A. Option 2 Stress incontinence. During coughing and sneezing intrathoracic and intraabdominal pressure is raised. In the presence of impaired sphincter action at the bladder outlet, a common consequence of damage during delivery, the raised pressure can expel some urine from the bladder. Laughing may have a similar effect.
B. Option 5 Automatic bladder. The patient had a spinal injury which has led to loss of bladder control. Such injuries isolate the micturition centre in the sacral cord from higher centre control. In such patients the bladder can empty automatically when distended by means of the bladder stretch reflex centred in the sacral cord. Pressure on the abdomen can initiate the reflex at a convenient time before it occurs automatically.
C. Option 4 Acute retention of urine. In elderly men, prostatic enlargement leads to progressive compression of the prostatic urethra. This leads to increasing resistance to flow so that the urinary stream is poor. If the obstruction becomes complete so that micturition is impossible, the bladder becomes painfully distended.
D. Option 1 Atonic bladder with overflow. This is another case of spinal injury isolating the micturition centre in the sacral cord from higher centre control. However, in the acute phase that comes on immediately and lasts for some weeks after the injury, the patient usually shows a complete absence of spinal stretch reflexes below the level of the lesion spinal shock. The micturition stretch reflex is abolished so that the bladder loses tone, becomes distended and leaks uncontrollably due to the high pressure in the passively distended organ. Catheterization is important, to prevent damage to the bladder by such over-stretching.
E. Option 3 Chronic prostatic obstruction. This is another case of prostatic obstruction but without acute retention of urine. Gradual narrowing of the prostatic urethra raises the urethral resistance which the bladder must overcome. Hypertrophy of the bladder wall occurs (as in the left ventricle in systemic hypertension), hence bladder pressure during a micturating cystometrogram (record of bladder pressure versus volume) is increased. As in the failing heart, the bladder muscle fails to empty as completely as usual.