Storage vs voiding symptoms of prostatism

Prostatism – urinary symptoms caused by the prostate

**IMPORTANT prostatism symptoms are not necessarily caused by an “enlarged” prostate because it’s not the absolute size of the prostate that causes symptoms, it’s how much the prostate is interfering with the flow of urine.

Useful to divide symptoms into storage and voiding.

Storage

  • Frequency
  • Urgency
  • Nocturia

Voiding

  • Hesitancy
  • Poor flow
  • Intermittent flow
  • Straining
  • Incomplete emptying

Symptoms can be graded using the International Prostate Symptom Score (IPSS) which rates emptying, frequency, intermittency, urgency, weak stream, straining, and nocturia on scales of 0 – 5. You then add the scores together to get a score out of 35.
0-7 Mildly symptomatic
8-19 Moderately symptomatic
20-35 Severely symptomatic
(www.prostatecancer.ca)

Stress, urge, overflow and mixed incontinence

Urinary incontinence is going when you don’t want to go. It is a big deal because socially it’s just not acceptable and can lead to a lot of psychological stress. If you can’t remember the stages of voiding or the neural control, click here for a refresher.

Types of urinary incontinence

  • Stress: it is caused by an increase in intraabdominal pressure (laughing, coughing, sneezing) and a sphincter that can’t contract enough to prevent leakage
    • Most common type of incontinence in young women
  • Urge: uninhibited contractions of the detrusor muscle, common in older individuals
    • Common in older individuals
  • Mixed: most common type of incontinence, usually refers to a mix of urge and stress incontinence
    • Most common in general
  • Overflow: when the bladder is so full it cannot hold in the urine
    • Common when there’s an obstruction or spinal cord injury

A handy mnemonic to remember the general causes of incontinence is DRIP
Delirium (drugs, acute illness)
Retention (hypocontractility, outflow obstruction)
Inflammation/Infection/Impacted stool
Polyuria (drugs, high output)

Treatment

  • Lifestyle: scheduled voiding, regulating fluid intake, kegel exercises
  • Medications to treat underlying cause (especially anti-cholinergics to treat urge incontinence as the detrusor responds to cholinergic stimulation)
  • Surgery: Such as tension-free vaginal tape (sling) procedure (TVT) for treating stress urinary incontinence

Neural control of micturition

Nerve control of the bladder

  1. Sympathetic: hypogastric nerve (T10-L2), involuntary control of bladder neck and intrinsic sphincter
  2. Parasympathetic: pelvic nerve (S2-S4), involuntary contraction of detrusor
  3. Somatic: pudendal nerve (S2-S4), voluntary contraction/relaxation of external sphincter
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