What is Detrusor Instability?
Detrusor Instability which is also known by the name of Overactive bladder Syndrome is a pathological condition of the bladder in which the affected individual experiences increased urinary urgency along with frequency and nocturia with at times urinary incontinence as a result of instability of the detrusor muscle. The detrusor muscle forms a layer of the wall of the bladder and plays an active role in bladder control. Detrusor Instability most of the times is idiopathic in nature. Detrusor Instability can be a cause of big embarrassment in people who suffer from this disorder and can ever make people disabled due to their frequent urge to go to the bathroom to urinate.
What Causes Detrusor Instability?
As stated, Detrusor Instability does not have a known cause but is known to be seen more in females than in males. The risk of suffering from Detrusor Instability increases with age. Certain neurological disorders like Parkinson Disease, any injury to the spinal cord, diabetic neuropathy, multiple sclerosis, stroke and the like increase the risk of Detrusor Instability. An enlarged prostate may also lead to Detrusor Instability.
What are the Symptoms of Detrusor Instability?
Some of the symptoms of Detrusor Instability are:
- Increased urinary frequency
- Pain or discomfort in the abdominal area
- Urinary urge incontinence, more prevalent in females.
How is Detrusor Instability Diagnosed?
In order to diagnose Detrusor Instability, to begin with the physician will order a Urine Dipstick study along with a midstream urine specimen for laboratory analysis to check for a urinary tract infection. Tests may also be done to rule out conditions like renal dysfunction and the like as a cause for Detrusor Instability. A confirmatory diagnosis of Detrusor Instability can be made through urodynamic studies which will clearly show involuntary contraction of the bladder.
How is Detrusor Instability Treated?
The treatment for Detrusor Instability is multi-fold and is as described below:
Lifestyle Modification to Treat Detrusor Instability: The treatment for Detrusor Instability begins with certain lifestyle modifications like limiting caffeine intake, modification of the intake of fluids so that the bladder does not fill in quickly, although this may lead to the urine becoming more concentrated thus irritating the muscles of the bladder. In overweight patients, weight loss is encouraged to get the symptoms of Detrusor Instability under control.
Bladder Training: This is the next step towards treating Detrusor Instability. This takes for a minimum period of six weeks before positive results can be achieved. This is done by scheduling timed voids which means going to the bathroom to void at specific intervals of time so that urge incontinence can be avoided.
Medications to Treat Detrusor Instability: At times, certain medications are also helpful in treating symptoms of Detrusor Instability. The drugs of choice are anticholinergic drugs like oxybutynin which tend to relax the muscles of the bladder thus reducing involuntary detrusor muscle contractions and increase bladder capacity. These medications are added depending on the severity of the symptoms and the duration of them. It is still not clear whether the treatment is effective in the long term or when the medications are stopped.
Interventional Techniques to Treat Detrusor Instability: There are also certain interventional techniques used for treating Detrusor Instability. Some of the techniques used are:
Botulinum toxin A: An injection of this in the bladder is quite effective in treating Detrusor Instability if conservative treatments are not effective in controlling the symptoms. This form of treatment carries a risk of urinary tract infections.
Nerve Stimulation: This is also a form of interventional technique used for treatment of Detrusor Instability. This is done by stimulating the sacral nerve and stimulating the percutaneous posterior tibial nerve.
Surgery: This is reserved for only those patients who are severely affected by Detrusor Instability and are not at all responding to conservative treatments. The surgery done is called as augmentation cystoplasty. Another procedure that can be done for Detrusor Instability is called urinary diversion in case the patient is not a candidate for augmentation cystoplasty.
What is the Prognosis of Detrusor Instability?
In more than 80% of cases, Detrusor Instability is adequately controlled by lifestyle modifications and conservative therapy alone with excellent long term results and the individual can go back to active life without any concern for symptoms caused due to Detrusor Instability.