Diabetic Neuropathy Bladder Symptoms
Diabetic Neuropathy Bladder Symptoms If you have diabetes, you may be familiar with the complications that can arise from this chronic condition. One such complication is diabetic neuropathy, which affects the nerves and can lead to various symptoms throughout the body. In this article, we will focus specifically on the bladder symptoms associated with diabetic neuropathy and explore how they can impact your urinary function.
Diabetic neuropathy is a condition characterized by nerve damage caused by high blood sugar levels over time. The nerves that control bladder function can be affected, leading to problems with urinary frequency, urgency, incomplete bladder emptying, and difficulty starting or stopping urine flow. These symptoms can significantly impact your quality of life and require careful management.
Understanding the relationship between diabetic neuropathy and bladder issues is crucial in effectively addressing these symptoms. As the nerves that control bladder function are damaged, communication between the bladder and the brain is disrupted, resulting in urinary problems. By exploring the impact of diabetic neuropathy on urinary function, we can gain insights into why these symptoms occur.
Diagnosing bladder symptoms related to diabetic neuropathy is essential for appropriate treatment and management. Healthcare professionals often employ specific medical evaluations, tests, and assessments to identify bladder dysfunction and evaluate its severity. These diagnostic measures are crucial in tailoring a treatment plan that suits your individual needs.
Managing bladder symptoms in diabetic neuropathy requires a comprehensive approach that includes both medical and non-medical interventions. We will explore various treatment options, medication strategies, lifestyle modifications, and non-medical interventions that can help alleviate these symptoms and improve your overall bladder function.
Coping with incontinence concerns is a common challenge for individuals with bladder symptoms related to diabetic neuropathy. We will discuss strategies and resources available to help you navigate these concerns, including protective garments, bladder retraining, and support networks that offer both emotional and practical assistance.
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In conclusion, understanding and managing bladder symptoms in diabetic neuropathy is vital for your well-being. By recognizing the impact of diabetic neuropathy on your bladder, seeking appropriate medical help, and employing a comprehensive approach to treatment and management, you can effectively navigate these symptoms and improve your bladder function, enhancing your overall quality of life.
Understanding Diabetic Neuropathy and its Complications
Before we explore the specific bladder symptoms associated with diabetic neuropathy, it’s important to have a clear understanding of what this condition entails and how it can lead to various complications. Diabetic neuropathy is a type of nerve damage that occurs due to long-term uncontrolled diabetes. It primarily affects the nerves in the legs and feet, but can also impact other parts of the body, including the bladder.
When it comes to the bladder, diabetic neuropathy can have significant implications on its normal functioning. The nerves that control bladder function can be damaged, leading to a range of bladder issues. These complications can include urinary incontinence, urinary retention, incomplete bladder emptying, and urinary tract infections.
The relationship between diabetic neuropathy and bladder issues is complex. The nerve damage disrupts the communication between the bladder and the brain, resulting in problems with bladder control and urinary function. As a result, individuals with diabetic neuropathy often experience bladder symptoms such as frequent urination, urgency, and difficulty initiating or stopping urine flow.
To better understand the impact of diabetic neuropathy on the bladder, let’s take a closer look at how the condition affects bladder function.
Nerve Damage and Bladder Dysfunction
Diabetic neuropathy affects the nerves that control the muscles of the bladder. These nerves are responsible for sending signals to the brain when the bladder is full, as well as coordinating the smooth muscle contractions that allow for efficient emptying of the bladder.
However, when these nerves are damaged, the coordination between the bladder and the brain is disrupted. This can result in a variety of bladder symptoms, including:
- Increased urinary frequency: Individuals with diabetic neuropathy may feel the need to urinate more often than usual, even during the night (nocturia).
- Urinary urgency: There may be a sudden and strong urge to urinate, making it difficult to hold urine until reaching the restroom.
- Incomplete bladder emptying: The nerves responsible for triggering the bladder muscles to contract may not function properly, leading to difficulty fully emptying the bladder.
- Urinary retention: In some cases, the bladder muscles may become weak due to nerve damage, resulting in an inability to empty the bladder completely.
These bladder symptoms can significantly impact an individual’s quality of life, causing discomfort, inconvenience, and potentially increasing the risk of urinary tract infections or other complications.
In the next section, we will delve deeper into the specific bladder symptoms that individuals with diabetic neuropathy may experience. We will explore the challenges of diagnosing bladder symptoms in diabetic neuropathy and discuss the various management strategies available for effectively addressing these issues.
| Diabetic Neuropathy and Bladder Issues | Complications of Diabetic Neuropathy on the Bladder |
|---|---|
| Damage to the nerves controlling bladder function | Increased urinary frequency |
| Disrupted communication between the bladder and the brain | Urinary urgency |
| Urinary incontinence | Incomplete bladder emptying |
| Urinary retention | Increased risk of urinary tract infections |
Common Bladder Symptoms in Diabetic Neuropathy
When it comes to diabetic neuropathy, the impact on bladder function can be significant. Understanding bladder problems in diabetic neuropathy is crucial for managing this condition effectively. Diabetic neuropathy affects bladder function in various ways, leading to a range of bladder symptoms in diabetics with neuropathy.
Understanding bladder problems in diabetic neuropathy:
1. Urinary Frequency
Individuals with diabetic neuropathy may experience increased urinary frequency, meaning they need to urinate more frequently than usual. This can disrupt daily activities and sleep patterns, causing significant inconvenience and discomfort.
2. Urinary Urgency
Diabetic neuropathy can also lead to urinary urgency, a strong and sudden need to urinate that may be difficult to delay. This urgency can cause anxiety and stress, making it challenging to engage in social activities or travel long distances.
3. Incomplete Bladder Emptying
In some cases of diabetic neuropathy, individuals may struggle to completely empty their bladder. This can result in a feeling of discomfort or the need to urinate again shortly after using the bathroom.
4. Difficulty Starting or Stopping Urine Flow
Diabetic neuropathy can interfere with the coordination between the bladder and the muscles that control urine flow. This can lead to difficulty initiating urination or problems with stopping the flow of urine, making the process more challenging and time-consuming.
These bladder symptoms in diabetics with neuropathy can significantly impact the quality of life and daily functioning of individuals. It is essential to recognize these symptoms and seek appropriate treatment and management strategies to alleviate discomfort and improve overall bladder function.
| Bladder Symptom | Description |
|---|---|
| Urinary Frequency | Increased need to urinate, disrupting daily activities and sleep patterns. |
| Urinary Urgency | Strong and sudden urge to urinate, causing anxiety and difficulties in social situations. |
| Incomplete Bladder Emptying | Feeling of discomfort or the need to urinate again shortly after using the bathroom. |
| Difficulty Starting or Stopping Urine Flow | Challenges in initiating urination or stopping the flow of urine, causing inconvenience and time-consuming bathroom visits. |
Impact of Diabetic Neuropathy on Urinary Function
Diabetic neuropathy, a common complication of diabetes, can have a significant impact on urinary function. Nerve damage caused by diabetic neuropathy disrupts the normal communication between the bladder and the brain, leading to various urinary issues in individuals with diabetes. These urinary issues can significantly affect the quality of life of those living with the condition.
When the nerves that control the bladder are damaged, it can result in a range of symptoms such as urinary frequency, urgency, incomplete bladder emptying, and difficulty starting or stopping urine flow. These symptoms can be distressing and impair daily activities.
The role of nerve damage in urinary dysfunction is critical to understand. The nerves responsible for carrying signals between the bladder and the brain play a crucial role in coordinating the storage and release of urine. When these nerves are damaged, the bladder may not receive proper signals from the brain or may contract involuntarily, leading to urinary incontinence or retention.
In addition to nerve damage, other factors such as impaired blood flow and bladder muscle dysfunction can further exacerbate urinary issues in individuals with diabetic neuropathy. Therefore, managing diabetic neuropathy and its impact on urinary function is essential to improve the overall quality of life for individuals living with diabetes.
Diagnosing Diabetic Neuropathy Bladder Symptoms
When it comes to diagnosing bladder symptoms in diabetic neuropathy, healthcare professionals employ a range of medical evaluations, tests, and assessments. These diagnostic tools help identify and evaluate the severity of bladder dysfunction caused by diabetic neuropathy. By gaining a clear understanding of a patient’s specific bladder symptoms, healthcare providers can develop a targeted treatment plan to address their individual needs.
Medical evaluations for diagnosing bladder symptoms in diabetic neuropathy typically involve a comprehensive review of the patient’s medical history and a detailed discussion of their symptoms. This helps the healthcare provider gather essential information that contributes to an accurate diagnosis.
Additionally, healthcare professionals may conduct a physical examination, which may include an assessment of bladder sensation, pelvic floor strength, and a neurological examination to evaluate nerve function. These examinations provide valuable insights into the underlying causes of bladder symptoms.
Further diagnostic tests may include urodynamic studies, which assess the bladder’s storage and emptying functions. These tests measure various parameters, such as bladder capacity, urine flow rate, and pressure during urination. urodynamic studies provide objective data that helps guide treatment decisions.
Common diagnostic tests for bladder symptoms in diabetic neuropathy include:
- Urinalysis: This test examines a urine sample for possible urinary tract infections or other underlying conditions that may contribute to bladder symptoms.
- Ambulatory bladder monitoring: In this test, a small catheter is placed in the bladder to monitor pressure and volume changes during the course of daily activities, providing valuable information about bladder function over an extended period.
- Cystoscopy: This minimally invasive procedure allows healthcare professionals to visually examine the bladder and urethra using a thin, flexible tube with a camera on the end.
- Nerve conduction studies: These tests measure the speed and strength of electrical signals traveling through the nerves, helping to identify nerve damage that may contribute to bladder dysfunction.
By utilizing a combination of these diagnostic approaches, healthcare professionals can accurately diagnose bladder symptoms in diabetic neuropathy and determine the most appropriate course of treatment. It is important for individuals experiencing bladder symptoms to seek medical attention promptly to receive an accurate diagnosis and appropriate management for their condition.
Managing Bladder Symptoms in Diabetic Neuropathy
When it comes to diabetic neuropathy, effectively managing bladder symptoms is essential for improving overall quality of life. By implementing various treatment approaches, lifestyle modifications, and self-care strategies, individuals can find relief and regain control over their bladder function.
Treatment Approaches
There are several treatment options available for managing bladder symptoms in diabetic neuropathy. Depending on the severity of the symptoms, healthcare professionals may recommend:
- Medications: Certain medications can help alleviate bladder dysfunction by relaxing the bladder muscles or reducing urinary urgency.
- Medical procedures: In some cases, medical procedures such as Botox injections or sacral nerve stimulation may be considered to improve bladder control.
- Catheterization: In individuals with severe bladder dysfunction, intermittent catheterization may be necessary to empty the bladder completely.
Lifestyle Modifications
In addition to medical interventions, making certain lifestyle modifications can significantly improve bladder symptoms in diabetic neuropathy:
- Fluid management: Maintaining a consistent fluid intake and avoiding excessive consumption can help regulate bladder function.
- Healthy diet: Eating a well-balanced diet can support overall bladder health. Avoiding irritants such as caffeine and spicy foods may also help reduce bladder symptoms.
- Bladder training: Re-training the bladder through scheduled voiding and gradually increasing the time between urination can improve bladder control.
- Pelvic floor exercises: Strengthening the pelvic floor muscles through exercises like Kegels can enhance bladder function and control.
Self-Care Strategies
Individuals with diabetic neuropathy bladder symptoms can also implement self-care strategies to better manage their condition:
- Maintaining a bladder diary: Keeping track of fluid intake, bathroom visits, and symptoms can help identify patterns and triggers for bladder dysfunction.
- Stress management: Stress can impact bladder function, so incorporating stress-reducing techniques like meditation or deep breathing exercises may be helpful.
- Regular exercise: Engaging in regular physical activity can improve overall health and support bladder function.
- Open communication: Talking to healthcare professionals and support networks about bladder symptoms can provide valuable guidance and reassurance.
By combining various treatment approaches, lifestyle modifications, and self-care strategies, individuals with diabetic neuropathy can effectively manage their bladder symptoms and improve their overall well-being. It is important to work closely with healthcare professionals to create a personalized management plan that addresses individual needs and goals.
Medications for Diabetic Neuropathy Bladder Symptoms
When it comes to managing bladder symptoms in diabetic neuropathy, medications can play a crucial role in alleviating discomfort and improving urinary function. These medications work by targeting specific aspects of bladder dysfunction, such as urinary frequency, urgency, and incomplete emptying. Here are some common medications prescribed for bladder symptoms in diabetic neuropathy:
1. Anticholinergic Medications
Anticholinergic medications, such as **Oxybutynin**, **Tolterodine**, and **Solifenacin**, are commonly prescribed to reduce bladder overactivity and control urinary urgency and frequency. These medications work by blocking the effects of acetylcholine, a neurotransmitter that stimulates bladder contractions. By inhibiting these contractions, anticholinergic medications help to improve bladder control and reduce urinary symptoms.
2. Alpha-Adrenergic Blockers
Alpha-adrenergic blockers, like **Tamsulosin** and **Doxazosin**, are often prescribed to manage bladder symptoms in diabetic neuropathy, particularly in cases where individuals experience difficulty initiating or stopping urine flow. These medications work by relaxing the smooth muscles in the bladder neck and prostate, facilitating urine flow and reducing hesitancy.
3. Tricyclic Antidepressants
Tricyclic antidepressants, such as **Amitriptyline** and **Nortriptyline**, have been found to be effective in managing bladder symptoms in diabetic neuropathy. Although primarily used as antidepressants, these medications also possess analgesic properties that can help alleviate bladder pain and reduce urinary frequency.
4. Beta-3 Agonists
Beta-3 agonists, such as **Mirabegron**, are a newer class of medications that help improve bladder function by relaxing the bladder muscle and increasing its storage capacity. These medications are particularly useful in managing symptoms of urinary frequency, urgency, and overactive bladder.
5. Botulinum Toxin Injections
In some cases, botulinum toxin injections, such as **Botox**, may be recommended for individuals with severe bladder symptoms that have not responded to other treatments. These injections work by temporarily paralyzing the bladder muscle, reducing its contractions and improving bladder control.
It’s important to note that the choice of medication will depend on the specific bladder symptoms experienced by each individual. Healthcare professionals will assess the severity of symptoms and consider any underlying medical conditions and potential interactions with current medications before prescribing the most suitable medication.
While medications can be effective in managing bladder symptoms, they may also have potential side effects. Common side effects include dry mouth, constipation, blurred vision, and dizziness. It’s essential to discuss any concerns or side effects with a healthcare professional to ensure the chosen medication is both effective and well-tolerated.
Non-Medical Interventions for Diabetic Neuropathy Bladder Symptoms
Alongside medications, there are various non-medical interventions that can be effective in managing bladder symptoms in individuals with diabetic neuropathy. These interventions focus on improving bladder function and can help alleviate symptoms such as urinary frequency, urgency, and incomplete emptying.
Pelvic Floor Exercises
Pelvic floor exercises, also known as Kegel exercises, are a widely recommended non-medical intervention for bladder symptoms in diabetic neuropathy. These exercises target the muscles that support the bladder and can help strengthen them, improving overall bladder control and reducing urinary symptoms. Research has shown that regular pelvic floor exercises can lead to significant improvements in bladder function and incontinence management.
Behavioral Therapies
Behavioral therapies, such as bladder training and prompted voiding, can also play a crucial role in managing bladder symptoms. Bladder training involves scheduled voiding at specific intervals, gradually increasing the time between voids to improve bladder capacity and control. Prompted voiding involves using cues or reminders to prompt individuals to empty their bladder regularly. These behavioral interventions aim to retrain the bladder and improve overall urinary function.
Complementary Approaches
In addition to pelvic floor exercises and behavioral therapies, there are other complementary approaches that can be helpful in managing bladder symptoms in diabetic neuropathy. These may include:
- Acupuncture: Some individuals may find relief from bladder symptoms through acupuncture, a traditional Chinese therapy that involves the insertion of thin needles into specific points of the body.
- Hypnotherapy: Hypnotherapy techniques can help individuals manage stress and anxiety, which can contribute to bladder symptoms. By reducing these psychological factors, hypnotherapy may improve bladder function.
- Dietary modifications: Certain food and drinks, such as caffeine and alcohol, can irritate the bladder and worsen symptoms. Making dietary adjustments, such as reducing or eliminating these irritants, can help manage bladder symptoms.
It’s important to note that while non-medical interventions can be effective in managing bladder symptoms in diabetic neuropathy, it’s best to consult with a healthcare professional for guidance and personalized recommendations. They can assess your specific condition and provide targeted advice on the most appropriate interventions for your individual needs.
Lifestyle Modifications for Diabetic Neuropathy Bladder Symptoms
Lifestyle modifications are essential for managing bladder symptoms associated with diabetic neuropathy. By making simple changes to your daily routine, you can improve bladder function and reduce the impact of these symptoms on your daily life.
Dietary Adjustments
Proper nutrition plays a crucial role in managing bladder symptoms. Consider incorporating the following dietary adjustments:
- Limiting fluid intake before bedtime to reduce nighttime urination.
- Avoiding bladder irritants such as caffeine, alcohol, and spicy foods.
- Including fiber-rich foods to maintain regular bowel movements, preventing constipation-related bladder issues.
Hydration Habits
While it may seem counterintuitive, staying properly hydrated is important for managing bladder symptoms. Follow these hydration tips:
- Drink an adequate amount of water throughout the day to maintain overall hydration.
- Spread your fluid intake evenly rather than consuming large amounts at once.
- Avoid excessive fluid intake close to bedtime to minimize nighttime bathroom trips.
Weight Management
Maintaining a healthy weight can alleviate bladder symptoms. Consider the following weight management strategies:
- Adopt a balanced and nutritious diet to support healthy weight maintenance.
- Incorporate regular physical activity into your routine to help manage weight and improve overall health.
- Consult a healthcare professional or registered dietitian for personalized guidance on weight management.
Other Lifestyle Changes
Additional lifestyle modifications that can improve bladder symptoms include:
- Establishing a regular bathroom schedule to encourage regular urination and avoid urgency episodes.
- Practicing pelvic floor exercises to strengthen the muscles that support bladder control.
- Reducing stress levels through relaxation techniques such as deep breathing exercises or meditation.
By incorporating these lifestyle modifications, you can effectively manage bladder symptoms associated with diabetic neuropathy and enhance your overall quality of life.
Coping with Incontinence Concerns
For individuals with bladder symptoms related to diabetic neuropathy, incontinence can be a significant concern. Coping with incontinence requires a multi-faceted approach that addresses both the physical and emotional aspects of this condition. In this section, we will explore various strategies to help you manage incontinence effectively.
Protective Garments
Protective garments, such as adult diapers or absorbent pads, can provide reassurance and support for individuals experiencing incontinence. These products are designed to absorb and contain urine, minimizing the risk of embarrassing accidents.
Bladder Retraining
Bladder retraining involves reestablishing control over your bladder by gradually increasing the time between bathroom visits. This strategy can help improve bladder function and reduce incontinence episodes. Working with a healthcare professional specializing in urology or neurology can provide guidance and personalized recommendations for successful bladder retraining.
Support Networks
Building a support network is crucial for individuals coping with incontinence concerns. Connecting with others who have similar experiences can provide emotional support, practical tips, and a safe space to discuss challenges and solutions. Look for support groups or online communities that focus on diabetic neuropathy and incontinence. Sharing your journey with trusted friends and family members can also provide valuable support.
| Benefits of Coping Strategies | Examples |
|---|---|
| Enhanced Comfort | Using absorbent pads for added protection |
| Improved Confidence | Practicing bladder retraining techniques to regain control |
| Emotional Support | Joining a support group for individuals with diabetic neuropathy and incontinence |
| Reduced Stress | Sharing concerns and experiences with trusted friends and family members |
Remember, everyone’s journey with incontinence is unique, and it may take time to find the coping strategies that work best for you. Be patient and persistent in your efforts, and don’t hesitate to seek professional guidance when needed. By actively managing your incontinence concerns, you can regain control and improve your overall quality of life.
Seeking Professional Help
When it comes to managing bladder symptoms in diabetic neuropathy, seeking professional help is crucial. Consulting healthcare professionals who specialize in treating bladder dysfunction in individuals with diabetes can provide invaluable support and guidance.
Urologists or neurologists are medical specialists who have extensive knowledge and experience in diagnosing and treating bladder problems related to diabetic neuropathy. They can offer a comprehensive evaluation of your bladder function and develop a personalized treatment plan based on your specific needs.
Professional help can make a significant difference in managing bladder symptoms effectively. These healthcare professionals have access to advanced diagnostic tools and treatment options that can help alleviate your symptoms and improve your overall quality of life.
By collaborating with a healthcare professional, you can expect:
- A thorough assessment of your bladder function and related symptoms
- Accurate diagnosis of bladder problems caused by diabetic neuropathy
- Personalized treatment plans tailored to your individual needs
- Access to medications and therapies specifically designed to address bladder symptoms
- Regular monitoring of your condition to ensure the effectiveness of your treatment
- Expert advice and support to effectively manage your bladder symptoms on a long-term basis
Remember, seeking professional help is not a sign of weakness or failure. It is a proactive step towards taking control of your health and improving your well-being. Don’t hesitate to reach out to a healthcare professional specializing in bladder dysfunction to get the support you need.
Conclusion and Final Thoughts
In conclusion, the symptoms of diabetic neuropathy that affect the bladder can significantly impact an individual’s quality of life. Understanding the relationship between diabetic neuropathy and bladder issues is crucial. The nerve damage caused by diabetic neuropathy disrupts the communication between the bladder and the brain, leading to urinary problems such as frequent urination, urgency, incomplete bladder emptying, and difficulties in urinary flow.
Managing bladder symptoms in diabetic neuropathy requires a proactive approach. Seeking professional help from healthcare specialists like urologists or neurologists is essential for accurate diagnosis and personalized treatment plans. With the right medical interventions, lifestyle modifications, and non-medical strategies such as pelvic floor exercises and behavioral therapies, individuals can effectively manage their bladder symptoms and regain control over their urinary function.
Living with bladder symptoms related to diabetic neuropathy can be challenging, but it’s important to stay positive and take proactive steps to improve overall bladder function. By adopting a proactive mindset, individuals can lead fulfilling lives while managing their symptoms. Remember, seeking professional help, implementing lifestyle modifications, and staying consistent with recommended treatment plans will play a significant role in enhancing bladder function and ultimately improving the quality of life for individuals with diabetic neuropathy.
FAQ
What are the common bladder symptoms in diabetic neuropathy?
Common bladder symptoms in diabetic neuropathy include urinary frequency (urinating more often than usual), urgency (sudden urge to urinate), incomplete bladder emptying, and difficulty starting or stopping urine flow.
How does diabetic neuropathy affect bladder function?
Diabetic neuropathy can disrupt the communication between the bladder and the brain, leading to bladder dysfunction. Nerve damage can result in impaired bladder sensation and control, causing various urinary problems in individuals with diabetes.
How are bladder symptoms in diabetic neuropathy diagnosed?
Bladder symptoms in diabetic neuropathy are diagnosed through medical evaluations and tests. Healthcare professionals may perform urodynamic testing, bladder ultrasounds, or cystoscopies to assess bladder function and determine the severity of dysfunction.
What are the treatment approaches for managing bladder symptoms in diabetic neuropathy?
Managing bladder symptoms in diabetic neuropathy involves a combination of treatment approaches. These can include medications to improve bladder function, lifestyle modifications, such as dietary changes and fluid management, pelvic floor exercises, and behavioral therapies aimed at retraining the bladder.
Are there medications available to alleviate bladder symptoms in diabetic neuropathy?
Yes, there are medications commonly prescribed to alleviate bladder symptoms in diabetic neuropathy. These may include antimuscarinic drugs, such as oxybutynin or tolterodine, which help relax the bladder muscles and reduce urge incontinence.
What are non-medical interventions that can help with bladder symptoms in diabetic neuropathy?
Non-medical interventions for bladder symptoms in diabetic neuropathy include pelvic floor exercises, behavioral therapies, and other complementary approaches. These interventions aim to improve bladder control and coordination.
How can lifestyle modifications help manage bladder symptoms in diabetic neuropathy?
Lifestyle modifications play a vital role in managing bladder symptoms. Making changes to diet, fluid intake, weight management, and establishing regular bathroom routines can help regulate bladder function and minimize symptoms.
What can individuals with incontinence concerns do to cope with bladder symptoms in diabetic neuropathy?
Individuals with incontinence concerns can cope with bladder symptoms by using protective garments, practicing bladder retraining techniques, and seeking support from healthcare professionals and support networks that specialize in managing incontinence.
When should individuals seek professional help for bladder symptoms in diabetic neuropathy?
It is crucial for individuals experiencing bladder symptoms in diabetic neuropathy to seek professional help. Consulting with urologists or neurologists who specialize in treating bladder dysfunction in individuals with diabetes can help develop personalized treatment plans and improve overall bladder function.
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