Human bladder is a reservoir where a certain amount of urine is collected before it is expelled out. The urine contains all the body toxins.
Normally the bladder can retain up to 300 ml of urine before sending out signals to the brain that it needs to empty. When the circumstances are not appropriate, the higher centers in the brain send signals to the bladder to hold the urine till a washroom is located. In such cases the bladder can hold up to 600 ml of urine.
Normally the urine collects in the bladder. The bladder slowly stretches till it reaches an elastic limit. At this point the nerves carry sensation of bladder fullness from the bladder muscles to the brain. If there is a washroom nearby, the brain sends signals through the nerves to the bladder for emptying. The sacral nerves supplying the bladder cause contraction of the bladder wall, relaxation of the external sphincter (ring of muscles that keep the bladder mouth closed) and the urine is expelled.
Voiding of urine is a result of combined and coordinated activity of the bladder muscles, the nerves that communicate between the brain and bladder and the higher centers in the brain. Any damage to the spinal cord or the brain results in a neurogenic bladder.
The neurogenic bladder can be of different types. Some people suffer from urge incontinence. In such a condition the person gets an urge to void and is unable to stop himself. This person passes small amounts of urine at frequent intervals. Some people suffer from increased urge to void, but are unable to do so. This results in dribbling incontinence. The Bladder contracts to expel the urine but the muscles around the mouth of bladder also contract to close it, as a result very little amount dribbles out. In another variety known as overactive bladder, the bladder muscles are in a state of spasm. With a small amount of urine, the bladder muscles contract and expel the urine as a result of a stretch reflex.
There are many different methods to treat incontinence. Sacral stimulation is one of the new techniques developed for this condition. Interstim is a small device which is of a size of a pacemaker. It is fitted in the buttock under the skin. One set of leads are attached to the sacral nerves that supply the bladder and the other set is connected to a control that is tied at the wrist. When the person feels a need to void, he can press the wrist band. This sends signals to the sacral nerves and their action and influence on the pelvic floor muscles, urinary tract, bladder muscles and sphincters is modulated. The person can then void at his own wish.
This therapy is relatively new and it has to be tried for 3-7 days to determine whether a person is suitable for it. The surgeon fits it to the ankle and then connects the leads to the sacral nerves in the lower back and the other set to the control tied at the wrist. The person is sent home and asked to see for a change in the urine output frequency. If the number of visits to the washroom reduces significantly, then the therapy is considered useful for long term.
There are few disadvantages of this technique. There can be a new pain, infection, lead migration, technical errors because of the device. The technique can only be used for various types of neurogenic bladder and not for incontinence due to any mechanical obstruction.
This is another new technique which is still in its infancy. It can be used for spasmodic or overactive bladders. Botox is a chemical that causes temporary paralysis of muscles. When Botox injections are given to spasmodic bladder muscles, they undergo relaxation. As a result they do not undergo immediate contraction when the bladder fills with less amount of urine. The method is useful as you can control the bladder emptying, but as the effect is transient, repeated injections at an interval of 6 months are required to sustain the desired effect. The drawback is that the bladder may become flaccid with repeated injections causing urine retention and infection.
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