Voiding dysfunction overview

The bladder is an organ in the urinary system that stores and empties urine. Voiding dysfunction is a general term that describes a disruption in normal bladder function. This disruption can result in an overactive (frequent urination) or underactive bladder (a bladder that is not emptying properly, or is disrupted). Voiding dysfunction can be caused by neurogenic (nerve-related), or non-neurogenic (behavioral; psychological; medical) factors.

Neurogenic bladder

Neurogenic bladder occurs when bladder function is negatively impacted by a neurological disease, nerve disorder, or injury. There are several conditions that can affect the nervous system and bladder activity. These conditions include:

• Diabetes
• Multiple Sclerosis
• Parkinson’s Disease
• Spinal cord injuries / trauma
• Congenital defects such as Spina Bifida
• Stroke

Treatment Options for Voiding Dysfunction

The appropriate treatment for voiding dysfunction will depend on the underlying cause – whether nerve damage, disease, urinary blockage, or behavior. In some cases, voiding dysfunction is tied to a specific urologic condition that will need to be treated in order to eliminate voiding dysfunction.

Behavioral Modification

Sometimes, an individual’s lifestyle or behavior will impact bladder function. For example, overactive bladder and urge incontinence can be triggered by lifestyle choices that irritate the bladder causing urinary frequency and urgency. Common bladder irritants include caffeine, smoking, alcohol consumption, carbonated beverages, sugar, and spicy foods. All of these are individual choices that can be modified.

Conservative treatment options for overactive bladder can include an adjustment in fluid intake (particularly before bedtime) and establishing a voiding schedule to control symptoms. Strengthening the pelvic floor muscles can also enable better control of urgency and overactive bladder symptoms.

Insertable Devices

If pelvic organ prolapse is the underlying cause of a voiding dysfunction, a pessary can be used to support the pelvic organ that may be affecting bladder function. Likewise, urethral inserts may be used for patients with stress incontinence causing voiding dysfunction.

Surgical Options

The cause of stress incontinence in many women is a lack of support for the bladder neck. The Pubovaginal Sling (PV) procedure corrects stress incontinence by reconfiguring the fascial support for the bladder neck. By inserting this device, voiding dysfunction can be controlled.

Interstim

InterStim Therapy applies a mild electrical stimulation to sacral nerves in order to regulate the behavior of the bladder and pelvic floor muscles. This surgical option is primarily used to control overactive bladder symptoms.

Collagen Injection

Some women have stress incontinence without bladder neck support. In this case, injection of a small volume of collagen into the region of the sphincter may improve urethral coaptation and prevent stress incontinence.

Enlarged Prostate

Men with enlarged prostates may also experience voiding dysfunction due to excess prostate tissue that disrupts the flow of urine. There are several procedures that can reduce or eliminate prostate tissue including Transurethral Resection of the Prostate (TURP), Rezum Water Vapor Therapy, and UroLift.

Artificial Urinary Sphincter

The artificial urinary sphincter is an implantable device that is used to restore continence to men who have persistent urinary leakage following radical prostatectomy.

Urinary Tract Reconstruction

Patients with severe bladder dysfunction caused by neurologic disease or spinal cord injury may benefit from urinary tract reconstruction to facilitate urine storage, bladder emptying, or urinary diversion.

If you are experiencing any type of voiding dysfunction, contact Urology Austin to schedule an appointment with one of our urologists.