Another cause of urethral syndrome, or unstable bladder is chronic ureterovesical reflux where urine backs up into the kidneys due to some congenital abnormality of the valves from the urine tubes of the kidney and the bladder. When the urine backs up into the kidney the bladder works very hard trying to empty itself, becomes thick-walled and irritable and causes frequency and urgency. In addition, after emptying the bladder the urine trickles back down filling the bladder with additional urine.
In order to solve the complicated urethral syndrome problems, your health care professional should think about the above disorders and then do appropriate evaluations. X-rays of the kidneys will determine the status of the kidneys and whether or not damage has occurred from tuberculosis of the bladder, another, but slim possibility, reflux of urine, or other bladder or urethral problems.
If a neurological condition such as a stroke, brain tumor, multiple sclerosis, diabetes, back or disc problems occur doctors may also suggest doing a pressure study on the bladder called a cystometrogram.
It involves putting a catheter in the bladder, infusing fluid which is usually a gas like carbon dioxide, then measuring the pressures in the bladder as the volume increases. At the same time the doctor can instill dye and observe the bladder before, during, and after urination to see if urine backs up into the kidneys in the case of ureterovesical reflux. You can also see if the bladder really does empty and is there any urine left behind after urination.
Another test is for your doctor to look into the bladder, which frequently can be done with a fiber optic-type flexible cystoscope. This instrument allows the physician to look at the lining of the bladder, the neck of the bladder and the urethra.
If you are concerned about interstitial cystitis the procedure must be done under anesthesia so the bladder can be stretched maximally above and beyond what one could normally tolerate, emptied, and then refilled to look for the characteristic hemorrhages associated with interstitial cystitis.
On occasion there are ulcerations in the bladder which are even more diagnostic of interstitial cystitis. With this test you are looking for inflammation, inflammatory polyps, stones, tumors, and/or pustules, all of which can be treated. Frequently they can be treated at the time of the endoscopic procedure, particularly if it is done under some type of sedation or anesthesia.
So you can see, the unstable bladder, urgency/frequency syndrome, or urethral syndrome is really a number of disorders many of which are often not diagnosed and appropriately treated.
Additional resources on incontinence are available from MayoClinic.com:
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