-pelvic floor weakness,
-oestrogen deficiency / the menopause,
-enlarged prostate,
-spinal problems (herniated disc, spinal stenosis),
-multiple sclerosis or other neurological conditions,
-diabetic neuropathy.
When is further investigation warranted?
It is advisable to request neurological and urological investigations if, in addition to urinary dribbling, the following symptoms are present:
– numbness in the legs or sensory disturbances in the perineal region,
– lower back or sacral pain,
-bowel dysfunction,
-new-onset urinary incontinence or significant retention,
-other autonomic symptoms (rapid pulse, fluctuating blood pressure, digestive disturbances).
If Lyme/Bartonella or other infectious causes are suspected, the investigation is always comprehensive: clinical symptoms, neurological status, laboratory tests and, if necessary, imaging must be assessed together.
(C) Lyme Borreliosis Foundation
