An underactive bladder is a bladder with reduced or no muscle contraction. This may cause retention overflow which is the loss of urine associated with an overfull or distended bladder. Persons may notice they strain to pass urine, their urine stream has changed and they have problemswith frequency, sometimes a constant dribble and a feeling of incomplete emptying of the bladder. This group often runs into problems with recurrent urinary tract infections.
Causes of underactive bladder:
- Enlarged prostate
- Faecal impaction
- Urethral strictures
- Spinal cord injury
- Some medications
Management of an underactive bladder:
- Surgery if enlarged prostate or strictures – this is to relieve the obstruction.
- Intermittent catheterization – in some instances intermittent catheterization is the only option that allows a person to effectively empty their bladder.
- Use of double voiding technique – this technique is to ensure less urine residual in the bladder.
- Correct toileting position – allows the pelvic muscles to relax and a normal anatomical position will allow bowel motions to pass easily.
- Reduce fluids which irritate the bladder – these include tea, coffee and alcohol.
- Review medications and adjust/change if appropriate – some medications may cause urinary retention.
- Ensuring a regular bowel routine – a full bowel can put pressure on the bladder causing leakage.
Functional incontinence is the loss of urine associated with the person’s inability to cope with normal bladder function.
Contributing factors include:
- Impaired cognitive function
- Impaired mobility
- Home, hospital or facility environment
- Availability of assistance
- Environmental adaptations – assessing home environment and the person’s ability to access toilet/bathroom. Use of adaptive equipment i.e commode by the bedside, urinal
- Clothing adaptations – if inability to undo clothing, the use of Velcro and other adaptive material allow the patient more independence when toileting.
- Changes in medications – some medication may cause issues with bladder emptying. Review of medications and change where possible.
- The use of appropriate containments aids – pads for male and female and condom drainage for males.