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The urinary system is composed of the kidneys, ureters, bladder, and urethra. The bladder is a balloon-shaped, muscular organ that stores urine until it is excreted from the body. The detrusor muscle, a smooth muscle that forms the walls of the bladder, allows the bladder to contract to excrete urine or relax to hold urine. Decreased urinary structure muscle tone can be caused by various factors, including underlying health conditions, lifestyle choices, and neurological issues. These factors can lead to urinary incontinence, urinary retention, or other bladder control problems.
| Characteristics | Values |
|---|---|
| Detrusor Muscle Abnormalities | Urinary retention, incontinence, or a combination of both |
| Pelvic Surgery | Radical prostatectomy, perineal resection, radical hysterectomy, and proctocolectomy |
| Smoking | Irritates the bladder |
| Obesity | Excess body fat can reduce muscle tone |
| Chronic Constipation | Regular straining to have a bowel movement can weaken the muscles that control urination |
| Diabetes | Damages nerves and interferes with sensation |
| Spinal Cord Injury | Interrupts signals between the bladder and the brain |
| Disability or Impaired Mobility | Diseases such as arthritis, which make walking painful or slow, may cause accidents before reaching a toilet |
| Overflow Incontinence | Retaining urine in the bladder due to weak muscle tone or blockage below the bladder |
| Neuropathic Incontinence | A problem affecting one or more nerves, causing the detrusor muscle to over-contract or the interior sphincter to lack tension |
| Traumatic Incontinence | Incontinence that occurs after a pelvic injury, such as a fracture, or as a complication of surgery |
| Congenital Incontinence | May occur in people born with bladder or ureter abnormalities |
| Bladder Muscle Dysfunction | Inability to squeeze or empty fully/partially |
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What You'll Learn
Obesity
Abdominal obesity can lead to urethral hypermobility, where the urethra moves out of its usual position, resulting in urine leakage. This type of obesity can also cause the muscles and nerves of the pelvic floor to stretch and weaken, leading to stress urinary incontinence (SUI). Physical activities that temporarily increase abdominal pressure, such as coughing, sneezing, or exercise, can trigger urine leakage in people with SUI.
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Spinal cord injury
Spinal cord injuries (SCI) can cause a loss of muscle tone in the bladder and urinary sphincter, resulting in urinary incontinence. The spinal cord contains cells that send and receive signals from the brain to various parts of the body, including the bladder and bowel. When the spinal cord is damaged, these signals are interrupted, and the bladder and bowel may not function properly.
The impact of an SCI on bladder function depends on the level of the injury and whether the damage is complete or incomplete. Complete SCI occurs when the nerves below the injury no longer communicate with the brain. In general, the higher up the damage occurs in the spinal cord, the more severe the injury, and the more muscles are affected. For example, an SCI at or above the level of the vertebrae TH12/L1 can lead to detrusor sphincter dyssynergia, or the inability to empty the bladder or control bladder impulses. In this case, the bladder and sphincter work against each other, causing a buildup of high pressure in the bladder. This can lead to urine flowing back up to the kidneys, a dangerous condition that can potentially destroy them.
On the other hand, an SCI below TH12/L1 can cause lost muscle tone of the bladder and sphincter. In this case, the bladder muscle becomes flaccid or weak, and the bladder reflex is impacted. This results in diminished bladder sensation, urges to urinate, and the ability to contract. The bladder may hold a lot of urine without the individual being aware of how full it is. When it comes time to void the bladder, it can be challenging for contractions to occur, leading to urinary retention. Over time, the bladder, prostate, rectum, uterus, and pelvic ligaments can become strained and stressed, potentially leading to pelvic organ prolapse.
The first line of treatment for urinary incontinence due to SCI is typically intermittent catheterization to reduce bladder pressure and empty the bladder. It is important to note that recent studies indicate that up to 30% of individuals who lose control of their bladder due to SCI may regain function sometime after the injury.
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Neurological conditions
There are two main types of bladder control problems associated with neurogenic bladder: overactive bladder (OAB) and underactive bladder (UAB) or obstructive bladder. OAB is caused by problems with the nerves that control the bladder, resulting in incontinence and an obstructed flow of urine. UAB, on the other hand, is characterized by the bladder's inability to squeeze and empty fully or at all. The sphincter muscles surrounding the urethra may also malfunction, remaining tight during attempts to empty the bladder, leading to dribbling and urinary retention.
Neurogenic bladder can be caused by various neurological conditions, including multiple sclerosis (MS), stroke, and herpes zoster, which can present with both OAB and UAB symptoms. Additionally, spinal cord injuries can interrupt signals between the bladder and the brain, disrupting bladder function. Diabetes is another contributing factor, as it can damage nerves and interfere with sensation.
Treatments for neurogenic bladder aim to manage symptoms rather than provide a cure. These treatments include augmentation cystoplasty (bladder augmentation), botulinum toxin (Botox) injections to relax the bladder muscles, and medications such as oxybutynin, tolterodine, mirabegron, and solifenacin succinate. Pelvic floor exercises, or Kegel exercises, can also help to tighten and tone the pelvic floor muscles, reducing incontinence episodes. In more severe cases, surgery may be required to implant a device, such as an artificial sphincter, to alter bladder muscle function.
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Pelvic floor dysfunction
Pregnancy and childbirth are well-known risk factors for pelvic floor dysfunction, with research indicating that the risk increases with the number of children a woman has delivered. The mode of delivery also plays a role, as studies have shown that vaginal delivery, particularly with the use of forceps or a vacuum device, is associated with a higher risk of pelvic floor disorders compared to cesarean section. However, it is important to note that pelvic floor problems can also occur in women who have never been pregnant, and cesarean delivery does not completely eliminate the risk.
Obesity is another contributing factor to pelvic floor dysfunction, as excess body fat can reduce muscle tone, including the muscles responsible for controlling urination. Chronic constipation and straining during bowel movements can also weaken the pelvic floor muscles, leading to urinary incontinence. Additionally, certain medical conditions such as diabetes can damage nerves and interfere with bladder function, potentially causing decreased urinary structure muscle tone.
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Chronic constipation
The detrusor muscle, a smooth muscle that forms the walls of the bladder, contracts to push urine out of the bladder and into the urethra. The urethra is surrounded by sphincter muscles that control the release of urine from the bladder.
The risk of developing LUTS due to constipation is higher in middle-aged women, with constipation affecting an estimated 12-32% of this demographic. The National Institute for Health and Care Excellence guidelines recommend screening for constipation in women while assessing and treating LUTS. Constipation can be treated by increasing fiber intake, drinking plenty of fluids, and setting a regular schedule for using the toilet. Kegel exercises can also help strengthen the sphincter and pelvic floor muscles, improving bladder control.
In addition to chronic constipation, other factors that can contribute to decreased urinary structure muscle tone include smoking, obesity, diabetes, spinal cord injuries, and certain disabilities or impaired mobility.
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Frequently asked questions
The urinary structure refers to the urinary system, which is composed of the kidneys, ureters, bladder, and urethra.
The detrusor muscle is the main muscle component of the urinary bladder wall. It contracts during urination to push urine out of the bladder and relaxes to allow the storage of urine.
Decreased urinary structure muscle tone refers to a reduction in the strength or tension of the muscles involved in urinary function, such as the detrusor muscle and the sphincter muscles surrounding the urethra.
Several factors can contribute to decreased urinary structure muscle tone, including obesity, chronic constipation, diabetes, spinal cord injuries, neurological conditions, and certain medications.
Treatments for decreased urinary structure muscle tone depend on the underlying cause and may include pelvic floor exercises, medications, botulinum toxin injections, catheterization, and in some cases, surgery.
