Non-neurogenic voiding dysfunction is the inability to fully empty the bladder. In contrast, neurogenic voiding dysfunction (which is also called neurogenic bladder) is a condition in which problems with the brain, nerves, or spinal cord impair bladder control.
Symptoms of Non-Neurogenic Voiding Dysfunction
Patients with non-neurogenic voiding dysfunction may experience the following symptoms:
- Difficulty beginning urination
- Straining to urinate
- Slow urine stream or flow that starts and stops
- Constipation
- Need to push with the stomach muscles or push onto the abdomen with the hands to urinate
- Inability to fully empty the bladder
- Urinating more than usual
- Infrequent urination
- Urinary incontinence
- Frequent urinating at night
- Strong, sudden need to urinate
- In children, wetting during the day and crossing the legs or squatting to hold in urine
Causes of Non-Neurogenic Voiding Dysfunction
Individuals with non-neurogenic voiding dysfunction struggle to fully empty the bladder due to a blockage in the flow of urine, weak bladder muscle, or behavioral problems or habits that develop over time.
Factors that may contribute to voiding dysfunction include:
- Overactive bladder
- Constipation
- Blockage in the flow of urine
- Infections, such as urinary tract infection
- Dysfunctional elimination syndrome
- Ignoring the urge to urinate until the bladder is very full
- Underactive bladder that doesn’t create an urge to urinate
Diagnosing Voiding Dysfunction
During a doctor’s appointment, the physician will review the patient’s medical history and perform a physical exam. Female patients will have their pelvic region examined, while male patients will be checked for issues with their prostate, such as an enlarged prostate. Some patients may be asked to keep a bladder diary to track daily urination.
The following tests may also be necessary to diagnose voiding dysfunction:
- Urinalysis to check for urinary tract infection.
- Blood test to check for high levels of prostate-specific antigens (PSAs) in men.
- Cystoscopy to evaluate the bladder.
- Ultrasound to assess the amount of urine that remains in the bladder after urination and identify a voiding problem.
- Urodynamic testing to measure the bladder’s ability to hold urine and the ability of the muscles in the urethra, bladder, and pelvis to work together.
Treatment Options For Voiding Dysfunction
Treatment for patients diagnosed with voiding dysfunction will depend on the underlying cause. Common treatments include:
- Bladder training to teach the muscles how to support the bladder and allow patients to hold the urine longer or to urinate more easily.
- Medications such as tamsulosin to improve voiding problems, or oxybutynin and tolterodine to treat urinary urgency or leakage.
- Pelvic floor therapy to teach patients how to relax the muscles in the pelvic floor to make urination easier. Biofeedback sensors may also be placed in the vagina or retum to ensure the patient is using the right muscles during therapy.
- Botox injections to relax the muscles in the bladder and treat urge incontinence.
- Sacral nerve stimulation to help reduce urinary urgency and leakage and to empty the bladder more effectively. A neurotransmitter is placed under the skin, above the buttocks and sends mild electrical impulses to the sacral nerve through a wire under the skin.
- Percutaneous tibial nerve stimulation (PTNS) to help improve control over the bladder. An electrode is placed near the tibial nerve in the ankle, while a stimulator device sends mild electrical signals to the sacral nerve in the pelvis, which controls the bladder, urinary sphincter, and pelvic floor muscles.
- Self-catheterization to drain urine from the bladder.