Pharmacology of urinary bladder

 

The following physiological anomalies can be present in the urinary bladder which warrants treatment by drugs

Unstable bladder: This is caused by detrusor instability, or by an upper motor neuron lesion or by bladder neck obstruction.

Decreased bladder activity or hypotonia. This can be caused by lower motor neuron lesion or it may be due to distension of the urinary bladder.

Urethral sphincter dysfunction: This is caused by weakness of muscle around the bladder neck (both internal and external sphincters) including descent of urethrovesical junction or periurethral fibrosis. It causes stress incontinence.

Urinary frequency - pollakisuria

Atrophic changes in the distal two thirds of the female urethra due to post-menopausal degeneration of estrogen receptors causing urinary incontinence.

Treatment

Tricylic antidepressant can be used to treat nocturnal and day time incontinence. They include imipramine, amitriptyline, nortriptyline. The have antimuscarinic effects  but also have effect on sleep.

Antimuscuaric agents Oxybutynin and flavoxate  are for pollakisuria.

Estrogen can be used to treat atropic changes in the distal 2/3 of urethra in the female.

Parasympathomimetic drugs can be used to stimulate the detrusor in conditions of detrusor inactivity caused by upper motor neuron lesions. They include bethanechol, distigmine and carbachol.


Urinary bladder explanatory video

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