- Normally, filtered urine from the
kidneys is stored in a balloon-like muscular sac called the
bladder. It exits the body via a thin tube called the
urethra (a long, thin tube in the male; a short, thin tube
in the female).
- Conditions that block or make it difficult for the urine to leave the bladder, or weaken its muscular tone will result in the accumulation of the urine. Once the bladder is full, the urine simply overflows (unless the urine is completely blocked), and small amounts leak out without the person's being able to contain or hold it.
- Sensation that the bladder is never completely empty, even after urinating
- Urge to urinate, but unable to, or only a small amount of urine comes out at any one time.
- Dribbling small amounts of urine, even after emptying the bladder.
- May not be able to voluntarily stop urinating once you have started
- Decrease in the force of urination
- Pain or fullness where the bladder is located (below the navel)
- Frequent urination
- Nocturia -- Getting up more than 3-4 times at night to urinate.
- Social isolation, embarrassment, dependence on others, and Depression can occur, especially in the elderly.
- Obstruction of the urethra:
- Urethral strictures -- Urethra can be damaged, causing thick scars (strictures) to form. This may occur due to previous infection (such as Gonorrhea or Urinary Tract Infection) or previous surgeries.
- Urinary tumors -- tumors can arise within the bladder or urethra.
- Urinary stones -- bladder or Kidney Stones can get stuck at the junction of the urinary bladder and the urethra; or in the urethra.
- In males: Enlarged Prostate gland (which surrounds the male urethra)
- In males: Prostate Cancer or other prostate masses
- In females: ovarian tumors; or benign tumors or the uterus (fibroids)
- Medical history and a general physical exam is the first step in the process.
- The history of symptoms, medications, illnesses, infections, surgeries, habits, and a family history are also important.
- A general examination of the entire body is necessary for a proper diagnosis.
- The physician may need to perform a rectal examination in which the gloved index finger is lubricated with a gel, and inserted into the rectum. The prostate is then examined for size and tumors.
- In female patients, a pelvic exam may also be done where 2 fingers of one gloved hand are inserted inside the vagina, while the other hand feels the lower abdomen for tumors or cysts.
- The rectal and pelvic exams are slightly uncomfortable, but not painful.
- A continence calculator is a series of questionnaires that help the doctor to distinguish between various types of incontinence.
- A voiding diary is 24-hour record of urination, and is often helpful with diagnosis.
- The blood may be tested for diabetes (and for prostate disease with a special prostate test called PSA).
- PSA is a chemical in the prostate that, when found in the blood, may indicate prostate enlargement or cancer.
- Blood may be tested for kidney function and Electrolytes.
- Urine samples may be sent for analysis if bleeding (Hematuria) or an infection is suspected.
- Special tests are done to further study bladder function and investigate the cause. These tests are done by a urologist.
- Trans Rectal Ultrasound -- uses a small camera (size of a hot dog) that is inserted in the rectum, and generates sound to measure the size, and assess the structure of the prostate.
- Cystoscopy uses a pen like camera to give the urologist a direct view of the urethra and the bladder.
- Urodynamics are used to measure pressure in the bladder, and evaluate the flow of the urine.
- Cystometry is used to test the bladder muscle's squeezing power, as well as the ability to hold urine.
- Uroflometry is a test in which the patient drinks water until the bladder is full while sitting in a special chair (void chair). The patient is then asked to cough, and the volume of the urine that comes out is measured and subtracted from the volume of the urine remaining in the bladder. The remaining urine is measured by regular Ultrasound, or a
plastic tube is inserted into the bladder via the urethra. This is called urinary catheterization.
- Pressure Flow studies are done by placing a pressure sensor (wire) into the bladder and recording its function and capacity.
- An Electromyography or
EMG is beneficial if nerve damage is suspected. A sensor is placed inside the urethra or the bladder via a catheter, and the electrical activity of the muscles is recorded.
- Age greater than 60
- Drugs and medications
- Sexually transmitted diseases
- Spinal cord injury
- Timed voiding refers to the times when the patient records urination patterns (leakage, urination) on a special chart reviewed by the physician. The doctor then finds patterns in the chart, and the patient uses this timetable to empty the bladder before leakage can occur.
- Bladder training refers to the times when the patient tries to control and resist the urge to urinate.
- The urination is done according to a timetable (i.e., every hour, etc.). Special muscle contraction exercises called Kegel exercises (hold-release-urinate) strengthen weak muscles around the bladder.
- If the prostate is enlarged (BPH), medications such as Hytrin may be prescribed.
- If medications are not helpful, then surgery may in fact be needed.
- Strictures are also corrected with surgery.
- The distended bladder may need to be emptied with frequent timed catheter insertions by the patient to empty the urine.
- Devices such as urethral inserts (small tubes) can be placed to keep the urethra open.
- Medications such as Ditropan may help in certain cases such as in diabetes cystopathy.
- Avoid an excess of coffee and alcohol.
- Ask your doctor if diuretics such as Lasix can be stopped
- Drink plenty of fluids, but only small amounts at a time
- Control your glucose if you have diabetes.
- Contact your doctor and remember -- there are plenty of therapies that work.
- Men: make sure you get yearly prostate exams, starting at age 40. Women: make sure you follow your physician's schedule of regular pelvic exams for you.
- Diabetes -- nerves, damaged by
long-term uncontrolled diabetes, cause bladder weakness
- Spinal cord trauma
- Drugs, narcotics, alcohol, anticholinergics, (atropine, Bentyl) and some
- Other types of
- When urine leaks with coughing, physical activity, or any other like forms of stress that may occur
- The inability to hold urine, as seen with the use of diuretic medications such as Lasix or after menopause.
- Neurogenic, as in Parkinson's and diabetes
- Post prostatectomy -- after the
prostate is removed
- Prostate Infection or Prostatitis
- Bladder neck abnormalities that are sometimes present at birth
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