| Bladder dysfunction | |||
| Spastic bladder | Atonic bladder | Sphincter dyssynergia | |
| Anatomy | Upper motor neuron lesions | Lower motor neuron lesions | varies |
| Causes | Brain or spinal cord problem | Conus medullaris, cauda equina, plexus, peripheral nerve dysfunction | |
| Symptoms | Incontinence with urgency | Overflow incontinence | increased residue urine |
| Urodynamic findings | decreased capacity, reduced compliance, uninhibited detrusor contractions | increased capacity, increased compliance, low voiding pressure & flow rate | fluctuating voiding pressure, intermittent flow rate |
| Management | timed bladder emptying, intermittent catherization | Crede's or Valsalva's maneuver, intermittent catherization | |
| Medication | anticholinergics, musculotropics, calcium antagonists, beta agonists | Cholinergic med, limited by side effects | |
| Medications used in treatment of bladder problem | |
| Anticholinergics | |
| Propantheline bromide (Pro-banthine) tab: 7.5, 15 mg Dose: 15-30 mg q6 h |
|
| Glycopyrrolate (Robinul) tab: 1 mg Dose: 1 mg bid or tid |
|
| Dicyclomine (Bentyl) tab/Cap: 10mg, Tab: 20 mg, Syrup: 10mg/5ml Dose: 20 mg tid |
|
| Musculotropics (antispasmodics) | |
| Oxybutynin (Ditropan) tab: 5 mg, syrup: 5 mg/5ml. 5 mg tid to qid Ditropan LA: 5, 10, 15 mg qd, max 30 mg/day |
|
| Flavoxate (Urispas) tab: 100 mg Dose: 100-200 mg tid or qid |
|
| Tolterodine (Detrol):
Tab: 1, 2 mg. Dose 2 mg
bid, to tid Detrol LA: 2, 4 mg. dose 1 cap qd Tolerated better than Oxybutinin Most frequent side effect: dry mouth. Other side effect: headache, dyspepsia, dizziness, urinary tract infection |
|
| Others | |
| Calcium antagonists | Terodiline Dose: 12.5 mg bid or tid |
| Beta agonist | Terbutaline (Brethine) tab: 2.5, 5 mg Dose: 5 mg tid |
| Tricyclics | Imipramine (Tofranil)| tab: 10, 25, 50 .. mg Dose: 25 mg tid to qid |
| Cholinergics | Bethanecol (Urecholine) tab: 5, 10, 25, 50 mg Dose: 25-100 mg qid |