Introduction
The term "non-neurogenic voiding dysfunction" describes a group of urinary issues that impact the regular urination process and result from non-neurological causes. For better quality of life and general well-being, it is imperative to understand this illness and treat it appropriately.1
Causes of non-neurogenic voiding dysfunction
The kidneys, ureters, bladder, and urethra make up the urinary system, which functions as a whole to remove waste from the body. Disruptions to this complex mechanism can cause dysfunction related to voiding. These include:1
Structural abnormalities
Urinary tract abnormalities might make it difficult for urine to flow normally. Bladder diverticula, urethral strictures, and other ureteral abnormalities can all result in obstructions or restrictions that make it difficult to evacuate.
Functional issues
Non-neurogenic voiding disorder may also result from urinary system malfunctions. Disorders such as an overactive bladder (OAB), reduced detrusor activity, or dysfunctional voiding can cause the bladder muscles to contract irregularly, impairing the normal ejection of urine.
Inflammatory conditions
Dysvoiding can be considerably increased by urinary tract inflammation. Chronic inflammatory diseases like interstitial cystitis or infections like urinary tract infections (UTIs) can irritate the bladder and surrounding tissues, resulting in pain and impairing regular urination.
Symptoms of non-neurogenic voiding dysfunction
A person's everyday life may be significantly impacted by a variety of symptoms that are indicative of non-neurogenic voiding disorder. It is essential to comprehend these signs to recognise them early and take appropriate action:2
Difficulty initiating urination
Having trouble starting to urinate is one of the main signs of non-neurogenic voiding dysfunction. When starting the urinary process, some people may hesitate or have a weaker stream. This symptom frequently points to bladder or urethral problems that need to be looked at further.
Incomplete bladder emptying
Those with non-neurogenic voiding disorder often complain of feeling as though their bladder is not fully emptying. Even after trying to empty their bladder, some people may still feel that it isn't empty. If this symptom is not treated, it may cause discomfort, an increase in the frequency of urine, and possibly even consequences.
Frequent urination
Another common sign of non-neurogenic voiding dysfunction is frequent urination. People can discover that they are going to the restroom more frequently than usual, which would interfere with everyday activities and may lower their quality of life. This symptom is frequently caused by abnormal contractions of the muscles that contract the bladder or by other malfunctions in the urinary system.
Urgency and incontinence
One of the main signs of non-neurogenic voiding dysfunction is the sensation of urgency or an intense and sudden need to urinate. Incontinence, a condition in which people find it difficult to control their bladder and accidentally leak, may accompany this urgency. Socially and emotionally taxing symptoms like this highlight the significance of early identification and treatment.
Diagnosis
Precise diagnosis is essential to develop successful treatment plans and enhance the quality of life for those with non-neurogenic voiding disorder.
First, a thorough evaluation of the patient's medical history is necessary to diagnose non-neurogenic voiding disorder.1 The patient's history of urinary tract problems, current and past symptoms, frequency, and relevant lifestyle factors will all be questioned by healthcare professionals. This data aids in directing future diagnostic initiatives.
Healthcare practitioners can furthermore evaluate the physical and functional elements of the reproductive and urinary systems through a comprehensive physical examination, which includes a rectal exam or a pelvic exam, depending on the sex of the patient. These tests aid in locating any abnormalities or problems that might be causing voiding dysfunction. Several diagnostic tests can additionally help to diagnose non-neurogenic voiding disorder. These can include:
Uroflowmetry
A diagnostic procedure called uroflowmetry counts the volume and rate of urine discharged during voiding. This non-invasive test can assist in detecting problems like blockage or weak bladder contractions and provide useful information about the flow of urine.3
Cystoscopy
Cystoscopy is the process of viewing the bladder's interior with a thin, camera-equipped tube. Through this process, medical professionals can visually examine the bladder lining to look for any abnormalities, obstructions, or irritation.4
Imaging studies
To acquire detailed images of the urinary system and detect structural abnormalities, stones, or other problems influencing voiding, X-rays or ultrasounds may be used.1 These imaging tests help with diagnosis by offering a thorough picture of the urinary system.
Treatment options
A person's everyday life can be greatly impacted by non-neurogenic voiding disorder, but there are a number of therapeutic options that can help manage the condition effectively. It's critical to customise interventions to meet the unique needs of every patient.
Lifestyle modifications
For those who have voiding disorder, proper fluid management is crucial.1 Reducing urine frequency and relieving symptoms can be achieved by keeping an eye on fluid consumption, particularly in the evening. Implementing additional behavioural techniques into practice can train the bladder to operate better. Urine can be more controlled and less urgent by using techniques like double voiding and scheduled voiding.
Medications
Alpha-blockers are drugs that help the prostate and bladder neck muscles relax, resulting in a more fluid flow of urine.5 Anticholinergic drugs may be an alternative to this: The mechanism of action of anticholinergic drugs is the blockage of the impulses that result in aberrant contractions of the bladder muscles. These medications are frequently recommended to people who have symptoms of an overactive bladder, such as urgency and incontinence.6
Physical therapy
According to the NHS, pelvic floor exercises or bladder training can be used to manage non-neurogenic voiding disorder.
Kegel exercises, or pelvic floor exercises, are good for both men and women. By strengthening the muscles that support the urethra and bladder, these workouts enhance general control over the bladder.
By progressively extending the duration between bathroom visits, bladder training helps the bladder hold more urine and lessens the urge to urinate. Retraining the bladder's function can be accomplished with the help of this behavioural method.1
Surgical interventions
Transurethral resection of the prostate
When prostate enlargement is linked to non-neurogenic voiding dysfunction, transurethral resection of the prostate (TURP) may be advised. To increase urine flow, this surgical treatment includes removing extra prostate tissue.7
Bladder neck suspension
Bladder neck suspension is a treatment option for people of the female sex who have problems voiding due to bladder prolapse. Urinary incontinence problems associated with incomplete bladder emptying are lessened by this surgical procedure, which supports and realigns the bladder neck.8
Prevention strategies
Proactive healthcare procedures in conjunction with lifestyle habits are the key to preventing non-neurogenic voiding disorder:9
- A balanced diet, regular exercise, and enough hydration are all components of a healthy lifestyle that can enhance general well-being and promote a functioning urinary system
- Frequent check-ups enable medical professionals to keep an eye on urinary health and spot possible problems early. Prompt action can enhance treatment results and stop voiding dysfunction from worsening
- Exercises targeting the pelvic floor promote bladder function and lower the risk of dysfunctional voiding by strengthening the pelvic muscles
Living with non-neurogenic voiding dysfunction
Although non-neurogenic voiding dysfunction might be difficult, people can have happy, fulfilling lives if they have the appropriate help and coping mechanisms. Effective communication with healthcare providers, community support, and personal resilience are all necessary for navigating this journey.
Developing coping mechanisms that enable people to successfully control their symptoms is necessary for those who live with voiding disorder.9
- Deep breathing exercises and meditation are examples of mindfulness and relaxation practices that can relieve stress and lessen urgency and incontinence symptoms
- Creating a routine for frequent bathroom visits can furthermore help to bring structure and lessen the unpredictable nature of voiding difficulties. This behavioural approach encourages improved bladder control and aids in the management of symptoms
- Keeping up with proper hygiene habits might help ease incontinence-related worries. Having extra clothes and personal hygiene supplies on hand can boost confidence in unexpected circumstances
Additional psychological support and education may be very beneficial to lessen the symptoms and improve the well-being of the patient.
- Community support: Participating in support groups for people with voiding dysfunction enables people to exchange stories and coping mechanisms. Empathy and a sense of community might arise from realising that others deal with comparable difficulties
- Educational resources: It is essential to have access to trustworthy teaching materials regarding non-neurogenic voiding disorder. Books, seminars, and websites can all offer a wealth of knowledge about the illness, available treatments, and lifestyle modifications
- Professional counseling: To resolve emotional factors associated with living with voiding disorder, seeking the counsel of a mental health expert can be therapeutic. Counselling offers a secure setting for talking through issues and creating coping skills
The most efficient way to manage non-neurogenic voiding disorder effectively, however, is keeping lines of communication open with medical professionals.9
- Make time for routine check-ups with your healthcare professionals so you can assess how your therapy is going and change as needed. This proactive strategy aids in quickly resolving problems
- Be upfront and honest when discussing treatment-related issues, possible adverse effects, and the efficacy of prescription drugs. Changes can be implemented according to the person's response
- Inform medical professionals of any changes to your lifestyle, such as new physical activities or nutritional adjustments. With this information, they can better customise recommendations to meet the needs of each individual
Summary
In conclusion, coping with non-neurogenic voiding disorder is a journey that calls for confidence, encouragement, and skilful communication.
- The symptoms of non-neurogenic voiding dysfunction include incontinence, urgency, frequent urination, trouble starting, and incomplete bladder emptying
- A comprehensive review of the patient's medical history, a physical examination, and diagnostic procedures like cystoscopy, uroflowmetry, and imaging studies are all part of the diagnosis process
- Personalised for each patient, treatment choices include everything from medication and lifestyle changes to physical therapy and surgical procedures
- Getting expert assistance is an essential first step in managing effectively
- Healthcare professionals are qualified to help patients with diagnosis, treatment, and aftercare
- Individuals with non-neurogenic voiding dysfunction can control and improve their symptoms with appropriate therapy
- A positive and empowered path is facilitated by lifestyle changes, community support, and open communication with healthcare practitioners
When accepting their non-neurogenic voiding disorder, people can draw strength from their resiliency, social support, and the awareness that there are useful interventions that can improve their quality of life.
References
- Riccabona M, Fotter R. Non-neurogenic bladder-sphincter dysfunction(“Voiding dysfunction”). In: Riccabona M, editor. Pediatric Urogenital Radiology [Internet]. Cham: Springer International Publishing; 2018 [cited 2023 Nov 28]. p. 397–422. (Medical Radiology). Available from: https://doi.org/10.1007/978-3-319-39202-8_23.
- Jeong SJ, Lee M, Song SH, Kim H, Choo MS, Cho SY, et al. Prevalence and urodynamic characteristics of detrusor overactivity with impaired contractility in the community-dwelling elderly with non-neurogenic lower urinary tract symptoms: Is it from a single or two independent bladder dysfunctions? Investig Clin Urol [Internet]. 2021 Jul [cited 2023 Nov 29];62(4):477–84. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8246009/.
- Faasse MA, Nosnik IP, Diaz-Saldano D, Hodgkins KS, Liu DB, Schreiber J, et al. Uroflowmetry with pelvic floor electromyography: inter-rater agreement on diagnosis of pediatric non-neurogenic voiding disorders. Journal of Pediatric Urology [Internet]. 2015 Aug 1 [cited 2023 Nov 29];11(4):198.e1-198.e6. Available from: https://www.sciencedirect.com/science/article/pii/S1477513115002004.
- Sammer U, Walter M, Knüpfer SC, Mehnert U, Bode-Lesniewska B, Kessler TM. Do we need surveillance urethro-cystoscopy in patients with neurogenic lower urinary tract dysfunction? PLOS ONE [Internet]. 2015 Oct 29 [cited 2023 Nov 29];10(10):e0140970. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0140970.
- Nachawati D, Patel JB. Alpha-blockers. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 24. July 2024]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK556066/
- Nadeau G, Schröder A, Moore K, Genois L, Lamontagne P, Hamel M, et al. Double anticholinergic therapy for refractory neurogenic and nonneurogenic detrusor overactivity in children: Long-term results of a prospective open-label study. Can Urol Assoc J [Internet]. 2014 [cited 2023 Nov 29];8(5–6):175–80. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4081246/.
- Lee KH, Kuo HC. Recovery of voiding efficiency and bladder function in male patients with non-neurogenic detrusor underactivity after transurethral bladder outlet surgery. Urology [Internet]. 2019 Jan 1 [cited 2023 Nov 29];123:235–41. Available from: https://www.sciencedirect.com/science/article/pii/S0090429518310719.
- Nambiar AK, Arlandis S, Bø K, Cobussen-Boekhorst H, Costantini E, de Heide M, et al. European association of urology guidelines on the diagnosis and management of female non-neurogenic lower urinary tract symptoms. Part 1: diagnostics, overactive bladder, stress urinary incontinence, and mixed urinary incontinence. European Urology [Internet]. 2022 Jul 1 [cited 2023 Nov 29];82(1):49–59. Available from: https://www.sciencedirect.com/science/article/pii/S0302283822016037.
- Johnson EK, Bauer SB. Neurogenic voiding dysfunction and functional voiding disorders: evaluation and nonsurgical management. In: The Kelalis--King--Belman Textbook of Clinical Pediatric Urology. 6. Aufl. CRC Press; 2018. Available from: https://www.taylorfrancis.com/chapters/edit/10.1201/9781315113982-58/neurogenic-voiding-dysfunction-functional-voiding-disorders-evaluation-nonsurgical-management-emilie-johnson-stuart-bauer