Bladder Dysfunction

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      • 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)
        • Treatment
          • 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
      • Treatment
        • 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

Bladder Dysfunction

Treatments, Compliance, Relapse and Bladder Issues with Multiple Sclerosis

Urinary incontinence and bladder dysfunction