Incontinence when the bladder is underactive

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OWM often addresses overactive bladder (OAB). After a few moments on Twitter updating whom we follow, I came across an organization that deals with just the opposite — ie, underactive bladder — where patients lose bladder control because they cannot pass urine. We have touched on this in the past, but I felt it was worth revisiting.

Underactive bladder (like some forms of overactive bladder) may be due to a condition called neurogenic bladder, where the nerves that control the holding or release of urine do not function properly. The messages that make the brain aware of a full bladder and that it is time to urinate are disrupted, so the bladder continues to fill but the person is unable to pass urine. Urine pressure in the bladder overcomes the sphincter muscle's ability to hold it, and urine leaks out.

This condition may occur in men and women and may be attributed to injury, diseases that affect the nervous system (eg, polio, syphilis, multiple sclerosis), diabetes, acute infections, genetic nerve problems, or heavy metal poisoning. Persons with neurogenic bladder can experience urine leakage or retention, damage to the tiny blood vessels in the kidney, and bladder or ureter infection.

Patients with the condition may need to use catheterization in order to drain the bladder — ie, a thin tube is inserted through the urethra and into the bladder. Clean intermittent catheterization (CIC) is an on-demand approach. An alternative is an indwelling Foley catheter placed in the bladder for extended periods. When the patient’s bladder and sphincter muscle do not work in tandem, the problem can be addressed surgically. Urinary diversion and bladder augmentation can divert the urine or enlarge the bladder to help protect the kidneys and keep patients continent.

Lesson: incontinence can just as likely be caused by not being able to go as it is by going too much.

Adapted from a Columbia University Medical Center posting