Female abnormal voiding: Underactive bladder disease

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After 5 years of urology practicing in Cambodia, a female abnormal urination problem is getting more and more common in my female urology clinic. Today we will discuss about “Underactive bladder” disease in female. Normally, the bladder’s function is to store urine and squeezing all urine out when we urinate, but this kind of disease making bladder cannot contract as strong as it should be, leading to the following symptoms.

• Weaken urinary stream
• Prolonging urination time in toilet
• Sense of incomplete emptying

After Urologist carefully found that the problem didn’t causes by the other common conditions such as bladder infection so we will focus on underactive bladder disease instead.

The etiologies of the underactive bladder disease are shown as below

1. Neurologic-related conditions – Bladder is an organ which is controlling by the brain and spinal cord so any disorders from them it will be affect the bladder functioning.
   • Stroke
   • Brain or spinal cord tumor
   • Spinal cord injury
   • Disc herniation
   • Rare disease – Multiple sclerosis
2. Aging process – As an all organs in our body, the bladder can be old and degenerative. There is a sub-conscious muscle which surrounding the bladder functioning as squeezing the urine, the more aging, the weakest muscle it is, so leading to a weak bladder contraction.

3. Prolong bladder over-distension period – This event is commonly found in postoperative spinal anesthesia.
4. Diabetes Mellitus (DM) – This common degenerative disease also affects bladder functioning. Less sense of urination and less bladder contraction power are the classical endpoint of poor control DM.

The underactive bladder disease’s treatment options are shown below (Based on currently practicing in Cambodia)

1. Behavioral therapy
   • Setting time voiding – Regular timing urinate can prevent bladder overdistension.
   • Assist void by abdominal straining
   • Double-voiding techniques – Try urinating again in 20 minutes the first micturition for emptying more the bladder.
2. Oral medications – there are several choices of medication which contain the following effects.
   • Increases sense of bladder fullness
   • Facilitate voiding mechanism
3. Clean intermittent self-catheterization (CIC) – CIC is considered when patients experienced the complication of a high residual urine whether on the above treatment already. The example of complications.
   • Urinary retention
   • Repeatable bladder infection
   • Renal failure from high residual urine

Female underactive bladder problem always the difficult issue for both urologist and the patient. Better understanding the causative and proper treatment that will bring out the best outcome. Any questions, you can discuss with your trusted urologist, or you can text me directly here.

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