- Normally filtered urine from the kidneys is stored in a balloon like muscular sac called the bladder. It exits the body via a long, thin tube called a Urethra.
- 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, and small amounts leak out without the person being able to contain or hold it.
- Obstruction of the Urethra:
- Enlarged Prostate
gland -- The Prostate gland is only present in males, and surrounds the urethra.
- Prostate Cancer or tumors
- Urethral strictures -- Urethra can be damaged, causing thick scars (strictures) to form. This may occur due to previous infections, such as with Gonorrhea or previous surgeries.
- Urinary tumors -- tumors can arise within the bladder or urethra.
- Urinary stones -- bladder or kidney stone can get stuck at the opening of or in the urethra.
- Ovarian tumors or tumors called fibroids in females
- 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 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 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 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 functions 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 an 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, assessing 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's muscle 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). They are 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 a urinary catheter.
- 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 are recorded.
- Age greater than 60
- Drugs and medications
- Sexually transmitted diseases
- Spinal cord injury
- 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 time.
- Dribbling small amounts of urine even after using the bathroom.
- May not be able to voluntarily stop urinating once you have started
- Decrease the force of urination
- Pain or fullness below the belly button where the bladder is located
- Frequent urination
- Nocturia -- Getting up more than 3-4 times at night to urinate.
- Social isolation, embarrassment, dependence, and Depression can occur,
especially in the elderly.
- Time 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 (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.
If you have this condition
- Contact your doctor and remember -- there are plenty of therapies that work.
- Get yearly prostate exams after 40, and for females, make sure your keep up your pelvic exams.
- Diabetes -- nerves damaged by long-term uncontrolled diabetes causes bladder weakness (cystopathy).
- Spinal cord trauma
- Drugs, narcotics, alcohol, anticholinergics, (Atropine, Bentyl) and some anti depressants
- Other types of incontinence:
- 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 present at birth
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