Bladder dysfunction refers to any abnormality of the way the urinary bladder works, and does not always mean incontinence of urine.
The most common bladder dysfunction that urologists see are patients complaining of frequency and urgency, that is going to the toilet more frequently than they did, and feeling they need to get to the toilet very urgently, in case they “wet themselves”.
Some patients will also complain of nocturia, waking up overnight with the need to pass urine.
Other bladder dysfunction symptoms can be burning discomfort when passing urine, pain when the bladder is full, sometimes relieved by passing urine.
Some patients will also notice a change in the colour or smell of the urine, spraying of the urinary stream, or other concerns that they seek assistance for.
The causes of bladder dysfunction are many, and obstruction to the bladder outflow by the prostate is a common one in men as they age. The combination of frequency, urgency, nocturia, hesitancy to get the flow started, a slow urinary flow, or dribbling at the end of the stream are very typical of an Enlarged Prostate.
Other causes of that symptom complex are other conditions that obstruct the outflow of the bladder, like a tight bladder neck or a stricture (narrowing) in the urethra.
If there is no issue with flow however, it is less likely that obstruction is the cause of bladder dysfunction, and we need to consider many other causes such as abnormalities of bladder pressure and contraction ability (overactive or under-active bladders), abnormalities of bladder sensation (sensory urgency), infections and inflammatory conditions, diseases of the nervous system, issues related to fluid intake (either amount or timing), poor bladder habits, medication side-effects, and conditions effecting kidney function.
To understand what is causing bladder dysfunction a number of investigations may be required, such as urine tests, ultrasound examination of the bladder, blood tests for kidney function, charting of fluid intake and amount and timing of urination, urinary flow studies, measurement of residual urine, pressure studies of the bladder (urodynamics), or bladder examination with an internal telescope (cystoscopy).
How we treat bladder dysfunction will depend on the cause, but may include medications of various types, bladder retraining exercises, pelvic floor muscle exercises, injections of Botox into the bladder wall, learning self-catheterisation to empty the bladder, electrical stimulation of nerves that control the bladder, or perhaps some minor surgical procedures
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