A recent review published discusses the historical background and current understanding of giggle incontinence, which is a bladder storage disorder.
Giggle Incontinence
Giggle incontinence is a type of daytime urinary incontinence characterized by uncontrollable episodes of urinary incontinence due to loud, powerful, or bursting laughter. Unlike enuresis, stress urinary incontinence, non-neurogenic voiding dysfunction, bladder and bowel dysfunction, or anatomical disorders causing incontinence, giggle incontinence lacks additional functional symptoms.
Historically, giggle incontinence has been mistaken for stress urinary incontinence and an overactive bladder. Moreover, giggle incontinence has been considered a particular type of laughter-induced daytime urinary incontinence that can be distinguished from laughter-induced stress urinary incontinence by its specific feature of complete emptying of the bladder.
The exact etiology of giggle incontinence is not fully understood. However, two main hypotheses indicate the involvement of the central nervous system and dysfunction of the detrusor and pelvic floor muscles.
The authors of the current review systematically searched various scientific databases and identified 26 studies on giggle incontinence published between 1959 and 2023. These studies were assessed to describe the historical background, current understanding, and challenges associated with giggle incontinence.
Pathophysiology
A widely accepted hypothesis on the pathogenesis of giggle incontinence indicates the involvement of the central nervous system, similar to cataplexy, which is the loss of voluntary muscle control. Laughter acts as a stimulus to induce hypotonia and relaxation of pelvic floor muscles, thereby leading to uncontrolled micturition.
Mechanistic evidence links cataplexy with type 1 narcolepsy-associated laughter-induced muscle weakness. Most patients with type 1 narcolepsy are positive for the human leukocyte antigen HLA-DQB1*06:02, which may contribute to the familial tendency observed in some giggle incontinence patients.
Attention-deficit hyperactivity disorder (ADHD) is a common condition observed in about 23% of giggle incontinence patients. Existing evidence also links giggle incontinence pathogenesis with pelvic floor muscle dysfunction, as the proper functioning of these muscles is required for the closing of vaginal, urethral, and anal sphincters in response to increased intra-abdominal pressure. It has also been hypothesized that laughter-induced instability of the detrusor muscle can lead to giggle incontinence.
Treatment and Significance
Medications that are commonly used to treat neurodynamic lower urinary tract disorders include anticonvulsants, antidepressants, anticholinergics, α-adrenergic blockers, and electric shocks. Three therapies are currently being used to control incontinence, including standard urotherapy, biofeedback, and methylphenidate.
Previous studies have shown that six-month standard urotherapy can partially improve giggle incontinence in 33% of patients; however, this therapy failed to cure the condition. Patients who are unresponsive to standard urotherapy are typically advised to undergo specific urotherapy.
Studies using biofeedback for giggle incontinence patients have reported an efficacy rate of 73% after ten weeks of weekly sessions. Patients are often advised to continue biofeedback training alone or in combination with methylphenidate once continence is achieved.
Methylphenidate is a central nervous system stimulant that acts by influencing urethral smooth muscles and increasing dopamine activity in the brain. Methylphenidate has been found to completely resolve giggle incontinence symptoms in patients; however, the treatment may cause adverse side effects in some patients, including insomnia, tachycardia, hypertension, anorexia, weight loss, abdominal pain, headache, irritability, agitation, or anxiety.
Source:
https://www.news-medical.net/news/20240227/Understanding-giggle-incontinence-Causes-symptoms-and-management.aspx