The bladder has two distinct roles:
1. To store urine: under normal bladder control, the urine is collected and stored in the bladder without leakage. As the bladder reaches capacity, messages are sent to the brain that tell you that you need to go to the toilet.
2. To release urine when passing urine: As the bladder fills to capacity increasing messages are sent to the brain to void (pass urine). When comfortable to void the bladder contracts and the urethra relaxes to allow voiding. Women pass urine much faster then men, at a rate of 30-50 mls a second.
For females, the usual bladder capacity is approximately 500mL. Most females will pass 350-700mL each time they pass urine, which is 4-7 times per day. Prior to the age of 60, one night waking to pass urine is normal, and after the age of 60, one extra void during the day or night is also considered normal. There should be no urgency, frequency, burning, or blood in the urine.
At your visit, A/Prof Mahmoud may:
A/Prof Mahmoud may also order diagnostic tests including:
In women pregnancy, childbirth, obesity, and menopause often contribute to stress incontinence by causing weakness to the pelvic floor or damaging the urethral sphincter, leading to its inadequate closure, and hence the leakage of urine. Stress incontinence can worsen during the week before the menstrual period. At that time, lowered estrogen levels may lead to lower muscular pressure around the urethra, increasing chances of leakage. The incidence of stress incontinence increases following menopause, similarly because of lowered estrogen levels. In female high-level athletes, effort incontinence may occur in any sports involving abrupt repeated increases in intra-abdominal pressure that may exceed perineal floor resistance.
Overactive Bladder (OAB) is defined as frequency, which is more that 8 urinations in 24 hours, as well as a strong desire to void with or without urge incontinence (involuntary loss of urine with urgency). Approximately 15% of adults have OAB, with half of those actually experiencing urge incontinence.
The overactive bladder is characterised by urinary frequency (8 or greater voids in 24 hours) and urgency (a strong desire to void) with or without urge incontinence (involuntary loss of urine with urgency). This condition affects 15% of adults with women more commonly affected, and the incidence increases with age.
Involuntary bladder contraction resulting in urgency or incontinence and may be related to the bladder muscle contracting too quickly. Common triggers include washing hands, putting the key in the door, anxiety
Urinary urgency and or pain or urge incontinence when the bladder does not contract. Some causes include infection, inflammation, foreign bodies or tumours.
When the unstable bladder is due to neurological disease (ie. spinal cord injuries, parkinsons, alzhiemers, multiple sclerosis).
Diagnosis is made by a combination of history, examination and investigation by your doctor. Infection is usually excluded with a urine test. Your doctor may ask you to complete a 24-hour urinary diary. This is an excellent means of confirming how many times you void, the volume voided and the amount of incontinence experienced Your fluid intake may also be recorded. Women with a hypersensitive bladder classically pass small amounts of urine frequently. Women with an unstable bladder may have normal urinary frequency but experience significant urge incontinence. Urodynamics may be required to confirm the diagnosis.
Most therapies that address urgency urinary incontinence focus on decreasing the abnormal contractions in the bladder that lead to urinary leakage.
Functional incontinence is a form of urinary incontinence in which a person is usually aware of the need to urinate, but for one or more physical or mental reasons they are unable to get to a bathroom. The loss of urine can vary, from small leakages to full emptying of the bladder.
Overflow incontinence occurs when the patient's bladder is always full so that it frequently leaks urine. Weak bladder muscles, resulting in incomplete emptying of the bladder, or a blocked urethra can cause this type of incontinence. Sometimes neurological diseases, diabetes or other diseases can decrease neural signals from the bladder (allowing for overfilling) and may also decrease the expulsion of urine by the detrusor muscle (allowing for urinary retention). Additionally, tumors and kidney stones can block the urethra. Spinal cord injuries or nervous system disorders are additional causes of overflow incontinence. Overflow incontinence is rare in women, although sometimes it is caused by fibroid or ovarian tumors. Also overflow incontinence can be from increased outlet resistance from advanced vaginal prolapse causing a "kink" in the urethra or after an anti-incontinence procedure which has overcorrected the problem. Early symptoms include a hesitant or slow stream of urine during voluntary urination.
Pathway for the surgical treatment of pelvic organ prolapse:
Summary of pathway findings:
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