Although post void residual volume (PVR) is a valuable diagnostic test in patients with urinary incontinence. It has been shown to be non-specific and not completely accurate. In this study, researchers set out to determine the PVR characteristics of patients presenting with overactive bladder (OAB) symptoms.
Across nine myth-busting study participants. Researchers found that the average PVR measurement varied between 0.7–2.2 litres (25–54 ounces), depending on the severity of the symptoms. Post-void residual volume (PVR) measurement. On the other hand, was highly reliable (a high correlation of r = 0.97) in identifying mild symptoms of OAB.
As a preface, I would offer the fact that this interest in post void residual volume. Comes from an MS patient with years of first-hand experience of living with urinary problems.
Prior research suggested that PVR could not accurately predict symptom severity. But this study found it can accurately predict urine output based on symptom severity. Based on this finding, researchers suggest using PVR for other diagnostic purposes. Or before starting blood pressure medication, since it can be useful in identifying chronic TLD symptoms.
Post Void Residual Volume in Multiple Sclerosis
A few years ago, my MS nurse gave me a piece of medical measuring equipment to check my bladder retention. This was a sonic device, a little like the sonar in a submarine. This allowed me to check the level of retained urine in my bladder after “going for a pee”. The test kit showed that as much as 30% of my bladder volume was being retained.
This level of urine retention could lead to urine infection or UTI. At one stage my urologist had me using self-catheterization to alleviate the problem.
Prone takers of medication with high diuretic activity (i.e., beta blockers, calcium channel blockers and sodium nitrates). And men with symptomatic overactive bladder. Are at risk for developing “water retention” a term coined by clinicians to describe some OAB patients. Who produce significant volumes of urine that might be improperly attributed to dehydration and not properly excreted.
Researchers, led by John Bartel from the Pennington Biomedical Research Centre at Louisiana State University. Conducted an 8-week study to determine if PVR was useful as a potential screening tool for OAB in these patients. The study was approved by the Institutional Review Board at Louisiana State University. And all participants signed an informed consent statement prior to participation.
Presenting symptoms = symptom comorbidity and isolation.
In order to determine if the PVR diagnostic was useful in identifying patients at risk for developing water retention. The researchers wanted to determine the association between symptom severity and the usefulness of the PVR diagnostic tool.
The Science of the investigation
The participants, who were admitted to the hospital for overactive bladder syndrome. Due to repeated episodes (with no resolution) of straining to urinate in public places (i.e., trades or sporting events). Were assessed for symptom severity and their PVR levels were measured. Data were analyzed using multiple logistic regression. And the likelihood of developing water retention was compared using Shapiro-Wilk test. Which showed a high correlation of r = 0.97 with symptom severity and PVR.
Patients with obstructive uropathy not meeting our current criteria] can be correctly diagnosed through the PVR test. With 95% sensitivity and specificity. Yet, these patients also have the highest prevalence of drinking to achieve satiety. In these situations since they are always in the public domain.Bartel
The researchers also studied 50 participants with symptomatic overactive bladder symptoms. Divided into two categories hypothetically representative of patients with post void residual volume (PVR) and chronic orofactive bladder syndrome (COS).
Researchers recruited 42 participants (20 women and 22 men) to participate in an online survey. Regarding their symptom experience and their experiences with various diagnostic tools and software. However, when the study began. The participants had been instructed to refrain from using the following tools for eight weeks prior to the study. Pads, belts, catheters, urine monitoring apps, urine colour and colour tolerance tests, etc.
That is, the participants were told not to use the above-mentioned tools for eight weeks prior to the study. The test protocol used a modified version of the technique of chest physiotherapy. Which was well-established in the 1970s and 1980s. The technique utilizes an individualized interactive capsule therapy procedure designed to target the source of the pain. And increase the patient’s mobility, range of motion and function. Those in the study were taught exercises to target their dysfunctional patterns. And learned how to guide their therapists through the treatment based on the participant’s symptoms.
During the eight weeks of the study, 20 women and 22 men participated in the procedure. Of the participants, 78% commonly wet theit pants and 60% regularly wet their underwear. This results in a high PVR prevalence for patients with overactive bladder. Of the patients that were frequently wet. More than a quarter were diagnosed with OAB as well as a large number of chronic bed-wetting patients (37%).
Of those diagnosed with overactive bladder. More than 90% displayed severity A or B muscles with a prolonged tensor fasciae lata. (Tensor fasciae latae were identified in 33% of patients). While less than 50% participated in a treatment program (presence of therapy was younger and less common in the patients). Among the patients that were more severe with A and B muscle involvement. Symptoms were more widespread. With 66% displaying symptoms in both the anterior (in the lower abdomen) and posterior (lower back) muscles. In contrast to the results from the symptomatic arousal evaluation test. There was a lack of correlation between PVR and symptoms in severity.
Revision of the Science
Researchers found that accuracy was not a high goal of the PVR measures in this study. Of the methods utilized in this study, the superior incline method was shown to be most effective in identifying the source of the pain as well as improving functional mobility.
As is the case with other tests and studies, it is ideal to maintain an open dialogue with your doctor and all experts involved in your therapeutic plan so that you can discuss any concerns.
Using the Multi-Oral Assessment for Women (MOA) system, 20 women were assessed for symptom presence, especially the frequency and/or severity of urinary incontinence, as well as the presence of signs of pelvic floor dysfunction. As reported by Medical News Today, the findings showed that the average PVR score for these women was 12. Similar to the study findings, using the PVR, OAB patients were classified into three groups based on their rates of impairment: none, mild, and severe.
Post-void residual volume was not a robust diagnostic measure for the group with both moderate and severe symptoms. The findings are similar to the findings of previous studies on the PVR not being a reliable diagnostic tool for women suffering from POM.
When looking at prevalence rates, OAB was found to be most prevalent in females, as reported by Medical News Today and reported in a study by Women’s Health Network. The symptoms of POM were more severe and associated with greater distress than OAB, and symptoms of pelvic floor dysfunction were most common in those with moderate symptoms.
Naji et al hypothesized that the ultimate mechanism of symptomatic recovery differs in the two populations.
Although the patients in the two studies were found to have similar symptom presentations, mainly the frequency and intensity of improvement, the new study found that the severity of symptoms was predictive of poor aerobic fitness, an indicator of functional capacity, speed and acceleration during activities of daily living.
Keep-Fit for the Bladder
There was a greater prevalence of OAB in women with mild symptoms with increased aerobic and aortic function than in those with severe symptoms and worse aerobic function, according to the study findings.
Higher levels of aerobic fitness have been independently associated with decreased risk of death from cardiovascular disease and Type 2 diabetes, and the aerobic fitness advantage in athletes is even greater than it is in sedentary people, notes study author Andrea Rossi, PhD, chief of the Chronic Obstructive Pulmonary Disease Section at Massachusetts General Hospital.
Rossi explains that when individuals with mild symptoms with poor aerobic fitness perform high-impact workouts and are unable to maintain physiological activity, “inadequate recovery among females without POM, combined with the increased rate of injury among females, makes the condition potentially more deadly.” An injury leading to death, which is the major cause of preventable mortality in women with OAB, occurs frequently in popular dance fitness classes, according to study co-author Courtney Brown, MS, senior director of operations at Women’s Health Network.
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