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Since the body does not manufacture it, the only way to get it is through diet and/or supplementation

Perioperative implications were evaluated with emphasis on orthopaedic surgical risk domains relevant to total joint arthroplasty (TJA), including wound complications, hematoma formation, immune modulation, infection susceptibility, heterotopic ossification, and implant fixation considerations

Development of auto-antibodies Some cobalamin preparations in rare cases can stimulate an allergenic response where there is development of antibodies to the cobalmin injected

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Spinal stenosis can also cause problems with control of the bladder and bowels