![]() There is little difference in drug therapy for neurogenic or non-neurogenic overactive bladder syndrome, with the mainstay being antimuscarinic drugs. A shorter onset of symptoms (for example less than three months), haematuria, or a history of heavy smoking may suggest urinary tract malignancy and will require further tests such as urine cytology, imaging and a referral to a urologist. Examination of the S2-S4 nerve segment, for example by testing the bulbocavernosal reflex and anal tone, is vital to exclude occult neuropathology.Ī midstream urinalysis and culture, and measurement of the post-void residual urine volume is mandatory. ![]() Feel for a palpable bladder and examine the prostate or vagina and test for stress incontinence with coughing and for pelvic organ prolapse. The assessment focuses on the duration, severity and inconvenience of the overactive bladder syndrome, the presence of other lower urinary tract symptoms especially haematuria, as well as past urological, neurological, and obstetric or gynaecological history. The initial assessment requires a thorough history and examination. Also look for outlet factors such as benign prostatic hypertrophy or atrophic vaginitis. Age-related overactive bladder and idiopathic detrusor overactivity should be considered. In non-neurogenic overactive bladder syndrome, urinary tract infection and bladder malignancy must be ruled out along with foreign bodies such as bladder stones. Neurogenic overactive bladder can be associated with spinal cord injury, Parkinson's disease, multiple sclerosis and diabetes. There are many causes of overactive bladder syndrome and they can be divided into neurogenic and non-neurogenic causes. This syndrome has urgency as its pivotal symptom, although it may also be associated with frequency and nocturia. Urgency and stress incontinence are the most common symptoms of bladder storage dysfunction.Īpart from urinary tract infection the most common cause of urgency incontinence is the overactive bladder syndrome. This is often more realistic than rendering the patient completely continent and should be made clear to patients from the outset. The end point is improving quality of life by reducing symptoms (such as frequency, urgency, nocturia, incontinence). ![]() The goal of treatment is to improve this either via drugs or surgery. Obtaining a thorough history outlining the storage and voiding dysfunction is crucial to narrow the diagnosis of voiding dysfunction and identify the types of incontinence.Īlthough incontinence is not life threatening, patients with urinary incontinence have a reduced quality of life. For example, stress incontinence is a storage dysfunction caused by an outlet factor. 1 Storage and voiding dysfunction can each be further subclassified into bladder and outlet factors. Voiding dysfunction causes hesitancy, poor flow, terminal dribbling and incomplete emptying. Storage dysfunction often presents with symptoms such as frequency, urgency, urgency incontinence and nocturia. Bladder dysfunction can therefore be broadly classified into storage and voiding dysfunction. The bladder has two functions: it stores and voids urine.
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