Clinical Features – Bladder disorders
Bladder Infection (Cystitis)
This is bacterial infection in the urine which normally is sterile. Inflammation in the bladder causes pain and discomfort in the lower abdomen above the pubic bone, and in the urethra, while the person is urinating. Other symptoms are frequency of urination, (but not an increase in the total volume of urine produced) urgency, incontinence, fever, vomiting and diarrhoea, blood in the urine, “smelly” or offensive urine, and stranguary (the feeling of needing to pass something which is not present), which is often present at the end of urination. More than 80% of urinary tract infections (UTI’s) are caused by bacterial infections.
It occurs much more commonly in women because of the short urethra, whereby organisms can easily gain entrance to the bladder.
Bladder incontinence
Problems with continence (incontinence), occurs commonly in older people, especially and affects around 50% of residents in care homes. It is often a reason for institutionalisation, because of the extra burden it imposes on carers. 30% of the older population living at home are also affected. It causes a great deal of embarrassment, and can significantly limit the person’s lifestyle.
The four main types of incontinence are:
- Stress
- Urge
- Overflow
- Functional incontinence
Stress incontinence usually occurs in women, as a result of weakness of muscles in the pelvis or at the neck of the bladder. It results in leakage of urine in certain specific situations such as when coughing, laughing sneezing or during exercise. It tends to affect older women, particularly after the menopause, because of a lack of oestrogen and the tendency may be increased by stresses to the pelvic muscles during childbirth years ago. (This can lead to prolapse of certain pelvic muscles).
The bladder sphincter may be damaged from a previous trans-urethral resection (TUR) or radical prostatectomy and this can lead to incontinence in men. Stress incontinence is otherwise rare in men.
Urge incontinence is the result of instability of the bladder muscles, and is one of the biggest problems in the elderly. It results in an urgent need to pass urine at frequent intervals both day and night. Incontinence results if there is delay in reaching a toilet or suitable receptacle. Urge incontinence may result from a problem with the bladder itself, or it may arise as a consequence of damage to the central nervous system and nerves controlling bladder function. It also may be caused by an enlarged prostate gland.
Overflow incontinence occurs when the bladder fails to empty completely. Urine builds up and in the end overflows resulting in either intermittent or continuous dribbling. It may result from obstruction to the neck of the bladder, as occurs in older men due to enlargement of the prostate gland at the base of the bladder. It may also result from disease or injury of the brain or spinal cord, e.g. multiple sclerosis or traumatic paraplegia, which affects the nerves that control bladder function. In such cases there may be complete lack of control of bladder function.
Dribbling may result from partial retention of urine due to an enlarged prostate. (A small proportion of these may develop renal failure).
Functional incontinence is the passing of urine in inappropriate places. It may be a result of varying degrees of immobility, for example making it difficult or impossible for the person to reach a toilet or to manage their clothing. It may also be the result of disturbed mental function, e.g. dementia, severe behaviour disorders, in which normal awareness of acceptable social behaviour is lost.
Continual Incontinence
Continual incontinence means a constant dribble of urine and usually means a fistula (a track) is present between the bladder and the vagina or the ureter and the vagina.
It can be congenital, follow gynaecological surgery, or follow damage caused by radiotherapy to the area following malignancy.
Bladder stones (Bladder Calculi)
Bladder stones may cause lower abdominal pain and stranguary (the feeling of needing to pass something which is not present). Bacterial infection in the urine may be present. Other symptoms are pain on passing urine, frequency of passing urine, haematuria (blood in the urine), distension of the bladder and inability to pass urine at all, if the outflow of the bladder is blocked.
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Amended June 2008
