Disorders of Bladder Function 3 (Voiding Disorder)

(Filling)cystomanometry in a 7.6-year-old girl with urge symptoms and enuresis diurna. X-axis: Time in minutes. Y-axis from top to bottom: Pves = Intravesical pressure in cm H2O, Pabd = intraabdominal pressure measured by a rectal probe, Pdet = Detrusor pressure (intravesical minus intraabdominal pressure), EMG: Activity of the pelvic floor muscles in microvolt. With increasing length of bladder filling the intravesical and the basal detrusor pressure is increasing. In addition, involuntary contractions of the detrusor muscle occur (= contraction waves exceeding 15 cm H20); the latter evoke urgency which disappears after decrease in the detrusor contractions to the value of the basal pressure. As a retaining maneuvre, the pelvic floor muscles are activated during urgency (oscillations in the EMG) and by activation of the abdominal muscles the intraabdominal pressure increases. The diagnosis is an instable bladder which is characterized by strong involuntary contractions of the detrusor muscle during the filling period and leads to urgency and enuresis.