Bladder dysfunction in peripheral neuropathies

Abstract

Normal bladder function depends on the complex interaction of sensory and motor pathways. Bladder dysfunction can develop as a result of several neurological conditions. It can happen in a number of ways, including diabetic cystopathy, detrusor overactivity, bladder outlet obstruction, and urge and stress urinary incontinence. Diabetic neuropathy is the most common cause of peripheral neuropathy-associated bladder dysfunction. Guillain-Barré syndrome (GBS), human immunodeficiency virus (HIV)-associated neuropathy, chronic inflammatory demyelinating polyneuropathy (CIDP), and amyloid neuropathy are other major causes. The diagnosis of bladder dysfunction should be established by the history of neurological symptoms, neurological examination, and urological evaluation. Functional evaluation of the lower urinary tract includes cystometry, sphincter electromyography, uroflowmetry, and urethral pressure profilometry. Management of urinary symptoms in patients with bladder dysfunction is usually supportive. In some cases, alpha-blocker and/or anti-muscarinic agents are needed to help improve urinary dysfunction. Intermittent self-catheterization is needed occasionally for patients with slow and/or poor recovery.

An overview of urinary incontinence

“…o Diabetes mellitus can increase urine production and decrease bladder sensation due to peripheral neuropathy resulting in urgency and frequency, which may lead to incontinence if mobility and dexterity are also impaired (Burakgazi et al, 2012). o Heart disease can cause fluid retention and impaired renal function and as drug treatment increases urine output, frequency is common (Tannenbaum, and Johnell, 2014).…”

Diabetic Neuropathies: Diagnosis and Management

“…Impaired bladder sensation is usually the first manifestation of lower urinary tract involvement. Micturition reflexes are delayed due to diminished bladder sensation with increases in bladder capacity and urinary retention that usually occur asymptomatically [26,30]. Patients are frequently unaware of bladder dysfunction until they have a urinary tract infection secondary to increased residual urine volume [3,26,30].…”

“…Patients are frequently unaware of bladder dysfunction until they have a urinary tract infection secondary to increased residual urine volume [3,26,30]. The common symptoms are straining, hesitation and weakness of stream [26,30]. Diabetic cystopathy is characterized by impaired sensation of bladder fullness, which leads to overstretched bladder, reduced bladder contractility, increased residual urine and impaired uroflow [30].…”

“…The common symptoms are straining, hesitation and weakness of stream [26,30]. Diabetic cystopathy is characterized by impaired sensation of bladder fullness, which leads to overstretched bladder, reduced bladder contractility, increased residual urine and impaired uroflow [30]. …”

“…The cause of bladder dysfunction in diabetes mellitus is primarily peripheral and autonomic neuropathy. Animal and human studies have revealed that diabetic cystopathy develops as a result of polyneuropathy, which predominantly affects sensory and autonomic nerve fibres [30]. …”