Improve Detrusor Sphincter Dyssynergia

In Detrusor Sphicnter Dyssnergia, patients have trouble feeling the urge to urinate.

The human bladder has two functions: to store and empty urine. R

In Detrusor Sphincter Dyssynergia (DSD), the detrusor muscle, urinary sphincters, and the central nervous system malfunction in coordinating with each other to perform simple bladder functions. R

These malfunctions can be disrupted by injury, inflammation, degenerative process or congenital malformation. R

DSD can increase the risk of developing Type 2 Diabetes. R

In the intact spinal cord, long descending fiber tracts from the midbrain coordinate the activity of the detrusor muscle and the urethral sphincte. R

For example. the detrusor muscle is relaxed while the sphincter muscle is contracted to allow for filling of the bladder, while voiding is characterized by relaxation of the urethral sphincter and contraction of the detrusor muscle. R

After SCI, input from the brainstem is partially lost. R

As such, simultaneous contractions of detrusor and sphincter emerge. R

In cystometry, detrusor sphincter dyssynergia (DSD) is in part represented by detrusor contractions against a closed urethral sphincter without release of fluid (i.e. uninhibited bladder contractions). R

In DSD, the muscle around the wall of the bladder (detrusor) contracts causing the urinary sphincter to also contract, even though the bladder is closed. R

This is how you get "dysfunctional voiding".

DSD can happen from:

These are common biomarkers:

• C-reactive Protein R
• IL-6 R
• MMP2 R
• MMP9 R
• TNF-a R
• Urinary NGF levels R

Lifestyle/Diet

• Treat Multiple Sclerosis
• Stimulate the Dorsal Root Ganglion (strengthen the sensations/connection between brain and body) R
• Vagus Nerve Stimulation? (enhance parasympathetic system, can increase Acetylcholine) R
• Decrease BDNF and NGF (as they increase p75ntr signaling, you could take p75 inhibitors) R R R R R
• Increase Nitric Oxide (reduces bladder outlet obstruction) R R
• Treat underlying dysbiosis 

Supplements

• Prosultiamine (improves bladder pressure) R
• Capsaicin (helps spinal cord) R

Drugs

• Botox (Botulinum A Toxin)R
• Desmopressin R
• Antimuscarinics R
• Terazosin (if MS is confirmed) R

Advanced Treatments

• Stem Cell Therapy R
• GM6001 (a MMP inhibitor) R 
• Olfactory mucosal transplantation (very effective in rats) R
• Tibial nerve stimulation (for overactive bladder) 
• Tamsulosin R
• Baclofen (has trouble going through BBB, so needs to be taken intrathecally) R
• Intravesical Oxybutynin R
• Catheterization R
• Urethral Stents R
• Sphincterotomy R
• Rhizotomy R

Other

• Block α1D-Adrenoceptor (increases voiding after spinal cord injury) R
• p75 neurotrophin inhibitors R

Procedures to open the bladder neck/outlet, such as trans-urethral resection of the prostate (TURP) should be undertaken with caution in Shy-Drager and multiple systems atrophy, since they have a high likelihood of rendering the patient incontinent. R

• Dorsal Root Ganglion Stimulation R
• There are increased NPY- and VIP-containing fibres in striated muscle of the intrinsic external urethral sphincter in patients with areflexic bladder compared with those with detrusor-sphincter dyssynergia. R