The human bladder holds about 300-450ml of urine, it takes about 4-7 hours to fill this amount. Consequently, we feel an urge to urinate and visit the toilet to relieve ourselves, but not everyone does this without any problems. Something that sufferers in many cases do not even talk about are so-called micturition disorders.
What is a micturition disorder?
Summarized under the term micturition disorder are the difficult or partially incomplete emptying of the urinary bladder, the infrequent release of urine and the involuntary loss of urine (incontinence). The term micturition disorder is used to describe difficulty or partial incomplete emptying of the bladder, infrequent urine output and involuntary urine leakage (incontinence). Women are affected more frequently (14.7 percent) than men (only about nine percent) because the female bladder sphincter is more susceptible and the muscles of the pelvic floor are more often weakened. If no urine or less than 100 milliliters is excreted over a 24-hour period, doctors refer to this as anuria. However, if the daily amount of urine is more than three liters per day, it is called polyuria. A daily urine output of less than 500 milliliters is called oliguria. The interaction of various causes is responsible for the dysfunction of the bladder. Thus, micturition dysfunction is not a single clinical picture.
Causes
A broad spectrum exists as possible causes of micturition dysfunction. Mechanical causes include such things as when the urethra or urinary bladder is damaged, altered, or inflamed. Tumors of the urethra or urinary bladder, foreign bodies causing obstruction of the urethra or foreign bodies in the urinary bladder are also among them. Also urethral valves (spread sail-like membranes that appear in boys in infancy and are responsible for irreversible damage), urinary tract infections (urethritis) or a narrowing of the urethra (urethral stricture) can be the cause of impaired bladder emptying. Other possible causes are enlargement of the prostate (prostatic hyperplasia), cystitis, diverticula in the vaginal and bladder area, intestinal and bladder fistulas, urinary bladder stones or renal insufficiency. Neurogenic causes are dementia, Parkinson’s disease, multiple sclerosis or a spinal abscess or other spinal cord lesions. However, certain medications for dehydration (diuretics) can also be triggers for increased urine excretion. The signs of micturition dysfunction are varied. The feeling of incomplete bladder emptying (residual urine formation) and a persistent dripping of urine after urination can be signs. Sometimes the onset of micturition is delayed or there are interruptions in the urine stream, also known as “urinary stuttering“. Some people experience a weakening of the urinary stream to the point of dribbling
or even a prolonged duration of urination. Sometimes, however, an imperative urge to urinate can set in: a very strong and irresistible urge that can also lead to urge incontinence
and even increases to nocturia if the urge to urinate occurs more than twice a night. Micturition dysfunction may also be noticeable in smaller amounts of urine accompanied by a marked increase in the frequency of micturition or difficult micturition. Pain during urination is a clear sign, especially if voiding occurs only in a very small amount of urine and may even be accompanied by bladder spasms. Urinary incontinence, in which there is involuntary leakage of urine, can also cause micturition disorders. A distinction is made between urge incontinence, stress incontinence, overflow incontinence, reflex incontinence and mixed incontinence.
Diseases with this symptom
- Cancer of the urethra
- Urethritis
- Dementia
- Bladder cancer
- Prostate enlargement
- Kidney weakness
- Urethral stricture
- Cystitis
- Urinary bladder diverticulum
Diagnosis and course of the disease
Each affected person requires individualized care, as micturition disorders and incontinence are still a major taboo subject in our society and sufferers are often plagued by great shame. In most cases, urologists begin with the patient’s medical history (anamnesis).If the patient reports one or more of the typical symptoms of a micturition disorder, a physical examination is then performed. Here, important factors such as physical condition are ascertained. Obesity (overweight) is a risk factor for incontinence, but pregnancy can also be the trigger. Diabetes mellitus is also a cause of micturition disorders, as a metabolic derailment often leads to an abnormal increase in the amount of urine. The so-called laboratory diagnostics includes all apparative examinations. Urine test strips provide information about diseases of the bladder, kidney or liver, a microscopic examination of the midstream urine provides information about a possible urinary tract infection. In a urine overlay reaction, certain chemical substances are added to the patient’s urine. In this way, functional disorders and even metabolic disorders can be detected. To rule out possible prostatic hyperplasia, prostatic carcinoma and benign prostatic syndrome, a digital, rectal examination. Using a micturition cystourethrogram, the urinary bladder is filled with a contrast medium through a catheter via the urethra. Thus, the reflux of urine through the ureters into the renal pelvis can be detected to identify anatomical or functional disorders of urinary bladder emptying.
Complications
Micturition disorders have various causes with different complications. Some common ones are inflammation of the urethra or urinary bladder. As a complication here can come a systemic spread of the pathogen (sepsis). Sepsis is a life-threatening condition and leads to death in more than half of all cases. Urinary stones can also lead to urinary flow disorders. This leads to a buildup of urine up to the kidney, which can become inflamed and this can also lead to sepsis. An enlargement of the prostate (prostatic hyperplasia) can also cause micturition disorders. This can also lead to urinary retention and thus inflammation of the kidney. The kidney usually suffers permanent damage. Due to the prostate enlargement, the urinary retention causes a painful enlargement of the bladder, the wall of which may thicken as a result and possibly form diverticula, which may subsequently become inflamed. Another way in which the flow of urine is inhibited is by a urethral valve, which may form in the boy. Again, similar complications arise as with urinary retention. Some dementias also trigger urinary dysfunction. Complications vary depending on the type of dementia. Affected individuals usually change their behavior and personality, often becoming more aggressive and rude. In addition, there is still usually an exclusion from society, a social isolation, it is similar to Parkinson’s disease.
When should one go to the doctor?
A micturition disorder should be examined by a doctor at the latest when it occurs not only as an isolated case. In contrast, an isolated uncontrolled release of urine or an isolated feeling of not being able to urinate properly are often harmless. A doctor should be consulted urgently if uncontrolled urine leakage occurs over an entire day that can no longer be explained by a single cause (for example, a cramp or even vigorous laughter). Pain when urinating is also a reason to see a doctor. It is important to clarify what the cause is. Possible urinary tract infections must be recognized and treated before they can spread. A doctor must also be consulted immediately if urination stops working at all. Urinary retention is a medical emergency and requires immediate treatment to prevent kidney damage from backed-up urine. A visit to the urologist is unavoidable. The exact examination of the urinary tract and, if necessary, assistance with urination, can be better realized by a urologist than by a general practitioner. Also, urological practices have the necessary equipment to act quickly in acute causes.
Treatment and therapy
There are several therapeutic measures to treat micturition dysfunction. The exact diagnosis of the malfunction of the bladder and/or sphincter is decisive here. In obese patients, weight reduction is the first step, and in poorly controlled diabetics, an individualized insulin plan is established. In this way, metabolic derailments can be prevented and thus also polyuria.If the micturition disturbance has a mechanical cause (tumors, foreign bodies, fistula formations), this can be remedied surgically if necessary. In addition, it is possible to place a small tension-free band under the urethra in the case of involuntary urine loss. Today’s medicine would be unthinkable without drug treatment of micturition disorders, which is an important part of the therapy. Here the following drug groups of phytopharmaceuticals, alpha-1-receptor blockers as well as 5-alpha-reductase inhibitors, which among other things can reduce the prostate volume, are effective. However, easy-to-use pelvic floor training can also be used to treat possible pelvic floor weaknesses. Combination therapies are also possible.
Outlook and prognosis
Micturition dysfunction usually results in relatively rapid spread of the pathogen to other regions. For this reason, treatment by a physician is necessary. If urine builds up, inflammation of the kidneys may result. In this case, urination is associated with severe pain. In this case, the kidney may suffer severe irreversible damage, which usually cannot be treated. If the urine accumulates, the bladder may enlarge, which is also associated with severe pain. The patient’s everyday life is severely restricted by the micturition disorder. This can have a particularly negative effect on the exercise of certain professions. Social and societal problems can also arise. Treatment does not always lead to success and can also result in permanent damage to the kidney. In many cases, surgical intervention is necessary to correct the symptom and the associated pain. If the kidney is severely damaged and no longer functional, a kidney transplant is necessary. In diabetics, weight reduction is helpful in many cases to counteract the micturition disorder.
Prevention
Timely prophylactic measures are important if micturition disorders are to be avoided as far as possible. For example, obesity should be avoided to prevent stress incontinence later. Some medications can promote or worsen micturition disorders. Women should perform regular pelvic floor exercises, especially after pregnancy. Toilet or bladder training can help. This involves keeping a micturition log in which the frequency and quantity of urine excretion is recorded. It is important to drink appropriate amounts and to set times for urination. In this way, the bladder can become accustomed to regulated emptying. For all preventive measures, it is important to consult a urologist in order to prevent additional problems from arising in the first place. Constipation prophylaxis is also useful to prevent micturition disorders. Because a constipation leads to strong pressing and pressing- and possibly thus to an involuntary loss of urine.
What you can do yourself
In most cases, reducing weight will help with voiding dysfunction. This response must be made especially in patients with diabetes. In this case, healthy food and exercise is suitable to counteract the micturition disorder. However, there are no direct ways of self-help in micturition disorder. The disorder is usually treated with the help of medication and cannot be controlled by home remedies. To prevent micturition disorder, people should usually visit the toilet whenever they feel the urge to do so. It is extremely unhealthy to hold an urge to urinate and not empty the bladder. This is especially true for those people who cannot go to the bathroom very often because of their job. Thus, especially truck drivers or bus drivers are affected by this problem and should always empty their bladder regularly to avoid micturition disorder. In any case, patients with micturition dysfunction should limit their fluid intake at inconvenient times. This is especially true before bedtime. Coffee and alcohol should be avoided. Various pelvic and bladder exercises can be performed to treat the symptom.
