BLADDER OUTFLOW OBSTRUCTION

BLADDER OUTFLOW OBSTRUCTION

Definition of Bladder Outflow Obstruction

Bladder outflow obstruction (BOO) refers to the partial or complete blockage of urine flow from the bladder.

Types of Bladder Outflow Obstruction

1. Benign Prostatic Hyperplasia (BPH): non-cancerous enlargement of the prostate gland causing obstruction.
2. Prostate Cancer: cancer of the prostate gland causing obstruction.
3. Bladder Neck Obstruction: narrowing of the bladder neck, often due to scarring or inflammation.
4. Urethral Stricture: narrowing of the urethra, often due to injury or inflammation.
5. Pelvic Floor Dysfunction: weakness or paralysis of the pelvic floor muscles, causing obstruction.

Causes of Bladder Outflow Obstruction

1. Aging: the most common cause of BPH.
2. Prostate Enlargement: non-cancerous or cancerous enlargement of the prostate gland.
3. Urethral Stricture: narrowing of the urethra, often due to injury or inflammation.
4. Pelvic Floor Dysfunction: weakness or paralysis of the pelvic floor muscles, causing obstruction.
5. Neurological Disorders: conditions such as multiple sclerosis or spinal cord injury can cause pelvic floor dysfunction.

Symptoms associated with Bladder Outflow Obstruction

1. Urinary Frequency: frequent urination, often with a small amount of urine.
2. Urinary Urgency: a sudden, intense need to urinate.
3. Nocturia: waking up multiple times during the night to urinate.
4. Dysuria: painful urination.
5. Urinary Retention: inability to empty the bladder completely.

Diagnostic Tests

1. Urinalysis: to check for blood, protein, or bacteria in the urine.
2. Urine Culture: to check for infection.
3. Post Void Residual Volume (PVR): to check the amount of urine left in the bladder after urination.
4. Uroflowmetry: to measure the flow rate of urine.
5. Cystoscopy: to visualize the inside of the bladder and urethra.
6. Ultrasound: to check the size and shape of the bladder and prostate gland.
7. CT or MRI: to check for any abnormalities in the urinary tract.
8. Urodynamic Studies: to assess the function of the bladder and urethra.

Management

1. Conservative Measures: lifestyle modifications, such as:
   • Drinking plenty of water to help flush out the bladder.
   • Avoiding caffeine, alcohol, and spicy foods that can irritate the bladder.
   • Waking up at night to urinate.
   • Practicing pelvic floor exercises, such as Kegel exercises.
2. Surgical Interventions: to relieve the obstruction, such as:
   • Transurethral Resection of the Prostate (TURP): to remove tissue from the prostate gland.
   • Bladder Neck Incision: to widen the bladder neck.
   • Urethral Dilation: to widen the urethra.
   • Penile Prosthesis: to implant a device to help empty the bladder.

Patient Education and Counselling

1. Lifestyle Modification: to prevent further complications.
2. Follow-up Care: regular check-ups to monitor the condition.
3. Recognition of Complications: to identify any signs of urinary tract infection or kidney damage.
4. Red Flag Signs: to recognize any symptoms that require immediate medical attention.

Homoeopathic Therapeutic Medicines

1. Apis Mellifica: for urinary frequency and urgency.
2. Cantharis: for painful urination and burning sensation.
3. Lycopodium: for frequent urination and nocturia.
4. Sabadilla: for urinary retention and difficulty starting urination.

Important Key-Points

1. Bladder Outflow Obstruction: a partial or complete blockage of urine flow from the bladder.
2. Causes: aging, prostate enlargement, urethral stricture, pelvic floor dysfunction, and neurological disorders.
3. Symptoms: urinary frequency, urgency, nocturia, dysuria, and urinary retention.
4. Diagnostic Tests: urinalysis, urine culture, PVR, uroflowmetry, cystoscopy, ultrasound, CT or MRI, and urodynamic studies.
5. Management: conservative measures and surgical interventions.
6. Patient Education and Counselling: lifestyle modification, follow-up care, recognition of complications, and red flag signs.
7. Homoeopathic Therapeutic Medicines: Apis Mellifica, Cantharis, Lycopodium, and Sabadilla.