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Contributing Factors
Excess bladder pressure
1. from excess urine production
a. excess water intake
b. diuretics
c. diabetes mellitus
2. from excess urine retention
a. voluntary retention (e.g., disability, inaccessibility of toilet facilities)
b. physical obstructions (e.g., urinary stones, tumors, fecal impaction,
prostatic hypertrophy)
c. inadequate nervous stimulation of the bladder (e.g., spinal cord injury,
bladder nerve damage, certain tranquilizers)
d. weak bladder contractions (e.g., overstretched bladder from urine retention)
3. from excess stimulation
of the bladder
a. from excess urine retention (see above)
b. from inflammation (e.g., catheters, infection)
c. from nerve injury causing loss of voluntary inhibitory impulses (e.g.,
dementias, strokes)
Inadequate contraction of sphincter and pelvic floor
muscles
1. from sphincter and pelvic
muscle weakness
a. from physical injury (e.g., catheters, surgery)
b. from shrinkage (e.g., low estrogen)
2. from reduced nervous
stimulation of muscles
a. from CNS disorders (e.g., dementias, strokes)
b. from psychological problems (e.g., depression, anxiety)
Treatments
1. Regulate intake of fluids and diuretics
(e.g., alcohol, caffeine, drugs) to reduce urine formation.
2. Regulate all medications affecting urinary
or nervous system functioning.
3. Assure accessibility to facilities (bedpans,
urinals, care-giver assistance).
4. Urinate at scheduled times.
5. Cure urinary tract infections to reduce
bladder instability.
6. Exercise sphincter and pelvic floor muscles
to increase strength (e.g., Kagel exercises).
7. Estrogen therapy in women to increase urethral
strength.
8. Medications to modify bladder and internal
sphincter function.
9. Surgery to remove obstructions (e.g., prostate
surgery), enlarge the bladder, denervate the bladder, implant an artificial
sphincter.
10. Behavioral modification and training.
11. Biofeedback control to (1) increase awareness
of need to void and (2) gain better control of muscles.
12. Electrical stimulators to control muscles.
13. Absorbent pads or male condom catheters to catch
urine.
14. Skin care to avoid complications.
15. Catheters to drain urine (last choice due to
complications {e.g., infections, bladder instability}).
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© Copyright 1999 - Augustine G. DiGiovanna - All rights reserved.
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PERSPECTIVES by Augustine G. DiGiovanna, The McGraw-Hill Companies, New
York, 1994 or 2000; (2) If prior written permission is obtained
from Augustine G. DiGiovanna.