From the Guidelines
Psychogenic bladder, also known as neurogenic bladder, is a condition where bladder function is impaired due to psychological factors rather than physical causes, and treatment typically involves a combination of behavioral therapy, medication, and lifestyle modifications, with the goal of optimizing the patient's quality of life 1.
Treatment Approach
The treatment approach for psychogenic bladder should prioritize a shared decision-making process between the patient and the clinician, taking into account the patient's urologic symptoms, urodynamic findings, cognition, hand function, type of neurologic disease, mobility, bowel function/management, and social and caregiver support 1.
Behavioral Therapy
Patients should start with bladder training exercises, including timed voiding every 2-3 hours and pelvic floor muscle exercises (Kegel exercises) performed 3 times daily with 10-15 repetitions each session, as well as bladder training, which involves extending the time between voiding 1.
Medications
Medications such as anticholinergics like oxybutynin (5mg 2-3 times daily) or tolterodine (2mg twice daily) may help reduce urinary frequency and urgency, with tolterodine causing fewer harms than oxybutynin 1.
Lifestyle Modifications
Patients should maintain a bladder diary to track fluid intake, voiding patterns, and symptoms, and limit caffeine and alcohol consumption, avoid fluid intake 2-3 hours before bedtime, and manage stress through relaxation techniques like deep breathing or meditation.
Psychotherapy
Psychotherapy, particularly cognitive behavioral therapy, addresses underlying psychological factors contributing to bladder dysfunction, and is an essential component of the treatment plan. Some key points to consider when treating psychogenic bladder include:
- The importance of a comprehensive treatment plan that addresses the patient's physical and psychological needs
- The need for regular follow-up and monitoring to adjust the treatment plan as needed
- The importance of patient education and empowerment in managing their condition
- The potential benefits of lifestyle modifications, such as dietary changes and stress management, in reducing symptoms and improving quality of life.
From the Research
Definition and Diagnosis of Psychogenic Bladder
- Psychogenic bladder, also known as psychogenic urinary dysfunction, refers to a condition where psychological factors influence bladder function, leading to symptoms such as urinary retention, overactive bladder, or difficulty urinating 2, 3, 4.
- The diagnosis of psychogenic bladder is one of exclusion, requiring a thorough evaluation to rule out underlying urological or neurological causes 3, 5.
- Urodynamic studies, such as pressure-flow tests and electromyography, can help diagnose psychogenic bladder by identifying abnormal bladder sensation and detrusor muscle function 2, 3.
Symptoms and Characteristics of Psychogenic Bladder
- Symptoms of psychogenic bladder can include overactive bladder, difficulty urinating, and urinary retention, which may occur in specific situations or be triggered by psychological factors 3, 4.
- Patients with psychogenic bladder may exhibit increased bladder sensation, acontractile detrusor, or other urodynamic abnormalities 3.
- Psychogenic bladder can be associated with various psychiatric conditions, such as anxiety, depression, or conversion disorder 2, 3, 4.
Treatment and Management of Psychogenic Bladder
- Treatment for psychogenic bladder typically involves a combination of conservative approaches, including intermittent catheterization, urinary rehabilitation, and supportive psychiatric therapy 2, 4.
- Pelvic floor muscle training (PFMT) may also be beneficial in managing symptoms of overactive bladder and urinary incontinence 6.
- It is essential to avoid irreversible surgical procedures and instead focus on conservative management and psychiatric support 2, 4.