Bladder underactivity

Overflow Urinary Incontinence (OUI) (Urethral Overactivity and/or Bladder Underactivity)4... 

Urethral overactivity and/or bladder underactivity is known as overflow incontinence. The bladder is filled to capacity but is unable to empty, causing urine to leak from a distended bladder past a normal outlet and sphincter. Common causes of urethral overactivity include benign prostatic hyperplasia (see Chap. 82) prostate cancer (see Chap. 65) and, in women, cystocele formation or surgical overcorrection after UI surgery. 

Urethral overactivity and/or bladder underactivity is a rare, but important, cause of UI. Patients complain of lower abdominal fullness, hesitancy, straining to void, decreased force of stream, interrupted stream, and sense of incomplete bladder emptying. Patients can also have urinary frequency, urgency, and abdominal pain. 

For urethral overactivity and/or bladder underactivity, digital rectal exam or transrectal ultrasound should be performed to rule out prostate enlargement. Renal function tests should be performed to rule out renal failure. 

Bladder underactivity may also result in overflow incontinence. Under certain circumstances, the detrusor muscle of the bladder may become progressively weakened and eventually lose the ability to voluntarily contract. In the absence of adequate contractility, the bladder is unable to empty completely, and large volumes of residual urine... 

Currently there are no effective surgical treatments for bladder underactivity. After an appropriate evaluation is performed for reversible causes, the most effective management for this condition is intermittent self-catheterization performed by the patient or a caregiver... 

Mixed incontinence includes the combination of bladder overactivity and urethral underactivity. 

Differentiating Bladder Overactivity from Urethral Underactivity... 

Urethral underactivity is known as stress Ul (SUl) and occurs during activities such as exercise, lifting, coughing, and sneezing. The urethral sphincter no longer resists the flow of urine from the bladder during... 

Various types of UI may coexist in the same patient. The combination of bladder overactivity and urethral underactivity is termed mixed incontinence. This is often a difficult diagnosis to make because of the often-confusing array of presenting symptoms. Bladder overactivity may also coexist with impaired bladder contractility. This is most common in the elderly and is termed detrusor hyperactivity with impaired contractility. ... 

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