Underactive bladder

Bladder Cancer

Underactive Bladder (UAB) is a clinical condition characterized by a reduction in the sensation of bladder fullness, decreased bladder contractility, or a combination of both, leading to incomplete bladder emptying or difficulty in bladder voiding. This condition is also known by other terms such as detrusor underactivity or impaired detrusor contractility. It is a significant health issue that affects the quality of life of individuals, predominantly the elderly population.

Etiology

The causes of Underactive Bladder are multifactorial and can be broadly classified into neurogenic, myogenic, and idiopathic origins.

• Neurogenic causes involve neurological disorders that impair the nerve signals responsible for bladder contraction. Conditions such as Spinal Cord Injury, Multiple Sclerosis, and Diabetes Mellitus can lead to UAB due to their impact on the nervous system.
• Myogenic causes refer to issues within the bladder muscle (detrusor muscle) itself, which may result from chronic bladder overdistension, aging, or bladder outlet obstruction.
• Idiopathic causes are those in which the exact cause of underactivity cannot be determined.

Symptoms

Symptoms of Underactive Bladder include a slow urinary stream, difficulty initiating urination, a feeling of incomplete bladder emptying, and the need to strain to urinate. In severe cases, it can lead to urinary retention, which is the inability to urinate despite having a full bladder.

Diagnosis

Diagnosis of Underactive Bladder involves a combination of patient history, physical examination, and diagnostic tests. Key diagnostic tools include:

• Urodynamic Testing: This is the most definitive test for diagnosing UAB, assessing the bladder's ability to empty efficiently.
• Postvoid Residual (PVR) Measurement: Measures the amount of urine left in the bladder after urination, with higher volumes indicating a potential underactive bladder.
• Urinary Flow Rate: A test to measure the speed of urination, which can be reduced in UAB.

Treatment

Treatment of Underactive Bladder is challenging and often focuses on managing symptoms rather than curing the condition. Options include:

• Catheterization: Intermittent or indwelling catheterization can be used to manage urinary retention.
• Medications: Certain drugs can help improve bladder contraction, although their effectiveness is limited.
• Neuromodulation: Techniques such as sacral neuromodulation can help stimulate bladder nerves, improving symptoms in some patients.

Prognosis

The prognosis for individuals with Underactive Bladder varies depending on the underlying cause and the effectiveness of management strategies. While some individuals may experience improvement in symptoms, others may require ongoing interventions to manage their condition.

Epidemiology

Underactive Bladder is more common in the elderly, with both men and women affected. The prevalence of the condition increases with age, but accurate epidemiological data are limited due to variations in diagnostic criteria and reporting.

Conclusion

Underactive Bladder is a complex condition that requires a multidisciplinary approach for management. Early diagnosis and tailored treatment plans are essential for improving patient outcomes and quality of life.