Do you suffer from sudden urge to urinate that is associated with an involuntary loss of urine?
If yes, you may be suffering from urgency incontinence. Urgency incontinence is a part of the spectrum of symptoms covered under Overactive Bladder syndrome. You can read about overactive bladder syndrome here. Patients with urgency incontinence have involuntary losses of urine associated with a sudden urge to urinate.
One of the most common causes of urgency incontinence is detrusor instability, also called as detrusor overactivity. Detrusor muscle is the bladder wall muscle. Detrusor instability is a condition in which some patients have sudden spontaneous spasms of the detrusor muscle leading to leaking of urine. Prevalence of detrusor activity increases with age.
What causes detrusor instability?
In most cases, the cause of detrusor instability is not known. Spasms of the bladder muscle can be caused by
- Bladder infection
- Blood in urine due to various causes
- Tumour or any other pathology in the bladder
- Neurological conditions such as Parkinson’s disease, spinal cord injury, diabetic neuropathy, multiple sclerosis, dementia or stroke. Detrusor overactivity caused by neurological conditions is called as neurogenic detrusor instability. Neurogenic detrusor overactivity occurs because the spinal cord and the bladder are not able to communicate effectively due to neurological damage. As a result, the bladder muscle contract involuntarily. The increased pressure in the bladder decreases the volume of urine the bladder can hold, causing the patient to suffer from frequent andunexpected leaks of urine.
How is detrusor instability diagnosed?
Detrusor instability is an urodynamic diagnosis
The diagnosis of overactive bladder syndrome (of which detrusor instability is a part) has been covered in great detail here. A patient with suspected detrusor instability will undergo the same protocol.
An important point to mention here is that while urgency incontinence and overactive bladder syndrome refers to the symptoms of the patient;the diagnosis of detrusor instability is reserved for those patients in whom spontaneous, involuntary contractions of the bladder wall are demonstrated on advanced urodynamics. Urodynamics is a series of bladder tests where catheters inserted into the bladder and the vagina/ rectum are used to evaluate the ability of the bladder to fill, store and evacuate urine.
The treatment for detrusor instability is similar to that outlined for overactive bladder here. Lifestyle changes, behavioural modification and physiotherapy are the first steps in the treatment. Anticholinergic medication is useful in these patients because of its ability to reduce the spasm of the bladder muscle.
If oral medication fails, botox injection into the bladder muscle wall is an important treatment option as botox acts by preventing bladder muscle spasm. It is useful in both detrusor instability for unknown reasons and neurogenic bladder instability. You can read about botox injection for detrusor instability here.
Surgical treatments include sacral nerve stimulation (interstim) and very rarely bladder augmentation surgery.