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Bladder Control (bladder + control)
Selected AbstractsBladder control, urgency, and urge incontinence: Evidence from functional brain imaging,NEUROUROLOGY AND URODYNAMICS, Issue 6 2008Derek Griffiths Abstract Aim To review brain imaging studies of bladder control in subjects with normal control and urge incontinence; to define a simple model of supraspinal bladder control; and to propose a neural correlate of urgency and possible origins of urge incontinence. Methods Review of published reports of brain imaging relevant to urine storage, and secondary analyses of our own recent observations. Results In a simple model of normal urine storage, bladder and urethral afferents received in the periaqueductal gray (PAG) are mapped in the insula, forming the basis of sensation; the anterior cingulate gyrus (ACG) provides monitoring and control; the prefrontal cortex makes voiding decisions. The net result, as the bladder fills, is inhibition of the pontine micturition center (PMC) and of voiding, together with gradual increase in insular response, corresponding to increasing desire to void. In urge-incontinent subjects, brain responses differ. At large bladder volumes and strong sensation, but without detrusor overactivity (DO), most cortical responses become exaggerated, especially in ACG. This may be both a learned reaction to previous incontinence episodes and the neural correlate of urgency. The neural signature of DO itself seems to be prefrontal deactivation. Possible causes of urge incontinence include dysfunction of prefrontal cortex or limbic system, suggested by weak responses and/or deactivation, as well as abnormal afferent signals or re-emergence of infantile reflexes. Conclusions Bladder control depends on an extensive network of brain regions. Dysfunction in various parts may contribute to urge incontinence, suggesting that there are different phenotypes requiring different treatments. Neurourol. Urodynam. 27:466,474, 2008. © 2007 Wiley-Liss, Inc. [source] Behavioural treatment of urinary incontinence and encopresis in children with learning disabilities: transfer of stimulus controlDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 4 2000Linda Smith MAMSc Clinical Psychologist Urinary and faecal incontinence present a considerable problem in people with learning disabilities, despite the general effectiveness of behavioural techniques in continence training. Children with learning disabilities and obsessional behaviour may be particularly resistant to toilet training, even where relatively cognitively able, and often despite a substantial degree of control over their eliminatory functions. Their resistance may be more appropriately regarded as a challenging behaviour and their incontinence better explained by factors other than a simple failure to learn. A 'stimulus-control'hypothesis proposes that the child's nappy (diaper) /potty/underwear has developed strong stimulus control over the elimination response. This report describes three case studies in which treatment-resistant children, aged between 8 and 12 years, with mild or moderate learning disabilities, were successfully treated for nappy-dependent nocturnal encopresis or diurnal urinary incontinence. The children were routine case referrals for whom previous attempts to train bowel or bladder control had failed. Behavioural techniques, such as 'shaping'(gradually increasing the proximity to the toilet),,fading'(reducing the presence of the nappy), and rewards for eliminating, effected successful transfer of stimulus control over elimination from nappy to toilet. Treatment times varied, depending on the degree of the child's obsession and resistance to change. [source] Lower urinary tract symptoms and bladder control in advanced Parkinson's disease: Effects of deep brain stimulation in the subthalamic nucleusMOVEMENT DISORDERS, Issue 2 2007Kristian Winge MD Abstract Deep brain stimulation in the subthalamic nucleus (STN) leads to significant improvement in motor function in patients with advanced Parkinson's disease (PD). In this prospective study including 16 patients with PD, we investigated (1) lower urinary tract symptoms (LUTS) by questionnaires International Prostate Symptom Score (IPSS, symptoms only) and Danish Prostate Symptom Score (DanPSS, symptoms and bother of symptoms) and (2) bladder control (assessed by urodynamics) before and after implantation of electrodes in the STN. PD symptoms (Unified Parkinson's Disease Rating Scale score) improved significantly (P < 0.0001), and symptoms of overactive bladder (IPSS) decreased along with the troublesome symptoms of overactive bladder (DanPSS; P < 0.01 for both). Urodynamic parameters before and after implantation of electrodes in the STN, evaluated with and without the stimulation on, did not change significantly. © 2006 Movement Disorder Society [source] Bladder dysfunction in Parkinsonism: Mechanisms, prevalence, symptoms, and managementMOVEMENT DISORDERS, Issue 6 2006Kristian Winge MD Abstract The advent of functional imaging methods has increased our understanding of the neural control of the bladder. This review examines current concepts of the role of brain function in urinary control with particular emphasis on the putative role of dopamine receptors. Dopaminergic mechanisms play a profound role in normal bladder control and the dysfunction of these may result in symptoms of overactive bladder in Parkinsonism. The importance of this nonmotor disorder has been overlooked. We address the problem of bladder dysfunction as it presents to patients and their neurologist. The prevalence of bladder symptoms in Parkinson's disease is high; the most common complaint is nocturia followed by frequency and urgency. In multiple-system atrophy, the combination of urge and urge incontinence and poor emptying may result in a complex combination of complaints. The management of bladder dysfunction in Parkinsonism addresses treatment of overactive detrusor as well as incontinence. © 2006 Movement Disorder Society [source] A decade of functional brain imaging applied to bladder controlNEUROUROLOGY AND URODYNAMICS, Issue 1 2010Clare J. Fowler Abstract Over the last 10 years functional brain imaging has emerged as the most powerful technique for studying human brain function. Although the literature is now vast, including studies of every imaginable aspect of cortical function, the number of studies that have been carried out examining brain control of bladder function is relatively limited. Nevertheless those that have been reported have transformed our thinking. This article reviews that development in the context of emerging ideas of interoception and a working model of brain activity during bladder filling and emptying is proposed. Some studies have also been carried out using functional imaging methods to examine pathophysiological bladder conditions or the effect of treatments and these are reviewed and future work anticipated. Neurourol. Urodynam. 29: 49,55, 2010. © 2009 Wiley-Liss, Inc. [source] Bladder control, urgency, and urge incontinence: Evidence from functional brain imaging,NEUROUROLOGY AND URODYNAMICS, Issue 6 2008Derek Griffiths Abstract Aim To review brain imaging studies of bladder control in subjects with normal control and urge incontinence; to define a simple model of supraspinal bladder control; and to propose a neural correlate of urgency and possible origins of urge incontinence. Methods Review of published reports of brain imaging relevant to urine storage, and secondary analyses of our own recent observations. Results In a simple model of normal urine storage, bladder and urethral afferents received in the periaqueductal gray (PAG) are mapped in the insula, forming the basis of sensation; the anterior cingulate gyrus (ACG) provides monitoring and control; the prefrontal cortex makes voiding decisions. The net result, as the bladder fills, is inhibition of the pontine micturition center (PMC) and of voiding, together with gradual increase in insular response, corresponding to increasing desire to void. In urge-incontinent subjects, brain responses differ. At large bladder volumes and strong sensation, but without detrusor overactivity (DO), most cortical responses become exaggerated, especially in ACG. This may be both a learned reaction to previous incontinence episodes and the neural correlate of urgency. The neural signature of DO itself seems to be prefrontal deactivation. Possible causes of urge incontinence include dysfunction of prefrontal cortex or limbic system, suggested by weak responses and/or deactivation, as well as abnormal afferent signals or re-emergence of infantile reflexes. Conclusions Bladder control depends on an extensive network of brain regions. Dysfunction in various parts may contribute to urge incontinence, suggesting that there are different phenotypes requiring different treatments. Neurourol. Urodynam. 27:466,474, 2008. © 2007 Wiley-Liss, Inc. [source] Cerebral mechanisms and voiding functionBJU INTERNATIONAL, Issue 4 2007Ranan DasGupta Some of the most recent work investigating the cerebral mechanisms involved in bladder control has been very helpful in adding to our understanding of bladder dysfunction. The group behind this work, from London, presents a mini-review which will help to update our knowledge in this area. Authors from Australia present a review describing the interactions between bone and prostate cancer cells in metastatic disease. This area has generated much interest and is something for which we should develop a full understanding, to optimise our treatments for this condition. [source] Frequency of fainting, vomiting and incontinence in panic disorder: A descriptive studyCLINICAL PSYCHOLOGY AND PSYCHOTHERAPY (AN INTERNATIONAL JOURNAL OF THEORY & PRACTICE), Issue 3 2007Sheryl M. Green Little is known about how often individuals with panic disorder (PD) actually experience the physical catastrophes that they fear (e.g., fainting, vomiting, incontinence). This study investigated the frequency of such events in PD and the circumstances under which they occur. A systematic chart review of 574 consecutive patients diagnosed with PD was completed. Nineteen out of 35 patients who had previously reported a history of fainting, vomiting or incontinence (i.e., loss of bowel or bladder control) during a panic attack were interviewed by telephone. Of this sample, 11 confirmed a history of fainting, four confirmed a history of vomiting and four confirmed a history of incontinence during at least one previous panic attack. Four of these individuals reported more than one type of event and several others reported that they had only come close to experiencing these feared events. Participants also reported on the timing of these events (relative to their panic attacks), the circumstances under which the events occurred, as well as possible causes and outcomes of the events. Although rare, catastrophic events such as fainting, vomiting and incontinence appear to occur in the context of panic attacks for some individuals. The implications for cognitive behavioural treatment of PD are discussed. Copyright © 2007 John Wiley & Sons, Ltd. [source] | ||||||||||