Bladder pathologies

Other Bladder pathologies to consider which can affect bladder function and cause urinary incontinence include bladder stones, interstitial cystitis/painful bladder syndrome and radiation cystitis.

Bladder stones

Bladder stones (urolithiasis) in developed counties usually occur secondary to urinary stasis, recurrent urinary tract infection, foreign bodies or intestinal mucosa in the urinary tract (urinary diversion or augmentation).

The most common cause is urinary stasis. It mainly affects men over 50 or individuals with neurological bladder emptying disorders. The post void residual urine contains debris and the bladder stones develop from the uric acid, calcium oxalate and magnesium ammonium phosphate in the urine.

The individual will present with a urinary tract infection (UTI) that does not respond to treatment with antibiotics.

In developing countries malnutrition, dehydration and a diet deficient in animal proteins or dietary phosphate can cause bladder stones to develop and the stones can develop without the presence of a bladder emptying problem.

Did you know? Males suffer more than females as females can pass the stones more easily as they have a short urethra.

Interstitial cystitis/painful bladder syndrome

Interstitial cystitis is pain associated with the bladder or urinary urgency, and glomerulations or Hunner ulcers on cystoscopy under anaesthesia, in patients with nine months or more of symptoms^[1]

The following conditions exclude the diagnosis of interstitial cystitis:

• Bladder capacity >350ml
• Absence of intense urge to void during rapid filling of the bladder >150ml
• Autonomous detrusor contractions
• Absence of nocturia or <8 micturitions/day
• Active genital herpes
• Chemical cystitis, radiation cystitis or the bladder tuberculosis
• Bladder tumours

Relative exclusion criteria for the diagnosis of interstitial cystitis are complaints of less than nine months, response to anticholinergic drugs, antibiotics or anticonvulsants, age younger than 18 years, vaginitis, bladder calculi or ureteral calculi.

Interstitial cystitis is often difficult to diagnose. Further information about interstitial cystitis is available from the NIDDK (National Institute of Diabetes and Digestive and Kidney Diseases) website^[2].

Radiation cystitis

Radiation cystitis is damage to the urinary bladder as a complication from pelvic radiation therapy of malignant tumours, most commonly following radiation for prostrate, cervical and bladder cancers.

References

_{1. Wein AJ, Hanno PM, Gillenwater JY (1990). Interstitial cystitis: An introduction to the problem. In Hanno PM, Staskin, DR, Krane RJ et al. (Eds) Interstitial cystitis. London, Springer-Verlag. 1990:3-15.}

_{2. Definition & Facts of Interstitial Cystitis. NIDDK (National Institute of Diabetes and Digestive and Kidney Diseases) website. [Last updated July 2017, cited 24 September 2018] Available from: https://www.niddk.nih.gov/health-information/urologic-diseases/interstitial-cystitis-painful-bladder-syndrome/definition-facts}