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Urinary incontinence and neurogenic urinary disorders
Urinary incontinence is a prevalent condition characterized by the involuntary loss of urine, with significant implications for physical health and psychosocial well-being. The etiology of urinary incontinence is multifactorial, involving dysfunction of the lower urinary tract, pelvic floor muscles, and neural control mechanisms. Common subtypes include stress, urge, mixed, and overflow incontinence, each with distinct pathophysiological mechanisms. The prevalence of urinary incontinence increases with age and is higher among women, particularly following pregnancy, childbirth, and menopause. In men, urinary incontinence is frequently associated with prostate disease or as a complication of prostate surgery. Urinary incontinence is associated with reduced quality of life, increased risk of depression, and social isolation. Diagnosis relies on a comprehensive clinical assessment, including patient history, physical examination, and, when indicated, urodynamic testing. Conservative management strategies, such as pelvic floor muscle training and bladder retraining, are considered first-line therapies. Pharmacological and surgical interventions may be indicated for patients with moderate to severe symptoms or refractory disease. Ongoing research focuses on improving diagnostic accuracy and developing minimally invasive treatment modalities to optimize patient outcomes. Neurogenic bladder dysfunction is a loss of bladder control caused by damage to the brain, spinal cord, or nerves, resulting in either an overactive (spastic) or underactive (flaccid) bladder. Common causes include stroke, spinal cord injury, MS, Parkinson’s, and diabetes. Symptoms range from incontinence and frequency to urine retention. Types of Neurogenic Bladder Overactive (Spastic/Hyperreflexic): The bladder muscle contracts automatically, causing frequency, urgency, and urge incontinence. Underactive (Flaccid/Hypotonic): The bladder muscle does not contract, leading to urinary retention, overflow incontinence (dribbling), and inability to empty fully. Mixed: Features of both overactive and underactive. Detrusor-Sphincter Dyssynergia: The bladder contracts while the sphincter muscle remains closed, preventing emptying.
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