Patients would often have decreased bladder sensation, and impaired bladder contractility during voiding combined with a large residual volume left in the bladder after a void. Urodynamics is very useful in diagnosing the underactive bladder. Otherwise, an ultrasound of the urinary tract can be done to measure the prostate volume (in men) and look for kidney abnormalities. The bladder volume can sometimes be measured at more than 1L. In some patients with no bladder symptoms, an ultrasound or CT study done for other reasons is often what incidentally showed the enlarged bladder. A urodynamics test would be needed for that. However, the causes of the weak stream cannot be differentiated (obstruction vs impaired bladder contractility) from a simple flow rate test itself. Measurements of urinary flow rate and post-void bladder scan often show a weak stream with a large volume of urine left in the bladder after a void. The ratio of spontaneously voided urine volume to the residual volume gives an idea of how well the bladder can contract. If combined with intermittent self-catheterization (see below) after a voluntary void, it can measure how much residual volume is left in the bladder. What are the investigations? Bladder diaryĪ bladder diary is very useful in determining how much urine can be passed spontaneously and how frequently voiding occurs. More uncommonly, the urine in the bladder can build up enough pressure such as to cause reflux up the ureters (tubes that join the kidneys to the bladder), and cause kidney damage. These stones can harbour bacteria, promote infections and can cause symptoms like poor, interrupted urinary flow, urinary frequency and blood in the urine. Sediments can also accumulate in the urine and form bladder stones. This infection can be recurrent unless a way to drain the bladder is instituted. The urine that gets left behind in the bladder can act as a source of urinary tract infection. What complications can arise from an underactive bladder? In these patients, they may have less urge to urinate and can go for hours before doing so. When full, a normal bladder would send signals to the brain, but if the bladder has also lost some sensation, these signals are not sent and hence, the leakage would occur with no warning. This type of leakage often occurs all throughout the day with the patient being unaware. Overflow incontinenceīecause the patient does not fully empty the bladder, it does not take long for the bladder to fill up again and cause ‘overflow’ incontinence. There is often a sense of incomplete bladder emptying and patients would revisit the toilet soon after leaving it. Urination happens in small dribbles and takes a long time to complete. Patients have to sit and bear down, lean forward, strain or press on the lower abdomen to help empty the bladder. It is difficult to start a stream and often this would take many minutes. Patients usually complain of difficulty passing urine at all phases of voiding. Examples of such conditions are diabetes, multiple sclerosis, radiotherapy, pelvic surgery or spinal cord injury (lower levels). If these nerves are damaged, the bladder cannot sense and contract properly. They are responsible for transmitting bladder sensation to the brain and also coordinating bladder contraction during voiding. Peripheral nerves coming from the lower spinal cord supply the bladder. Some causes of bladder obstruction include prostatic enlargement in men and urethral meatal stenosis (scarring of the opening of the tube draining the bladder), which can also occur in post-menopausal women. What causes it? Chronic obstructionĪ bladder that has been obstructed for many years, can overstretch and become a ‘baggy’ pouch such that its muscle layer has also become stretched and weakened. The medical terms hypotonic and atonic bladder denote a bladder that has lost that contractility partially and fully respectively. An underactive bladder is one that has lost its ability to fully contract and empty itself after voiding.
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