- Detrusor instability
- An overactive bladder without neurologic impairment. (MCQ)
- External sphincter functions normally (MCQ)
- It may complicate multiple sclerosis or a stroke but in most cases, the cause is unknown.
- The symptoms are those of urge incontinence. (MCQ)
- Diagnosis can be made only on cystometry, spikes of increased intravesical pressure appearing without the specific instruction to void, and which cannot be inhibited. (MCQ)
- based on inhibiting the symptoms of urgency and increasing the interval between voids. (MCQ)
- Options include bladder training, biofeedback and hypnosis, and drugs. (MCQ)
- Surgery may also be considered either to interrupt the nervous pathways or to increase bladder capacity.
- A common approach is resection of the vesical plexus approached vaginally. (MCQ)
- Drugs with antimuscarinic activity e.g. oxybutinin, are used in the pharmacologic management of detrusor stability because they inhibit the cholinergically innervated unstable detrusor muscle contractions. (MCQ)
- oxybutynin – this drug also has a direct smooth-muscle relaxant action on the bladder in addition to its antimuscuranic action, is widely used in the management of detrusor instability.
- Oxybutin is however associated with a high incidence of side effects which limits its use.
- Modified release oxybutinin, propiverine and tolderodine may be considered as an alternative for patients unable to tolerate conventional-release oxybutinin (MCQ)
- propiverine, solifenacin and trospium are newer antimuscarinic drugs licensed for urinary frequency, urgency, and incontinence(MCQ)
- Neurogenic bladder
- Bladder can be Over or Underactive d/t in the presence of any neuological disorder
- Example – DM – Underactive Bladder d/t Peripheral Neuropathy
- Atonic neurogenic bladder (a sensory neurogenic bladder)
- neurogenic bladder due to destruction of sensory nerve fibers from the bladder to the spinal cord(MCQ)
- absence of control of bladder functions and of desire to urinate, bladder overdistention
- an abnormal amount of residual urine
- As the bladder fills, incontinence and dribbling occur, but no micturition reflex is initiated by the increase in pressure.
- usually associated with tabes dorsalis or pernicious anemia. (MCQ)
- Automatic bladder (A UMN bladder)
- neurogenic bladder due to complete transection of the spinal cord above the sacral segments(MCQ)
- loss of micturition reflexes and bladder sensation(MCQ)
- involuntary urination
- automatic is a hypertonic or spastic bladder….lesion at or above D12
- an abnormal amount of residual urine. (MCQ)
- Autonomic bladder (A LMN Bladder)
- neurogenic bladder due to a lesion in the sacral spinal cord
- interrupting the reflex arc controlling the bladder (MCQ)
- with loss of normal bladder sensation and reflexes
- inability to initiate urination normally (MCQ)
- incontinence. (MCQ)
- autonomic bladder….lower motor neuron at or below the level of S2…flaccid bladder
- Stress incontinence may be treated with surgical and nonsurgical means. (MCQ)
- Urge incontinence may be treated with behavioral modification or with bladder-relaxing agents. (MCQ)
- Mixed incontinence may require medications as well as surgery.
- Overflow incontinence may be treated with some type of catheter regimen. (MCQ)
- Functional incontinence may be resolved by treating the underlying cause (eg, urinary tract infection, constipation) or by simply changing a few medications.
Bladder Dysfunction and Management
Bladder Dysfunction in Multiple Sclerosis
Treatments, Compliance, Relapse and Bladder Issues with Multiple Sclerosis
Urinary incontinence and bladder dysfunction