Bladder retention problems take three forms: retention, incontinence and hyperactivity. Bladder retention can be an acute, one-time problem or a chronic issue. Urinary incontinence is classified as stress-incontinence, structural or neurogenic, and hyperactivity, commonly called overactive bladder can be mild or severe. The urologist is best equipped to manage bladder dysfunction sthough women commonly seek care from their gynecologists and some gynecologists hold a subspecialty in urology or urogenital surgery.
Acute Bladder Retention
Acute bladder retention occur when urinating fails to fully empty the bladder. It can happen after the birth of a baby due to bruising or swelling of the urethra.
Ten percent of acute cases take place when a medication blocks the voiding reflex; the nerve impulse that allows the muscle of the urinary sphincter to relax. These medications, according to pharmacology researchers writing in the May 2008 issue of "Drug Safety" include antipsychotic drugs, antidepressant agents, anticholinergic respiratory agents, opioids and anaesthetics, alpha-adrenoceptor agonists, benzodiazepines, NSAIDs, detrusor relaxants and calcium channel antagonists.
Acute bladder retention becomes increasingly uncomfortable over a few hours and is diagnosed by pressing on the lower abdomen when the bladder will be elevated, round and hard.
Chronic Bladder Retention
Chronic bladder retention is most commonly caused in men by benign prostatic hyperplasia, an enlargement of the prostate that grows increasingly common with age. In women, prolapse of the bladder or uterus can cause the bladder to lose muscle tone.
Neurologic problems, including multiple sclerosis, spinal cord injury, spinal tumors and Guillain-Barre Syndrome and other causes, are infections and inflammatory diseases, according to a review by Brian Selius, DO, and Rajesh Subedi, MD, from Northeastern Ohio University Medical School, in the April 2008 issue of the "Journal of the American Family Physician."
Incontinence
Incontinence is the inability to control the release of urine. It can be caused by infections, trauma during childbirth, prostatic enlargement, prostate surgery, and with increasing frequency, obesity.
Researchers from the University of California, San Francisco studied 338 obese women. In the Jan. 29, 209 issue of the New England Journal of Medicine they revealed that those who lost just 8 percent of their body weight experienced a 47 percent decrease in the frequency of urinary incontinence events.
Overactive Bladder
Overactive Bladder can lead to incontinence if not treated. One third of people older than age 65 with overactive bladder have urgency incontinence, according to John Lavelle, MD, of Standford University. In OAB the bladder signals an urgency to urinate more than eight times a day, and often at night during sleep. OAB can be caused by localized physical factors, such as damage to the bladder nerves from repeated infections or trauma during vaginal childbirth, or from central nervous system issues similar to fibromyalgia, which make the signal of bladder fullness more easily perceived by the brain. Anxiety, attention deficit hyperactivity disorder and depression have also been linked to OAB, according to urologist William Steers, MD, writing in the 2002 "Review of Urology." This may be because the decreased availability of the neurotransmitter, serotonin, affects emotions and brain activity, and the ability of the brain to filter out sensations from the body.
Because of embarrassment or perhaps because they don't know that effective treatments exist, many people wait for years before mentioning OAB symptoms to their doctors. But delaying treatment increases the risk of this condition progressing to incontinence.
References
- Pub Med: "Drug Safety"; Drug-induced Urinary Retention; Drug-induced Urinary Retention;K.M. Verhamme et al; May 2008
- "American Family Physician"; Urinary Retention in Adults; Brian Selius, D.O. and Rian Selius, M.D.; March 1, 2008
- "New England Journal of Medicine"; Weight loss to treat urinary incontinence in overweight and obese women; L.L. Subak, M.D. et al; January 2009
- Pub Med: National Association for Continence: Over Active Bladder
- Pub Med Central: "Review of Urology"; Pathophysiology of Overactive Bladder and Urge Urinary Incontinence; William Steers, M.D.; 2002 supplement
