Underactive bladder

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
Founder, WikiMD Wellnesspedia &
W8MD medical weight loss NYC and sleep center NYC

Underactive bladder
Synonyms	Detrusor underactivity
Pronounce	N/A
Specialty	N/A
Symptoms	Urinary retention, urinary frequency, urinary hesitancy, incomplete bladder emptying
Complications	Urinary tract infection, bladder stones, kidney damage
Onset	Can occur at any age, more common in older adults
Duration	Chronic
Types	N/A
Causes	Neurological disorders, diabetes mellitus, spinal cord injury, medications
Risks	Aging, neurological disease, prostate surgery
Diagnosis	Urodynamic testing, post-void residual volume measurement, bladder scan
Differential diagnosis	Overactive bladder, urinary tract infection, prostate enlargement
Prevention	N/A
Treatment	Bladder training, intermittent catheterization, medications, surgery
Medication	Bethanechol, alpha-blockers
Prognosis	N/A
Frequency	Common in older adults
Deaths	Rarely directly fatal, but complications can be serious

The underactive bladder (UAB) is a condition characterized by a bladder that does not contract with sufficient strength or duration to empty completely in a normal time span. This condition can lead to urinary retention and other complications.

Pathophysiology

The underactive bladder is often the result of a dysfunction in the detrusor muscle, which is responsible for contracting the bladder to expel urine. In UAB, the detrusor muscle may be weak or unable to contract effectively. This can be due to neurological disorders, muscle damage, or other underlying conditions that affect the bladder's ability to function properly.

Causes

Several factors can contribute to the development of an underactive bladder:

• Neurological Disorders: Conditions such as multiple sclerosis, Parkinson's disease, and spinal cord injury can affect the nerves that control bladder function.
• Diabetes Mellitus: Long-term diabetes can lead to neuropathy, which may impair bladder sensation and contractility.
• Aging: As people age, the bladder muscle may weaken, leading to decreased contractility.
• Medications: Certain medications, particularly those with anticholinergic properties, can reduce bladder contractility.
• Obstruction: Chronic bladder outlet obstruction, such as from benign prostatic hyperplasia, can lead to detrusor muscle decompensation over time.

Symptoms

Individuals with an underactive bladder may experience:

• Difficulty initiating urination
• Weak urine stream
• Sensation of incomplete bladder emptying
• Increased frequency of urination
• Urinary retention

Diagnosis

Diagnosis of UAB typically involves:

• Patient History and Physical Examination: Assessing symptoms and medical history.
• Urodynamic Studies: These tests measure the pressure and volume of the bladder and can help assess bladder function.
• Post-Void Residual Measurement: This test measures the amount of urine left in the bladder after urination.
• Imaging Studies: Ultrasound or other imaging techniques may be used to evaluate bladder structure and function.

Treatment

Treatment for underactive bladder may include:

• Behavioral Therapies: Bladder training and pelvic floor exercises can help improve bladder function.
• Medications: Drugs that enhance bladder contractility or reduce outlet resistance may be prescribed.
• Intermittent Catheterization: This technique can help empty the bladder completely and prevent urinary retention.
• Surgical Interventions: In some cases, surgery may be necessary to address underlying causes or to improve bladder function.

Prognosis

The prognosis for individuals with an underactive bladder varies depending on the underlying cause and the effectiveness of treatment. With appropriate management, many patients can achieve significant improvement in symptoms and quality of life.

See Also

• Overactive bladder
• Urinary retention
• Neurogenic bladder dysfunction