The Underactive Bladder is a symptom complex suggestive of detrusor underactivity and is usually characterized by prolonged urination time with or without a sensation of incomplete bladder emptying, usually with hesitancy, reduced sensation on filling, and a slow stream.
Underactive Bladder Syndrome is a chronic, complex and debilitating disease which affects the urinary bladder with serious consequences. Patients with an underactive bladder can hold unusually large amounts of urine but has a diminished sense of when the bladder is full and is not able to contract the muscles sufficiently and as forcefully as it should, resulting in incomplete bladder emptying.
The symptoms and severity of underactive bladder vary from one person to another and the course of the disease is often unpredictable.
Today, there is no way to prevent underactive bladder and there is no silver bullet. Treatments are available for some, but not all of the most serious complications of the disease. Current treatments include medications such as Bethanechol, Doxazosin, and Finasteride. Presently, most treatments focus on techniques to promote and assist bladder emptying such as intermittent self-catheterization and indwelling catheters. These techniques act to slow the progression of the disease and limit damage rather than truly arresting the disease. In addition, some of the drugs currently in use can have serious side effects. There is much work that remains to be done.
Despite the number of people affected by underactive bladder and the devastating effect the disease can have, bladder research remains critically underfunded by the National Institutes of Health. Until new therapies are made possible by advances in medical research, people living with underactive bladder syndrome continue to have hope, knowing that scientists are working every day on their behalf.
The International Continence Society (2002) refers to the condition of detrusor underactivity, defined as a contraction of reduced strength and/or duration, resulting in prolonged bladder emptying and/or failure to achieve complete bladder emptying within a usual time span. This condition has also been referred to as Hypotonic Bladder, Flaccid bladder, Lazy bladder and Detrusor Hypoactivity. Detrusor underactivity is a medical diagnostic term based on urodynamic testing that requires catheter insertion into the bladder and rectum. Progress on cures targeting detrusor under activity is painfully slow. For patients and their families, meaningful progress may be contingent on a pivot to a symptomatic based framework over urodynamic testing.
The symptoms and severity of underactive bladder vary from one person to another and the course of the disease is often unpredictable. The disease most often strikes between the ages of 40 and 60; however, young adults and those above age 60 across all ethnic groups are also affected.
The Underactive Foundation’s highest priority remains funding research to deliver a cure for underactive bladder and its complications. At the same time, the Foundation is also focused on efforts to strategize about methods to optimize thinking on underactive bladder syndrome to encourage meaningful progress to keep future generations from developing the disease. The Foundation strives to keep you informed of headlines, reports and announcements affecting the underactive bladder community.
UAB Definition: Chapple CR, et al. The Underactive Bladder: A New Clinical Concept?, Eur Urol (2015), http://dx.doi.org/10.1016/j.eururo.2015.02.030
Ref: Abrams P, Cardozo L, Fall M, et al: The standardization of terminology of lower urinary tract function: Report from the Standardisation Subcommittee of the International Continence Society. Neurourol Urodyn 22: 167-178, 2002.
Posted: July 26, 2020 by uabadmin
TrudyTriumph
Author, JoAnne Lake, is the mother of four grown children, one of whom has neurogenic bladder. She was diagnosed as a patient of neurogenic bladder in 2009 and shares her life experiences and emotions as a patient, mother, educator, and friend coping with these conditions on her blog: TrudyTriumph.
There is also a book that describes her journey in greater detail, “Beyond Embarrassment: reclaiming your life with neurogenic bladder and bowel” available at TrudyTriumph.com
Posted: July 27, 2020 by uabadmin
Scientific Presentations
Carolyn Best, PhD
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Lewis Chan, FRACS, DDU
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Kenneth M Peters, MD
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Michael B Chancellor, MD
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Tomas L Griebling, MD, MPH
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Michelle J Lajiness, FNP-BC
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Ananias C Diokno, MD
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Israel Franco, MD
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Tony Kanai
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Naoki Yoshimura, MD, PhD
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Pradeep Tyagi, PhD
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Kevin M Connolly
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Posted: July 26, 2020 by uabadmin
A Patient’s Guide to Underactive Bladder Syndrome
Last Updated: July 26, 2020 by uabadmin
Classification of Underactive Bladder
Etiological Classification of Underactive bladder
Pathophysiology: Decreased contractility – neural efferent or myogenic/decreased afferent stimulation.
– Congenital, inflammatory, neoplastic or trauma lesion to peripheral nerves
– Diabetes or other metabolic cause
Pathophysiology: decreased contractility secondary to smooth muscle damage.
-Fibrosis/collagen deposition
-Inflammation/obstruction/overdistension
Pathophysiology: decreased contractility secondary to receptor blockade of neural efferents or afferents.
– Antimuscarinics
-Smooth muscle relaxants/spasmolytics/membrane stabilizers.
Posted: July 26, 2020 by uabadmin
Current treatments
Current treatments available for underactive bladder patients
DISCLAIMER: The following information on treatment options for the symptoms of underactive bladder do not in any way constitute therapeutic recommendations, prescriptions or endorsements. Consult your physician for the treatment regimen that is best suited for your individual condition.
There are a number of treatments available to address the various conditions associated with underactive bladder and include techniques to promote and assist bladder emptying. None of these is a cure – they are designed to treat symptoms of the disease. Intermittent self-catheterization is probably the most common treatment option but many patients find the technique difficult and require intensive training, support and follow-up care.
Read MorePosted: July 26, 2020 by uabadmin
Risk Factors for Underactive Bladder
Scientists are working diligently to understand what biological factors contribute to underactive bladder pathogenesis. The most common risk factors associated with this syndrome are:
Nerve Damage
Damage to the peripheral nerves of the bladder by congenital, inflammatory, neoplastic or traumatic lesions may cause the sensation of bladder filling to be absent or reduced, and large volumes of urine may accumulate, which causes difficulty in emptying the bladder.
Diabetes
High blood sugar causes damage to peripheral nerves supplying bladder wall. Normal urination relies on the synergy between bladder contractions and bladder neck opening. When this is interrupted, such as diabetic patients, the result is incomplete bladder emptying with significant residual volumes.
Bladder Sarcopenia
The bladder should contract normally following parasympathetic nerve stimulation, but this activity may be absent or reduced due to wasting of muscular tissue, leading to acute retention of urine and insidious voiding difficulty. Fibrosis, inflammation, and overdistension may be a contributing factor in bladder sarcopenia.
Pelvic Surgery
It is reported that 20 per cent of patients with pelvic procedures fail to resume usual voiding within six months. Injury to the bladder nerve supply results in damage to the parasympathetic nerve fibers which in turn cause decreased bladder contraction and potentially underactive bladder.
Increasing Age
As we get older, the volume and elasticity of the urinary bladder can change in addition to the metabolic changes. The amount of muscular tissue as well as the amount of nerves per square mm of muscle decreases with age and occurs to the same extent in men and women.
Obstruction
Obstruction to the urinary outflow tract can result in chronic changes within the bladder wall. Prostatic enlargement is a very frequent cause of obstruction due to hyperplasia or, less frequently, prostate cancer. Severe vaginal prolapse also can lead to obstructed voiding.
Urinary tract Infections
Infections of the bladder and urethra have a potential to cause acute retention because of the reduced contractility of the detrusor muscle.
Medication
Drugs with antimuscarinic properties block the chemical transmission of acetylcholine so that the muscles relax – examples are Antidepressants, Antihistamines, Muscle relaxants etc.
Spinal cord injury
The degree of dysfunction is related to the severity and level of impairment. If the injury is above T12, the patient may have a reflex bladder action, which will require minimal intervention. The bladder still has some or all of its reflexes. Patient with injuries at L1 and below may have a flaccid bladder which does not contract. Bladder emptying may need to be assisted.
Posted: July 26, 2020 by uabadmin
What is Underactive Bladder Syndrome?
Underactive Bladder Syndrome is a chronic, complex and debilitating disease which affects the urinary bladder with serious consequences. Patients with an underactive bladder can hold unusually large amounts of urine but has a diminished sense of when the bladder is full and is not able to contract the muscles sufficiently and as forcefully as it should, resulting in incomplete bladder emptying.
The symptoms and severity of underactive bladder vary from one person to another and the course of the disease is often unpredictable.
Today, there is no way to prevent underactive bladder and there is no silver bullet. Treatments are available for some, but not all of the most serious complications of the disease. Current treatments include medications such as Bethanechol, Doxazosin, and Finasteride. Presently, most treatments focus on techniques to promote and assist bladder emptying such as intermittent self-catheterization and indwelling catheters. These techniques act to slow the progression of the disease and limit damage rather than truly arresting the disease. In addition, some of the drugs currently in use can have serious side effects. There is much work that remains to be done.
Despite the number of people affected by underactive bladder and the devastating effect the disease can have, bladder research remains critically underfunded by the National Institutes of Health. Until new therapies are made possible by advances in medical research, people living with underactive bladder syndrome continue to have hope, knowing that scientists are working every day on their behalf.
The International Continence Society (2002) refers to the condition of detrusor underactivity, defined as a contraction of reduced strength and/or duration, resulting in prolonged bladder emptying and/or failure to achieve complete bladder emptying within a usual time span. This condition has also been referred to as Hypotonic Bladder, Flaccid bladder, Lazy bladder and Detrusor Hypoactivity. Detrusor underactivity is a medical diagnostic term based on urodynamic testing that requires catheter insertion into the bladder and rectum. Progress on cures targeting detrusor under activity is painfully slow. For patients and their families, meaningful progress may be contingent on a pivot to a symptomatic based framework over urodynamic testing.
The symptoms and severity of underactive bladder vary from one person to another and the course of the disease is often unpredictable. The disease most often strikes between the ages of 40 and 60; however, young adults and those above age 60 across all ethnic groups are also affected.
The Underactive Foundation’s highest priority remains funding research to deliver a cure for underactive bladder and its complications. At the same time, the Foundation is also focused on efforts to strategize about methods to optimize thinking on underactive bladder syndrome to encourage meaningful progress to keep future generations from developing the disease. The Foundation strives to keep you informed of headlines, reports and announcements affecting the underactive bladder community.
UAB Definition: Chapple CR, et al. The Underactive Bladder: A New Clinical Concept?, Eur Urol (2015), http://dx.doi.org/10.1016/j.eururo.2015.02.030
Ref: Abrams P, Cardozo L, Fall M, et al: The standardization of terminology of lower urinary tract function: Report from the Standardisation Subcommittee of the International Continence Society. Neurourol Urodyn 22: 167-178, 2002.
Posted: July 26, 2020 by uabadmin
Self-catheterization Basics
Urinary retention is a serious risk of Underactive Bladder and patients must be willing and prepared to self-catheterize.
Your doctor can show you how to use your catheter. After some practice, it will get easier. Sometimes family members, a school nurse, or others may be able to help you use your catheter.
Your doctor will give you a prescription for the right catheter for you. There are different types and sizes. You can buy catheters at medical supply stores. You will also need small plastic bags and a gel such as K-Y jelly or Surgilube. Do not use Vaseline (petroleum jelly). Because of the sensitivity and pain in the region, most patients must use a prescription numbing jelly such as lidocaine jelly that numbs nerve pain.
Ask your doctor how often you should empty your bladder with your catheter. Usually it is three to six times a day. Always try to empty your bladder first thing in the morning and when you go to bed at night. You can empty your bladder while sitting on a toilet. Your doctor or nurse can show you how to do this correctly.
Catheter Sizes
Catheters are sized by French size (Fr). The French size refers to the diameter of the catheter. Typically sizes range from 5 Fr – 20 Fr. Your physician can determine which catheter French size is right for you.
Catheter Lengths
There are three different lengths available for catheters: male, female, and pediatric. Most male length catheters are 16 inches in length, and female length catheters range from 6-8 inches in length. There are some instances where females prefer to use male-length catheters. Pediatric length catheters typically range from 6-12 inches in length. Women and children generally use shorter lengths because of their shorter urethral length.
Catheter Tips
Catheters can have a straight tip or a coude tip. Most catheters come with a straight tip but sometimes a coude tip is recommended by your physician. The coude tip catheter is used when a blockage or stricture is present, making the use of a straight catheter more difficult.
Catheter Types
Straight catheters are a straight tube of flexible plastic or rubber. One end has a rounded tip, and the other end typically has a funnel end. Intermittent catheters can also come incoude tip, latex, silicone, red rubber, and antibacterial.
Hydrophilic catheters are coated with a hydrophilic polymer that becomes very slippery when wet to promote excellent gliding properties and provides up to 95 percent lower friction when compared to other catheters. The result is a much more comfortable insertion.
Closed system catheters are pre-lubricated catheters that are self contained, allowing for a sterile environment. It includes an introducer tip that allows the catheter to bypass the highest concentrations of bacteria located in the first few millimeters of the uretrha, significantly reducing the risk of infection. Closed system catheters have an attached collection bag which allows for discreet cathing where facilities are not available and also has the ability to measure output.
Posted: July 26, 2020 by uabadmin
How to do Intermittent Self Catheterization – for men
According to the Society of Urologic Nurses and Associates, Intermittent Self-Catheterization (ISC) is a safe and effective alternative method to empty the bladder. ISC is used to help protect the kidneys, prevent incontinence, and lessen the number of infections by promoting good drainage of the bladder while lowering pressure inside it. While self-catheterization is often done by UAB patients, they must take special precautions and should consult with a medical professional for additional advice.
The U.S. National Library of Medicine’s MedLine Plus service offers the following general instructions for self-catheterization:
For Men:
Using Your Catheter
Follow these steps to insert your catheter:
Single-Use Catheters
When to Call the Doctor
Call your doctor or nurse if:
Source: Adapted with modifications for UAB patients from ICA Update, Spring 2012 and MedLine Plus, U.S. National Library of Medicine . A fact sheet with additional details can be downloaded from the Society of Urologic Nurses and Associates website
Posted: July 26, 2020 by uabadmin
How to do Intermittent Self Catheterization – for women
According to the Society of Urologic Nurses and Associates, Intermittent Self-Catheterization (ISC) is a safe and effective alternative method to empty the bladder. ISC is used to help protect the kidneys, prevent incontinence, and lessen the number of infections by promoting good drainage of the bladder while lowering pressure inside it. While self-catheterization is often done by UAB patients, they must take special precautions and should consult with a medical professional for additional advice.
The U.S. National Library of Medicine’s MedLine Plus service offers the following general instructions for self-catheterization:
For Women:
Using Your Catheter
Follow these steps to insert your catheter:
Single-Use Catheters
When to Call the Doctor
Call your doctor or nurse if:
For additional guidance on female self-catheterization we recommend this educational video provided by The National Association For Continence (NAFC)
For additional information about the NAFC go to www.nafc.org
Source: Adapted with modifications for UAB patients from ICA Update, Spring 2012 and MedLine Plus, U.S. National Library of Medicine . A fact sheet with additional details can be downloaded from the Society of Urologic Nurses and Associates website
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