Rectal distension: the effect on bladder function.

AIMS: To assess how rectal distension affects urodynamics parameters and diagnosis. METHODS: Thirty women underwent filling cystometry with a rectal balloon inserted and filled with 150 ml of normal saline and repeated without the balloon distended. The volume at which first desire, strong desire and bladder capacity were reported by the women was recorded as well as urodynamics diagnosis. Women were randomized, using the closed envelope method, into having the rectal balloon distended during the first or during the second filling phase. Women with any bowel disease, history of bleeding per rectum were excluded, or women with any contraindication to undergoing urodynamics, or insertion of a device per rectum. All women of a reproductive age underwent pregnancy test and excluded if found to be pregnant. RESULTS: Thirty patients were recruited, 16 reported mixed urinary incontinence (53%), 5 (17%) had isolated overactive bladder (OAB) symptoms and 9 (30%) reported isolated stress urinary incontinence. Patients with distended rectum had statistically significant lower bladder volumes at which first (46% reduction) and strong desire (33% reduction) was felt and reduced maximum bladder capacity (26% reduction) when compared to the rectum being undistended. In four patients (13%) with a history of OAB a diagnosis of detrusor overactivity was found with the rectum was distended but not when the rectum was empty. CONCLUSION: Rectal distension alters bladder sensation and in some cases urodynamics diagnosis.

Ultrasound measurement of bladder wall thickness is associated with the overactive bladder syndrome.

AIMS: To assess the relationship between mean bladder wall thickness and components of the overactive bladder (OAB syndrome). METHODS: Women attending urogynaecology clinic was categorized into overactive bladder syndrome, stress urinary incontinence (SUI), and mixed urinary continence (MUI) according to International Continence Society (ICS) definitions based on symptom history. Women completed a bladder diary, visual analog score (VAS) for urgency, and the mean bladder wall thickness (BWT) was determined. Comparison was made between the mean BWT and symptom history, daytime frequency, nocturia, VAS scores. RESULTS: Three hundred seventy-nine women were recruited to the study with a mean age of 56 years (range: 24-92 years). The mean bladder wall thickness did not show any age-related difference. Of these women 138/379 (36%) reported overactive bladder symptoms (mean BWT = 5.6 mm) 75/379 (20%) gave a history of stress urinary incontinence (mean BWT = 4.7 mm), and 166/379 (44%) had mixed urinary incontinence (mean BWT = 5.4). Women with nocturia >1 had mean BWT 5.6 mm, with nocturia <1 a mean BWT 4.9 mm. Women with daytime frequency >7 had mean BWT 5.7 mm and those <7 had mean BWT 5.1 (P < 0.001). Women with a mean BWT of ≤5 mm had a mean VAS score lower than women with a BWT >5 mm (P < 0.001). CONCLUSIONS: Mean BWT is associated with a symptom history of OAB and MUI, higher daytime and nightime frequency, and higher VAS scores.