Bladder dysfunction
Overactive Bladder (Detrusor Instability)
Many older people have an overactive bladder because of age relating changes to the bladder. It is one of the most common causes of incontinence.
Symptoms are urgency, frequency by day and night, voiding small amounts or urine and not being able to reach the toilet in time (urge incontinence).
The causes are varied, such as Stroke, Parkinson's disease, Multiple Sclerosis and Spinal Cord Injuries. Symptoms may also occur because of bladder hypersensitivity arising from urinary tract infection, drinks that may irritate the bladder e.g. coffee and alcohol, concentrated urine, bladder stones / tumours, prostatic enlargement and faecal impaction.
Genuine Stress Incontinence
Symptoms are small loss of urine on physical exertion, such as coughing and sneezing, or getting out of a chair.
Genuine stress incontinence predominately occurs in females due to bladder outlet incompetence because of weak pelvic floor muscles. Childbirth, the menopause and constipation, and chronic coughing are contributing factors to this, but men may also get stress incontinence after prostate surgery.
Voiding difficulties caused by outflow obstruction or detrusor hypoactivity (Overflow Incontinence)
Symptoms are passing small amounts of urine frequently with hesitancy, poor flow, post micturition dribbling and sometimes terminal dribbling. Recurrent urinary tract infections can occur due to the residual urine.
Outflow obstruction
This symptom is much more common in men, a common cause being prostatic enlargement. Urethral stricture and chronic constipation are other causes of outflow obstruction.
Underactive Bladder (Detrusor hypoactivity)
This causes a weak contraction of the detrusor muscle resulting in ineffective bladder emptying. Symptoms are similar to outflow obstruction. The cause can be due to damage to the peripheral nerves e.g. in Diabetes, pelvic injury and Multiple Sclerosis. The bladder often increases its capacity as the sensation of bladder filling can be diminished. This can results in large residual volumes building up.
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