Detrusor-sphincter dyssynergia is a neurogenic disorder in the interaction of the detrusor and sphincter, both of which are involved in emptying the bladder. The external sphincter reflexively contracts at the same time as the detrusor and the bladder empties inadequately. Treatment options include conservative and surgical procedures.
What is detrusor-sphincter dyssynergia?
In dyssynergia, the interaction of a functional unit consisting of different structures is disturbed. Detrusor-sphincter dyssynergia is a urinary bladder dysfunction in which the urethral muscle and the bladder muscles are disturbed in their interaction. More precisely, the phenomenon corresponds to a lack of coordination of the detrusor vesicae muscle of the bladder and the external urethral sphincter muscle sphincter urethrae externus. The coordination of these two muscles plays a crucial role in the process of bladder emptying in terms of micturition. Since a coordination disorder of the muscles in this respect is due to the innervation and nervous control of the muscle elements, detrusor-sphincter dyssynergia is one of the neuromuscular dysfunctions of the urinary bladder. Thus, it is a neuromuscularly caused bladder emptying disorder. Detrusor-sphincter dyssynergia is often associated with weakness of the pelvic floor muscles, which is favored by age-related physiological changes.
Causes
The primary cause of detrusor-sphincter dyssynergia is neuromuscular. Neuromuscular dysfunction may be due to several primary causes. Instead of relaxation of the external sphincter, a reflex spastic contraction of the muscle occurs during micturition, which occurs simultaneously with contraction of the detrusor. Urine outflow is thus inadequate. This results in residual urine formation, which causes consecutive urinary retention. The coordination of the two muscles is impaired by neurogenic disorders affecting central bladder control. Such disorders are usually the consequence of lesions in the central nervous system. These lesions may occur in the context of a superordinate disease, for example, as a symptom of multiple sclerosis. On the other hand, they can also result from trauma, hemorrhage, or tumors and degeneration. When the control center in the brain is not affected by the lesions, thoracic or cervical spinal cord lesions are usually present.
Symptoms, complaints, and signs
The clinical presentation of patients with detrusor sphincter dyssenergy is similar to that of pollakiuria. This is a micturition disorder manifested by an increased frequency of bladder emptying to small amounts of urine. The amount of urine is therefore not increased. Only the micturition cycles increase. As a complication of detrusor-sphincter dyssynergia, various additional symptoms may occur, which are predominantly due to residual urine remaining in the bladder. This residual urine can be an optimal breeding ground for bacteria and, as a consequence, greatly increase the risk of recurrent urinary tract infections. Occasionally, during the course of detrusor-sphincter dyssenergy, symptoms such as vesicorenal reflux also present, which in turn can cause ascending infections and, in extreme cases, result in pressure atrophy of renal parenchyma. In this atrophy, the connective tissue of the kidneys degrades bit by bit. Therefore, this complication in particular must be prevented by early treatment.
Diagnosis
The first suspicion of dyssynergia comes to the physician after taking a medical history. To diagnose and clarify detrusor-sphincter dyssynergia, the physician has various examination procedures at his disposal. One of the most important examinations in this context is radiographic imaging of the micturition process with the administration of a contrast medium. Simultaneously with the X-ray imaging, a bladder pressure measurement is performed by video urodynamics. In most cases, an isolated pressure measurement within the urethra or bladder also takes place. This procedure usually corresponds to urethro-cystotonometry. In addition to these diagnostic tools, sonographic findings are available to the physician. Ultrasound should be used primarily to examine the urinary bladder in order to determine the amount of residual urine and additionally to detect secondary complications for the urinary tract system.The prognosis is considered relatively favorable as long as no complications have occurred.
Complications
Due to detrusor-sphincter dyssynergia, the affected person usually suffers from bladder emptying discomfort. This discomfort usually has a strong negative effect on the patient’s psyche, resulting in numerous psychological complaints and depression. In most cases, the patient is only able to evacuate very small amounts from the bladder and therefore has to visit the toilet more often. This manifests itself in a reduced quality of life. A urinary tract infection can also occur, which is associated with severe pain when urinating. The tissue on the kidney is slowly degraded, so that in the worst case it can lead to a complete loss of function of the kidney. In most cases, treatment is causal and depends on the underlying disease. It is not possible in all cases to completely limit detrusor-sphincter dyssynergia. Often, different therapies are used to stimulate the bladder. In severe cases, the patient may be dependent on an indwelling catheter to continue to manage daily life. Antibiotics are used for inflammation and infection. Complications usually no longer occur with treatment.
When should you see a doctor?
Detrusor-sphincter dyssynergia is when a doctor should be seen if there is discomfort with emptying the bladder. In most cases, the bladder must be emptied relatively frequently and only very small amounts of urine are discharged. Many of those affected also develop psychological complaints or depression, so that psychological treatment may also be necessary. Furthermore, treatment by a doctor is also advisable if a urinary tract infection occurs. This is usually associated with severe pain. Other kidney complaints may also indicate detrusor-sphincter dyssynergia and should be investigated. Early diagnosis can stop further deterioration of kidney tissue. Diagnosis and treatment of detrusor-sphincter dyssynergia can usually be made by an internist. Since treatment may require the implementation of various therapies, these are usually performed by specialists. Possible infections are treated with the help of antibiotics.
Treatment and therapy
Detrusor-sphincter dyssynergia is usually treated with causal therapy approaches. In such causal therapy, the primary cause of the condition should be eliminated. Thus, the goal of treatment corresponds to a coordinative improvement of muscle interaction. Targeted training of the pelvic floor muscles, for example, can help with this improvement in coordination. In addition to pelvic floor training, patients are advised to self-stimulate the bladder. This stimulation usually corresponds to gentle tapping of the organ. The gentle tapping movements should ideally be performed regularly and may improve overall bladder function. If the affected person’s spontaneous bladder emptying is extremely inadequate, self-catheterization is open for discussion. Depending on the patient’s ability, permanent suprapubic catheters may be placed as an alternative. If there is no improvement by conservative treatment routes, an invasive therapy option can be discussed. A surgical incision in the sense of a sphincterotomy may provide relief. Paralysis of the external sphincter by injection of botulinum toxin may also be considered in individual cases. The detrusor muscle can also be inhibited conservatively by administering anticholinergics. If urinary tract infections are already present, these infections are treated in acute cases by administering antibiotics. In most cases, therapy corresponds to a combination of several of the above options.
Outlook and prognosis
Detrusor-sphincter dyssynergia leads to various limitations in the patient’s life if the condition is not treated. Usually, this involves the disease having a very negative effect on the affected person’s toileting, causing them to have to visit the toilet more often. Only a small amount of urine comes out, so that residual urine remains in the bladder.For this reason, detrusor-sphincter dyssynergia, if left untreated, often leads to urinary tract infections and also to vesicorenal reflux, which can cause further infections. Detrusor-sphincter dyssynergia also destroys kidney tissue over time, so that in the worst case, kidney failure can result. In this case, the patient is dependent on dialysis or a donor kidney to avoid death. The treatment of this disease can be carried out in different ways and depends on the stage of the disease. In most cases, however, the symptoms are well limited and the quality of life of the affected person is increased again. No particular complications occur. In some cases, the affected person is dependent on a catheter. In this case, early diagnosis and treatment have a positive effect on the further course of the disease.
Prevention
Detrusor-sphincter dyssynergia in the context of neurological diseases such as multiple sclerosis is almost impossible to prevent. Age-related dyssenergia of the two muscles can be counteracted, at least in moderation, by regular training of the pelvic floor muscles. Prophylactic tapping of the bladder can also support bladder function.
Follow-up care
In detrusor-sphincter dyssynergia, measures of follow-up care are usually severely limited. In this case, the affected person is primarily dependent on early treatment to prevent further complications and discomfort. The earlier the disease is detected, the better the further course of the disease. If detrusor-sphincter dyssynergia is not treated, the symptoms usually worsen dramatically, and in the worst case, the patient may even die. The treatment of detrusor-sphincter-dyssynergia can be done by a special training or by a surgical intervention. In this case, the severity of the condition usually determines the further treatment. Some of the exercises from the therapies can also be performed by the affected person at home, which may accelerate the healing of detrusor-sphincter dyssynergia. When taking medications, sufferers should make sure to take them regularly and also use the correct dosage to limit the symptoms permanently. Self-healing cannot occur with this disease. After a possible intervention, it is advisable for the affected person to rest and take care of his body.
This is what you can do yourself
Basically, it is first important not to be ashamed of the lack of urine control. This can actually make the symptoms worse because of the psychological pressure. There are many tools that can catch the urine so that it does not show visibly. These include, if there is little urine leakage, liners to diapers or urinary condoms. Lack of urine control has several causes, so science and commerce have enough options on the market that can catch the urine. This leaves outsiders with no way to notice. Patients should be open about it, especially if they want to seek advice. It is a medical problem that is definitely not something to be ashamed of. In addition, the pelvic floor can be strengthened and trained in physiotherapy. Thus, the bladder muscles can be stimulated and improved. Also, the bladder can be tapped so that it is stimulated. Here it is important to have an expert show you the method properly. Regular training is the cornerstone for improvement. Pelvic floor training does not bring one hundred percent success after one-time practice, but the muscle behaves like any other muscle in the body that needs to be stimulated regularly. Patients can exchange information in self-help groups for incontinence. Many helpful tips can be found online in particular.
