Monday, 10 December 2012

The need to urinate (go to the loo)

Part of my digest of papers found a fairly recent one on the bladder side of the symptoms, and is my first look into this side of things. 
Title: Bladder dysfunction in hereditary spastic paraplegia: a clinical and urodynamic evaluation
Authors: M Fourtassi, S Jacquin-Courtois, M C Scheiber-Nogueira, A Hajjioui, J Luaute, K Charvier, D Maucort-Boulch and G Rode
Published in: Spinal Chord, Volume 50, Issue 7 (July 2012)
The link is here:

I've only read the abstract so far, but the principal findings appear to be: a large series (29) of HSP patients were analysed. Ultrasound examination revealed no upper urinary tract complications.

Symptom Pecentage Patients
Urinary urgency 72.4% 21
Urinary frequency 65.5% 19
Urinary incontinence 55.2% 16
Urinary hesitancy 51.7% 15
Neurogenic bladder 82.7% 24
Detrusor overactivity 51.7% 15
Detrusor sphincter dysynergia 65.5% 19
Post-void residual >10% of voided volume 41.4% 12

This abstract gets quite "heavy" in its terms - so I've tried to find out what all of these mean, and I've described them below. My take on the paper is that more than 80% of HSP patients have some kind of urinary symptoms, the most common of which is "urgency" - a sudden need to wee. 

In order to allow a bit of self-diagnosis I tried to find out what is "normal". The bladder normally holds 400-600ml although the urge to urinate is usually felt at about 150 ml. Most people go to the toilet four to eight times a day. Most people can sleep for 6 to 8 hours without having to urinate. 

It would seem that bladder problems normally increase with age. Middle aged and older men often wake to urinate once in the early morning hours. Up to 35% of the female population over the age of 60 years is estimated to be incontinent. 17% percent of men over age 60 experience urinary incontinence, with this percentage increasing with age.

My attempt at describing the terms used: 
Detrusor - The bladder muscle
Urination is also known as micturitionvoidingpeeingweeing
Urinary urgency - is a sudden, compelling urge to urinate.
Urinary frequency -  the need to urinate more often than usual
Nocturia - the need to get up in the night to urinate
Urinary incontinence - any involuntary leakage of urine
Urinary hesitancy - a delay between trying to urinate and the flow actually beginning
Neurogenic bladder - dysfunction of the bladder due to disease of the nervous system or nerves
Detrusor overactivity - when the bladder muscle contracts unexpectedly during bladder filling
Detrusor sphincter dysynergia - instead of the urethral sphincter muscle relaxing completely during voiding it contracts causing the flow to be interrupted and the bladder pressure to rise
Post-void residual - the amount of urine retained in the bladder after urination.

As usual, most of my facts are courtesy of Wikipedia with a few other medical sites thrown in for good measure. Having written this I'm reminded of the two Ronnies I want to go to the lavatory sketch about going to the loo with the various smallest room, spend a penny references....

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