Summary about Disease
Underactive bladder (UAB) is a condition where the bladder muscle doesn't contract with enough force or for a sufficient duration to fully empty the bladder. This can lead to urinary retention, incomplete bladder emptying, and various lower urinary tract symptoms. It's essentially the opposite of overactive bladder.
Symptoms
Weak or slow urinary stream
Difficulty starting urination (hesitancy)
Straining to urinate
Feeling that the bladder is not completely empty after urination
Frequent urination (urgency)
Nocturia (frequent urination at night)
Urinary retention (inability to empty the bladder)
Urinary incontinence (overflow incontinence, due to a full bladder)
Abdominal discomfort or pressure
Causes
Neurological conditions: Stroke, Parkinson's disease, multiple sclerosis, spinal cord injuries, diabetic neuropathy can damage nerves controlling the bladder.
Medications: Certain medications (anticholinergics, antihistamines, opioids) can interfere with bladder contractions.
Bladder muscle weakness: Age-related changes, chronic bladder overdistension, or prolonged catheter use can weaken the bladder muscle.
Obstruction: Blockages in the urethra (e.g., enlarged prostate in men, urethral strictures) can prevent proper bladder emptying, leading to muscle weakness over time.
Diabetes: Can damage nerves that control bladder function.
Surgery: Pelvic surgery may damage the nerves that control bladder function.
Idiopathic: In some cases, the cause is unknown.
Medicine Used
Bethanechol: A cholinergic medication that can stimulate bladder muscle contractions (although its effectiveness is debated and use is limited due to side effects).
Alpha-blockers: Can help relax the muscles in the prostate and bladder neck in men with prostate enlargement contributing to UAB.
Intermittent catheterization: Regular self-catheterization to empty the bladder completely if the bladder cannot empty on its own.
Medications to manage complications: Antibiotics for urinary tract infections, medications for constipation if that is contributing to the problem.
Is Communicable
No, underactive bladder is not a communicable disease. It is not caused by an infectious agent and cannot be transmitted from person to person.
Precautions
Manage underlying conditions: Control diabetes, manage neurological conditions under medical supervision.
Medication review: Discuss all medications with your doctor to identify potential contributors to UAB.
Regular bladder emptying: Try to urinate at regular intervals, even if you don't feel the urge.
Pelvic floor exercises: Can help strengthen pelvic floor muscles.
Avoid bladder irritants: Caffeine and alcohol.
Adequate fluid intake: Maintain appropriate hydration.
Prompt treatment of UTIs: Urinary tract infections can worsen UAB symptoms.
Monitor urinary symptoms: Report any changes in urinary habits to your doctor.
How long does an outbreak last?
Underactive bladder is not an "outbreak." It's a chronic condition. Symptoms can fluctuate in severity, but the underlying problem persists unless the cause is treated, managed, or compensated for (e.g., with intermittent catheterization).
How is it diagnosed?
Medical history and physical exam: Discussion of symptoms, medications, and relevant medical history.
Post-void residual (PVR) measurement: Ultrasound or catheterization to measure the amount of urine remaining in the bladder after urination. A high PVR suggests incomplete bladder emptying.
Urine tests: Urinalysis to check for infection or other abnormalities.
Urodynamic testing: A series of tests to evaluate bladder function, including bladder capacity, bladder pressure during filling and emptying, and urine flow rate.
Cystoscopy: Examination of the bladder lining with a small camera.
Neurological evaluation: If a neurological cause is suspected.
Timeline of Symptoms
The onset and progression of symptoms can vary widely depending on the cause.
Gradual onset: Common with age-related changes, diabetic neuropathy, or slowly progressing neurological conditions. Symptoms may develop over months or years.
Sudden onset: May occur after a stroke, spinal cord injury, or as a side effect of medication.
Fluctuating symptoms: Some individuals may experience periods of worsening symptoms followed by periods of relative stability.
Important Considerations
Differential diagnosis: It's crucial to differentiate UAB from other conditions with similar symptoms, such as bladder outlet obstruction, overactive bladder (OAB) with impaired contractility, and urinary tract infections.
Individualized treatment: Management should be tailored to the underlying cause and the severity of symptoms.
Impact on quality of life: UAB can significantly affect quality of life, leading to social isolation, anxiety, and depression. Addressing these issues is an important part of management.
Potential complications: Untreated UAB can lead to urinary retention, urinary tract infections, bladder stones, and kidney damage.
Importance of specialist referral: A urologist or urogynecologist can provide specialized evaluation and management.