While you may have heard about Overactive Bladder (OAB) due to lots of media attention, many do not know about Underactive Bladder (UAB). UAB is a syndrome that includes the urinary symptoms of hesitancy, straining and incomplete bladder emptying in the absence of any blockage of the bladder or the urethra. The current definition of underactive bladder (UAB) states, “UAB is characterized by a slow urinary stream, hesitancy, and straining to void with or without a feeling of incomplete bladder emptying, sometimes with storage symptoms.”
What Is Underactive Bladder?
UAB is a serious, ongoing, and difficult disease and it has serious consequences if not treated. Your healthcare professional may refer to underactive bladder as detrusor underactivity, hypotonic bladder, flaccid bladder, lazy bladder, and detrusor hypoactivity. A diagnosis of UAB is usually confirmed with pressure flow urodynamic tests and patient history. How many people have UAB is not known, and studies are needed to determine its prevalence.
People with UAB can usually hold large amounts of urine in their bladders but are not able to sense that their bladders are full and need emptying. A person can have both UAB and OAB. Persons with UAB are not able to contract their muscles with enough strength or force to empty their bladders completely when they go to the bathroom. Like many diseases, UAB varies from person to person as far as the symptoms and the severity level, and it can affect people from a young age to those over 60 years. All ethnic groups are affected, also.
Prevention and Treatment of Underactive Bladder
We do not know how to prevent UAB at this time, but there are some treatment options available, although none is an absolute cure for this problem. A large amount of research on UAB is under way, however, which could bring new treatments and the potential for cures in the future.
Current treatments are the use of prescription medications (Bethanechol, Doxazosin and Finasteride), double or triggered-reflex voiding, and the use of intermittent self-catheterizations to drain the bladder. These treatments may not represent a cure, but instead they slow down the disease and helps limit the damage done by UAB on the bladder and kidneys.
What Causes an Underactive Bladder?
The Underactive Bladder Foundation has identified several risk factors associated with this syndrome. They are:
- Nerve damage – damage to peripheral nerves may lessen or eliminate the feeling of the bladder filling and also cause difficulty in emptying the bladder
- Diabetes – high blood sugar can cause damage to peripheral nerves leading to incomplete emptying of the bladder
- Bladder sarcopenia –sarcopenia is the age-related loss of muscle mass and muscle strength. When the bladder muscle loses strength, it can lead to retention of urine and difficulty voiding (peeing).
- Pelvic surgery – surgery can potentially injure the bladder nerves resulting in damage that would then cause decreased bladder contractions
- Increasing age – the volume and elasticity of the bladder can decrease as we age
- Obstruction – enlargement of the prostate and prostate cancer in men and severe vaginal prolapse in women can block the urine’s flow down the urinary tract
- Urinary tract infections – the bladder muscle will have reduced contractility if there is an infection present in the bladder or urethra. This leads to urinary retention.
- Medication – drugs with an antimuscarinic property block a chemical that relaxes the bladder muscle. Examples of these drugs are antidepressants, antihistamines, and muscle relaxants.
- Spinal cord injury (SCI)– injuries above T12 usually leave a patient with reflex bladder action, but those with injuries at L1 and below may have a flaccid bladder, which will not contract. In these cases, bladder emptying will need assistance.
All changes in your urination patterns should be reported to your healthcare professional at the earliest opportunity. Proper diagnosis and treatment is essential for your continuing good health. This information on treatments for the symptoms of Underactive Bladder does not in any way constitute therapeutic recommendations, prescriptions or endorsements. Consult your physician for the treatment regimen that is best suited for your individual condition.
For more information on UAB, visit the Underactive Bladder Foundation’s website.
Medical reviewer: Diane Newman, DNP, ANP-BC, FAAN
Dr. Newman is Adjunct Professor of Urology in Surgery and Research Investigator Senior at the Perelman School of Medicine, University of Pennsylvania. She also serves as Co-Director of the Penn Center for Continence and Pelvic Health, Division of Urology at the University of Pennsylvania Medical Center. Dr Newman has over 30 years’ experience practicing as a urology nurse, since 2000, in the Division of Urology at the University of Pennsylvania in Philadelphia. Her current practice involves the evaluation, treatment, and management of urinary incontinence and related problems including the use of catheters and other devices in the management of bladder dysfunction. Dr Newman has held multiple leadership positions in professional groups and government-sponsored expert panels over the last decade. She’s been quoted frequently as an incontinence expert in top-tier media outlets like The New York Times, and has co-authored many notable books and medical publications on the topic. She is the author of the books, The Urinary Incontinence Sourcebook, Managing and Treating Urinary Incontinence (1st and 2nd editions), Overcoming Overactive Bladder and a coauthor of Fast Facts: Bladder Disorders. She is the lead editor of the Society of Urologic Nurses and Associates Core Curriculum for Urologic Nursing. She is the lead editor of Clinical Application of Urologic Catheters, Devices and Products. She is the Principal Investigator of three NIH studies on prevention and treatment of urinary incontinence, Co-investigator of PCORI and VA funded grants on prostate cancer.