Page 15 - Bladder Dysfunction in the Context of the Bladder-Brain Connection - Ilse Groenendijk.pdf

Introduction 13
increasing significant economic and social burden.7-10 The economic burden in the USA was estimated at > $ 9 milliard a year and ranges between countries in Europe from € 333 million to € 1.2 milliard per year.11, 12 Social embarrassment and shame prevents patients with urinary incontinence (UI) and other LUTS, from seeking help and treatment. Conse- quently, these symptoms are underexposed and the currently estimated prevalence is most likely underestimated.13, 14
Storage symptoms can present in the form of UI, increased daytime frequency, urgency, and nocturia. Urinary incontinence is sub classified into urgency UI , stress UI and mixed UI. Urgency UI is involuntary urine leakage accompanied by or immediately preceded by urgency. Stress UI is involuntary urine leakage on effort or exertion, or on sneezing or coughing. Mixed UI is both urgency UI and stress UI together.15 Voiding symptoms can present in the form of hesitancy, slow stream, intermittency, the feeling of incomplete emptying and post-micturition dribble.15
Within functional urology, various syndromes have been described, e.g. overactive bladder (OAB), underactive bladder (UAB) and the bladder pain syndrome (BPS). The latter is included in the LUT domain of chronic pelvic pain.16 OAB and UAB can present concomitantly.
OAB has the highest prevalence of more than 10% worldwide,7 and is characterized by storage symptoms: urinary urgency, with or without urgency UI, usually with urinary frequency and nocturia, if there is no proven infection or other obvious pathology.17
UAB is defined as having voiding symptoms: slow urinary stream, hesitancy and strain- ing to void, with or without a feeling of incomplete bladder emptying sometimes with storage symptoms.18
The BPS is persistent or recurrent chronic pelvic pain, pressure or discomfort perceived to be related to the urinary bladder, accompanied by at least one other urinary symptom such as an urgent need to void or urinary frequency.19
As described above, an intact innervation of the LUT is essential for a proper function of the LUT. Within functional urology it is important to distinguish non-neuro-urological patients from neuro-urological patients. In neuro-urological patients, the innervation is disturbed due to a known neurological disorder, for instance spina bifida (congenital) or multiple sclerosis (acquired). Different disorders of the LUT can occur in this patient group, such as low bladder compliance or dysfunction of the pelvic floor muscles which create various symptoms, like UI, the inability to empty the bladder properly or recurrent urinary tract infections. Proper treatment and follow-up are very important to preserve kidney function in neuro-urological patients.1, 20
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