N245: Disorders of the Bladder and Lower Urinary Tract

Micturition

Urination

What causes micturition?

Stretch receptors in the bladder send signals to the spinal cord --> send signals to the brain

How do we control micturition?

Control over micturition involves the prefrontal cortex and the motor cortex

What does potty training do?

Potty training teaches children to sense and control their urinary bladder

Causes of urinary obstruction

STDs, constipation, bladder tumors

Benign prostatic hyperplasia

A benign growth of cells within the prostate gland, develops in 90% of men over 80 yrs old

Early stages of urinary obstruction

Bladder compensates for obstruction --> muscle hypertrophy, frequent and urgent urination

Later stages of urinary obstruction

Detrusor muscle cannot contract --> urine retention --> increased frequency of urination

Trabeculae

Hypertrophied smooth muscle in the bladder --> develops due to obstruction

Cellules

Small pockets of mucosal tissue

Diverticula

Abnormal pockets/protrusions in the urinary bladder wall --> develops due to obstruction

Incontinence

Inability to control urination

Enuresis

Involuntary urination by child age older than 4 years

Stress incontinence

Relaxed pelvic floor muscle + increased abdominal pressure --> involuntary urination when coughing laughing, sneezing, running --> puts pressure (stress) on the bladder --> urination

Urge incontinence

Bladder hypersensitivity --> sudden urge to urinate --> involuntary urination

Overflow incontinence

Full bladder --> small leaks because the bladder simply cannot hold anymore

Retention

The inability to empty the bladder

What are some causes of retention?

Spinal injury/anesthesia --> prevents micturition reflex from firing

Neurogenic bladder disorders

Disorders that interfere with the neural control over the ability to keep urine in the bladder (spastic) or pee urine out (flaccid)

Causes of neurogenic bladder disorders

Stroke, Parkinson, MS, spinal cord injuries

Spinal shock

Spinal cord injury --> lack of neural transmission/stimulation --> bladder cannot contract --> catheter is needed to prevent retention

Spastic bladder

What: The inability of the bladder to store urine (brain cannot halt urination anymore)

Cause: Spinal injury above T12

S+S: Involuntary urination

Flaccid bladder

What: The inability of the bladder to empty urine

Causes: Spinal injury below T12

S+S: Urine retention

Treatment for neurogenic bladder disorders

1. Prevent overdistention

2. Prevent UTIs

3. Prevent renal damage

4. Prevent harmful social stigma

Non-urologic conditions that lead to urinary bladder problems

"DIAPPERS"

D - Dementia

I - Infection

A - Atrophic vaginitis

P - Pharmaceuticals

P - Psychological

E - Endocrine (diabetes)

R - Restricted mobility

S - Stool impaction

Treatment for incontinence

Catheters, medicines, surgery, KEGELS

Characteristics of bladder cancers

Multiple tumors, often malignant --> metastasizes to pelvic lymph nodes, liver, and bone

Early S+S of bladder cancers

Hematuria, dysuria, UTIs

Causes of bladder cancers

Exposure to chemicals, smoking, UTIs

Treatment of bladder cancers

Surgery, chemo, radiation, photoradiation