Aims of Study:
Detrusor instability (DI) is the most common cause of urinary urgency,
frequency,
and
urinary
incontinence,
particularly
in
the
elderly.
However,
functional
evidence
of
detrusor
instability
is
often
difficult
to
elicit
during
urodynamic
evaluation
despite
symptoms
of
urgency
and
urge
incontinence.
Like
DI,
bowel
disorders
are
highly
prevalent
in
the
elderly
and
are
associated
with
significant
health
care
costs.
Symptoms
affecting
the
bladder
and
recto-sigmoid
colon
often
coexist
[1,2],
indicating
a
common
pathophysiology
at
the
level
of
integration
or
regulation
of
pelvic
viscera.
A
previous
study
suggests
that
detrusor
overactivity
is
associated
with
the
presence
of
rectal
contractions
[3].
The
aim
of
this
study
was
to
determine
the
relationship
between
detrusor
instability
and
rectal
contractions,
and
determine
its
clinical
relevance
in
identifying
detrusor
instability
in
the
absence
of
unstable
bladder
contractions.
Methods:
Comprehensive
videourodynamic
studies
from
men
without
overt
neurologic
disease
were
retrospectively
evaluated
(n=30,
age
range
=
35-81
years).
Abdominal
pressure
measurements
were
acquired
during
medium-fill
cystometry
using
a
small
rectal
balloon
catheter. The frequency and amplitude of rectal contractions
were
determined
with
respect
to
bladder
capacity
after
the
data
was
transformed
using
a
first
order
low
pass
recursive
filter
and
eliminating
abdominal
pressure
changes.
Studies
from
urodynamically
normal
patients
(no
detrusor
instability,
no
bladder
outlet
obstruction,
normal
bladder
contractility,
n=16)
and
those
with
detrusor
instability(n=6)
or
urge
incontinence
(n=8)
were
analyzed.
Results:
The
frequency
of
spontaneous
rectal
contractions
was
not
significantly
different
among
patients
with
detrusor
instability,
urge
incontinence
(without
urodynamic
evidence
of
detrusor
instability),
or
normal
urodynamics.
Rectal
contraction
amplitude
was
significantly
higher
in
patients
with
detrusor
instability
than
in
urodynamically
normal
patients.
Even
in
patients
without
urodynamic
evidence
of
detrusor
instability
but
who
complained
of
urge
incontinence,
the
amplitude
of
rectal
contractions
near
bladder
capacity
was
significantly
greater
than
in
normal
patients.
Conclusion:
Our data demonstrate that marked rectal contractions
develop
during
bladder
filling
in
patients
with
detrusor
instability
compared
to
those
with
normal
urodynamics.
Since
rectal
contractions
are
also
significant
in
patients
with
urge
incontinence
without
urodynamic
evidence
of
detrusor
instability,
the
rectal
pressure
measurement
pattern
may
provide
indirect
evidence
of
bladder
dysfunction
when
detrusor
instability
cannot
be
elicited.
1.
Gut 27:37-40, 1986.
2. Gut 27:1014-1017, 1986.
3. Neurourol Urodyn. 14:73-
80,
1995.
