From the Guidelines
Bladder dysfunction can be caused by a variety of factors, including neurological conditions, structural abnormalities, and systemic diseases, with the most recent evidence suggesting that neurological causes, such as stroke, multiple sclerosis, and diabetic neuropathy, are significant contributors to bladder dysfunction 1.
Causes of Bladder Dysfunction
The causes of bladder dysfunction can be broadly categorized into:
- Neurological conditions, such as stroke, multiple sclerosis, Parkinson's disease, spinal cord injuries, and diabetic neuropathy, which disrupt the normal nerve signals controlling bladder function 1
- Structural issues, such as bladder stones, tumors, benign prostatic hyperplasia in men, and pelvic organ prolapse in women, which can obstruct urine flow or alter bladder anatomy 1
- Systemic diseases, such as diabetes, which can cause long-term damage to the bladder and urinary tract 1
- Infections, such as urinary tract infections, which can cause temporary dysfunction through inflammation 1
- Certain medications, particularly anticholinergics, antidepressants, and opioids, which may affect bladder control as a side effect 1
- Age-related changes to bladder muscles and decreased bladder capacity, which contribute to dysfunction in older adults 1
- Pregnancy and childbirth, which can weaken pelvic floor muscles in women, while radiation therapy to the pelvic area may damage bladder tissues 1
- Psychological factors, such as anxiety, which can also influence bladder function through complex brain-bladder neural pathways 1
Importance of Identifying Underlying Cause
Identifying the specific underlying cause of bladder dysfunction is crucial for effective treatment, as it allows for targeted interventions, such as medications, physical therapy, lifestyle modifications, or surgical interventions, to improve patient outcomes and quality of life 1.
From the Research
Causes of Bladder Dysfunction
The causes of bladder dysfunction can be attributed to various neurological conditions. Some of the key causes include:
- Neurological disorders such as multiple sclerosis 2, 3, 4, which can lead to detrusor overactivity and other bladder-related symptoms
- Peripheral neuropathies, including diabetic neuropathy, Guillain-Barré syndrome, and chronic inflammatory demyelinating polyneuropathy 5
- Central nervous system (CNS) diseases, such as Parkinson's disease, multiple system atrophy, and stroke 4
- Spinal cord injuries, which can disrupt the neural pathways connecting the pontine micturition centre to the sacral spinal cord 3
- Other conditions, such as amyloid neuropathy and human immunodeficiency virus (HIV)-associated neuropathy 5
Pathophysiology of Bladder Dysfunction
The pathophysiology of bladder dysfunction can vary depending on the underlying condition. Some common mechanisms include:
- Disturbances of neural communication between the frontal cortex and pontine micturition center 4
- Detrusor hyperreflexia and incomplete bladder emptying 3
- Detrusor overactivity secondary to neurological disease 2
- Bladder outlet obstruction and urge and stress urinary incontinence 5
Diagnosis and Treatment of Bladder Dysfunction
The diagnosis of bladder dysfunction typically involves a combination of medical history, neurological examination, and urological evaluation. Treatment options may include:
- Medical management, such as anticholinergic medication and intermittent self-catheterization 2, 3
- Minimally invasive procedures, such as injection of botulinum neurotoxin type A into the detrusor muscle and sacral or pudendal neuromodulation 4
- Surgical methods, such as reconstructive continent or incontinent urinary diversion 4