Editing Functional: Pathophysiology and Classification of LUT Dysfunction (section)

==== Bladder Overactivity ====

* Overactivity of the bladder during filling/storage can be expressed as phasic involuntary contractions, as low compliance, or as a combination.
* If an individual has urgency urinary incontinence (UUI), it can be assumed that an involuntary contraction has occurred.
** The symptom of urgency without incontinence suggests detrusor overactivity, but this is often not demonstrable on urodynamic study. Conversely, urodynamically demonstrable detrusor overactivity may not be associated with clinically troublesome filling/storage symptoms.
* '''<span style="color:#ff0000">Involuntary contractions are most commonly seen in association with (6):</span>'''
*# '''<span style="color:#ff0000">Neurologic conditions</span>'''
*# '''<span style="color:#ff0000">Bladder outlet obstruction</span>'''
*# '''<span style="color:#ff0000">Iatrogenic</span>''' (radiation)
*#'''<span style="color:#ff0000">Aging</span>''' (probably related to neural degeneration)
*#'''<span style="color:#ff0000">Stress urinary incontinence</span>''' (perhaps because of sudden entry of urine into the proximal urethra, eliciting a reflex contraction)
*# '''<span style="color:#ff0000">Increased afferent input related to inflammation or irritation of the bladder or urethral wall or an increased sensitivity</span>'''
*# '''<span style="color:#ff0000">Idiopathic</span>'''
*
* '''<span style="color:#ff0000">Neurologic conditions</span>'''
** '''Any neurologic process interrupting the normal suprapontine inhibition of the pontine micturition center may result in neurogenic detrusor overactivity (NDO) and cause urge urinary incontinence.'''
*** '''<span style="color:#ff0000">Most common neurologic causes of urge urinary incontinence</span>'''
***#'''<span style="color:#ff0000">CVAs</span>'''
***#'''<span style="color:#ff0000">Multiple sclerosis</span>'''
***#'''<span style="color:#ff0000">Parkinson disease</span>'''
* '''<span style="color:#ff0000">Bladder outlet obstruction</span>'''
** <span style="color:#ff0000">'''In males, bladder outlet obstruction induced by prostatic enlargement (or other obstructive process) can be associated with detrusor overactivity and resultant urgency urinary incontinence.'''</span>
**In females, obstruction resulting from anti-incontinence surgery can lead to de novo urgency urinary incontinence secondary to induced detrusor overactivity.
* '''<span style="color:#ff0000">Iatrogenic</span>'''
**'''<span style="color:#ff0000">Pelvic external beam radiation can alter bladder compliance</span>''', increase detrusor leak point pressure, and contribute to UI.
*'''<span style="color:#ff0000">Diabetes, even early in diagnosis, has been associated with neurogenic detrusor overactivity and urge urinary incontinence</span>'''
** '''Whereas early in the diabetes disease process can lead to urge urinary incontinence, later in the process sensation can be altered as can detrusor contractility, resulting in impaired bladder emptying, UTIs, and urinary incontinence.'''