The Bladder tenesmus it is the urgent need to urinate, occurring repeatedly, even when the bladder is empty. It is a symptom that is related to voluntary effort when perceiving bladder fullness, feeling the need to urinate.
Urinary urgency accompanies other symptoms of urinary disorders. Frequency and dysuria, which involve pain and difficulty in urination, are some associated symptoms..
It is important not to confuse urgency with urgency; the urgency occurs when the bladder is full of urine, prompting the person to urinate immediately when feeling that they cannot contain themselves.
Bladder tenesmus is a nonspecific symptom that basically consists of various reflex mechanisms involved, which initiate bladder smooth muscle contractions, promoting the appearance of tenesmus, with multiple causes. Symptomatic treatment will bring relief from urgency, but there may be recurrences.
An adequate diagnosis of the causes, and the establishment of a treatment of the same will determine the definitive elimination of the annoying symptom..
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The pathophysiological mechanism of tenesmus requires understanding its anatomy and physiology.
The urinary bladder is a predominantly muscular organ behind the pubis; It has elastic properties that allow it to widen, its function being to contain urine.
The bladder muscle is called detrusor, with relaxation and contraction functions, involved in its filling and emptying.
A triangular space located in the wall of the bladder, called the trigone, corresponds to the mouth of the ureters that carry urine from the kidneys to the urinary sphincter. Beyond the sphincter, the urinary tract continues with the urethra in charge of carrying urine to the outside.
The detrusor and the bladder sphincter have opposite and coordinated actions: the relaxation of one implies the contraction of the other.
Urination has voluntary and involuntary components: the first is conscious, allowing it to be held to empty the bladder, through voluntary action on the bladder sphincter..
The involuntary component of urination is determined by the autonomic nervous system: the sympathetic innervation dependent on the hypogastric nerve plexus and the parasympathetic innervation established by the sacral plexus. Both nervous systems are simultaneously coordinating the filling and emptying phases of the bladder..
Both the actions of the different muscle groups related to urination, as well as the reflexes that allow this physiological act, have been extensively studied, and a total of twelve reflexes have been described so far..
Urination requires the coordinated action of receptors in the bladder wall, autonomic nerves, and central nervous system. Wall receptors will pick up the product tension of a full bladder, or relaxation after emptying.
The stimulus travels through the afferent pathway to the pontine micturition center (CPM) to coordinate the voiding reflex; the effector response will produce the desire to urinate. The CPM is located in the medulla oblongata, but a structure called the locus coereleus is believed to be involved as well..
The corresponding effector response will then be:
There are three mechanisms on which urination depends:
The induced response that tenesmus produces is somewhat complex, involving multiple receptors and effectors; however it can be explained in a simple way.
Any stimulus capable of producing inflammation of the bladder structures can produce the voiding reflex or urgency. The same happens with compression of the bladder structures or the presence of foreign bodies inside..
As the bladder wall is stimulated, the impulse travels to the CPM, and is interpreted as a full bladder. The response sent to the bladder will produce the characteristic sensation of urgency..
This is how tenesmus is a sensory symptom, dependent on an irritating stimulus of the bladder, the consequence of which is an annoying and repeated sensation.
Urinary urgency is a symptom related to multiple causes. Infections are the most common cause of urinary symptoms, including urgency; other factors such as the presence of foreign bodies, tumors or inflammations can also cause it.
A fairly precise approach to the causes of urgency appears in a consensus of experts in palliative care. This consensus classifies the causes of tenesmus according to its origin into 6 groups:
-Bacterial, including STIs, cystitis, urethritis, or vaginitis caused by bacteria.
-Fungal, as in the case of Candida albicans candidiasis.
-Viral, such as those produced by herpes-like viruses (Herpes simplex).
-Pelvic tumors.
-Cystocele (protrusion of the bladder).
-Urinary obstruction or urethral stricture.
-Amyloid.
-Radiotherapy and Chemotherapy, the latter induced by the use of Cyclophosphamide.
-Idiopathic cystitis.
-Foreign body reaction.
-Primary or idiopathic bladder spasm.
-Secondary bladder spasm, such as contractions due to catheters or blood clots.
-Cancer of the bladder, urethra, or any pelvic organ.
-Bladder catheters or catheters
-Urinary bladder stones.
-Hypersensitivity reactions.
-Female pelvic disorders, including pelvic inflammatory disease.
The treatment of urinary urgency should be aimed at improving the symptom, as well as suppressing the original causes. The treatments used, in some cases, may be common to those used for other urinary symptoms.
Among the most used treatments for symptomatic relief are:
Its effect is relaxing antispasmodic of visceral smooth muscles.
They work by inhibiting inflammatory and pain mediators.
Its effect is clearly anti-inflammatory, thus achieving symptomatic relief
Used locally, either in gel, creams or by local instillation.
Although a side effect of tricyclic antidepressants may be acute urinary retention, they are often helpful in chronic urinary symptoms..
The mention of these drugs is referential, and they should only be used under indication and strict medical supervision..
A proper diagnosis will determine the causes of urgency and its treatment..
Treatment of the causes of urinary symptoms, including urgency, is important to prevent their recurrence..
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