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~ Disorders of Bladder Emptying, Sensation, and Contents ~

 

² Definitions:

  1. Abnormal Emptying:
  2. Hesitancy: trouble initiating voiding

    Straining to void: voiding accompanied by abdominal straining

    Poor stream: decreased force of flow of the urinary stream

    Intermittent stream: a “stop-and-start” pattern of urination

    Incomplete emptying: a persistent feeling of bladder fullness after voiding

    Postmicturition dribble: urine loss occurring just after normal voiding has been completed

    Acute urinary retention: sudden inability to void resulting in painful bladder overdistention

    and the need for catheterization to obtain relief

  3. Abnormal Sensation:
  4. Urgency: a strong desire to void

    Dysuria: burning pain with urination

    Bladder pain: conscious, hurting, suprapubic pain in the bladder

    Flank pain: pain between the lower rib cage and the ilial crest

    Pressure: a feeling of heaviness or constant force being exerted in the bladder or lower pelvis

    Loss of bladder sensation: decreased sensation in the bladder

  5. Abnormal Bladder Contents:

Abnormal color, Abnormal smell, Hematuria, Pneumaturia, Stones, Foreign bodies.

 

² Voiding Difficulty:

  1. Causes:
  2. j failure of pelvic floor relaxation

    k failure of the detrusor muscle to contract appropriately

    ø Outflow obstruction: detrusor pressure > 50 cm H2O in associated with urine flow rate < 15 ml/sec

    (usually found in patients having undergone obstructive bladder neck surgery for stress incontinence)

    ø Detrusor-sphincter dyssynergia in some patients with multiple sclerosis

  3. Treatment: depending on the cause of the condition

À Drug therapy:

- Mild sedatives:

- a -blockers: reducing urethral tone (eg. prazosin, phenoxybenzamine)

- Cholinergic agonists: enhancing detrusor contractility (eg. bethanechol chloride)

Á Self-catheterization: the mainstay in the treatment of voiding difficulty

* The most important protection against urinary tract infection is frequent and complete

bladder emptying rather than avoidance of the introduction of a foreign body into the

bladder.

 Suppressive antibiotics:

* Acute infections should be treated with an appropriate antibiotic for 3 days.

* Chronic suppressive antibiotic therapy should not be used.

 

² Acute Urinary Retention:

  1. Causes:
  2. * Eg. epidural anesthetic during childbirth, painful P-repair leading to pelvic floor spasm

    * A careful search should always be made to determine the cause of the retention,

    particularly if any neurologic signs are present.

  3. Treatment: (self)-catheterization

 

² Disorders of Bladder Sensation: among the most frustrating urogynecologic conditions

  1. Causes of bladder pain or painful voiding:
  2. - Bladder cancer (especially smokers or worker exposed to chemical)

    - Urethral diverticulum

    - Vulvar disease

    - Endometriosis

    - Chemical irritation from soaps

    - Bubble bath

    - Feminine hygiene products

    - Urinary stones

    - Urogenital atrophy from estrogen deprivation

    - Sexually transmitted diseases

    - Interstitial cystitis

  3. Management: usually no definite diagnosis and only symptomatic treatment

- Voiding regiment similar to that for detrusor instability

- Local care and hygiene

- Urinary tract analgesics (eg. Urised)

colorings

- Instillation of 50 ml of a 50% solution of dimethylsulfoxide (DMSO)

- Antihistamine (based on the theory: increased histamine g bladder pain)

diphenhydramine hydrochloride 25-50 mg po

cimetidine 300 mg po tid

 


Filename: Disorders of Bladder Emptying, Sensation, and Contents