Bladder Dysfunction: Causes, Symptoms & Treatment

Bladder dysfunction is a collective term for all urinary bladder dysfunctions. This includes all bladder emptying and urine storage disorders.

What is bladder dysfunction?

Bladder dysfunction is diagnosed when bladder function is impaired. However, bladder dysfunction is not a disease in its own right, but rather a collective term for all urinary storage and voiding disorders. In urinary storage dysfunction, the reservoir function of the bladder is impaired. Intentional voiding of urine is not possible. In bladder emptying disorder, emptying the bladder is very difficult. Functional, mechanical, neurological, and psychogenic factors may be causative for both forms of bladder dysfunction.

Causes

Mechanical causes are most often responsible for bladder voiding dysfunction. In this case, mechanical obstruction is caused by an obstruction to outflow. Pressure increases in the part of the urinary tract that is upstream of the obstruction. Possible mechanical causes of bladder dysfunction include urethral strictures, a urethral valve, bladder stones, or a narrowing of the bladder neck. Narrowing of the urethral orifice and a spherical dilation of the ureter in the bladder, called a ureterocele, can also affect bladder function. In men, bladder voiding dysfunction can also be caused by benign prostate enlargement or prostate cancer. Another cause is a severe narrowing of the foreskin (buttonhole phimosis). If the nerve supply to the urinary bladder is disturbed, a neurogenic bladder develops. This neurogenic disorder is usually caused by damage to the spinal cord. Less commonly, the cause is in the presacral plexus. In addition, a neurogenic bladder may develop in the setting of Fowler-Christmas-Chapple syndrome. Multiple sclerosis also frequently underlies neurogenic bladder voiding dysfunction. Three quarters of all multiple sclerosis patients develop bladder dysfunction in the course of the disease. If the duration of the disease is over ten years, almost 100 percent of patients have bladder dysfunction. Multiple sclerosis can also be the cause of urinary retention dysfunction. Bladder dysfunction in the form of urinary retention disorders mainly affects women of advanced age. Risk factors are bladder infections, obesity and diabetes mellitus. Stress incontinence often occurs in women who have given birth to several children naturally. However, urinary retention disorders can also occur in childhood and adolescence. If involuntary enuresis is present in children without an identifiable physical cause, it is referred to as enuresis. Bladder dysfunction can also be congenital. The most common causes here are malformations of the urinary bladders. One example of such a malformation is the split bladder. Here, the urinary bladder is open to the outside.

Symptoms, complaints, and signs

In a urinary storage disorder, urine cannot be stored in the urinary bladder without loss. The result is urinary incontinence. Urinary incontinence can be divided into several forms. The most common form is urge incontinence. It is characterized by a sudden strong urge to urinate. This urge is so strong that the toilet can no longer be reached in time. In stress incontinence, the loss of urine is triggered by increased intra-abdominal pressure. The abdominal pressure increases, for example, due to straining, pressing, lifting, carrying, laughing, sneezing or coughing. Stress incontinence is also known as stress incontinence. There is also a mixed form of urge and stress incontinence. This is called mixed incontinence. Overflow incontinence is more a result of bladder emptying dysfunction. If urine residue constantly remains in the bladder due to voiding dysfunction, an overflow bladder develops. The pressure in the bladder increases until it exceeds the pressure in the draining urinary system. This results in a constant dribbling of urine. However, the bladder emptying disorder is usually manifested by difficult urination (dysuria). This dysuria often occurs in combination with so-called pollakiuria. In pollakiuria, the affected patients urinate more frequently, but only ever excrete small amounts of urine. Despite the frequent urination, the total amount of urine does not increase.

Diagnosis and course

If bladder dysfunction is suspected, a detailed history and clinical examination are performed first. During this, the physician palpates the abdomen. In women, an assessment of the pelvic floor muscles should also take place. In men, a rectal examination is performed to assess the prostate. In addition to this clinical examination, imaging techniques such as sonography can provide further clues. With the help of these procedures, many causes of bladder voiding dysfunction can be visualized. Bladder manometry, a urodynamic examination, can functionally assess the voiding process. An assessment of bladder function is also possible with uroflowmetry. This measures the flow of urine. Cystometry, on the other hand, assesses bladder pressure during voiding and during storage. For this purpose, a catheter is inserted into the urinary bladder. Urinary tract infections should be ruled out as a possible cause with urine and laboratory tests. If the tests do not provide clear results, a cystoscopy can also be performed. Here, a mini-endoscope is inserted into the bladder via the draining urinary tract. The treating physician can thus gain an insight into the urinary tract and the bladder. Ultrasound, computed tomography or magnetic resonance imaging are other ways to visualize the bladder and the draining urinary tract.

Complications

Because bladder dysfunction is a collective term for various urinary bladder dysfunctions, potential complications depend on the exact cause. If an underlying condition is responsible for the bladder emptying dysfunction, its treatment is the primary concern. With effective therapy, the complications of bladder emptying and urinary retention disorders can thus be largely prevented. Urinary retention (ischuria) is the most feared complication of bladder dysfunction. For a variety of reasons, this can involve an inability to empty the bladder. These include: Outflow obstructions in the area of the bladder or urethra, inflammation of the prostate or urinary tract, bladder stones, benign prostatic hyperplasia and neurogenic bladder emptying disorders. Depending on the symptoms that occur, doctors distinguish between a painful, acute urinary retention and a symptomless, chronic form. Chronic urinary retention often results in overflow incontinence. Because of the risk of bladder rupture, acute urinary retention is an emergency. If ischuria persists for a prolonged period, urine backs up into the ureters and kidneys. This damages the renal parenchyma with the possible consequence of a shrunken kidney. Other complications of bladder dysfunction include:

  • Sepsis,
  • Inflammation of the renal pelvis (pyelonephritis),
  • Urine poisoning (uremia),
  • Chronic renal failure,
  • Recurrent urinary tract infections.

When should you go to the doctor?

Not every disorder of the bladder function requires treatment. A harmless bladder infection can also be cured with good old home remedies such as heat and bladder tea. It does not always have to be antibiotics. However, it should improve after a few days. If this is not the case and there is also a fever or recurring urinary tract infections, a doctor, preferably a urologist, should be consulted to clarify the cause. If a bacterial infection is behind the bladder symptoms, treatment with antibiotics is advisable, and with antimyotics in the case of a fungal infection. In addition to urinary tract infections, bladder or kidney stones or bladder tumors can also cause bladder dysfunction. These are anything but harmless and should be examined by a doctor immediately to avoid complications. Narrowing of the urethra and urinary retention are also a case for the urologist. As a rule, incontinence also requires medical attention, and sometimes psychological support. In principle, it is not wrong to see a doctor first in case of bladder problems.

Treatment and therapy

The therapy of bladder dysfunction always depends on the cause. For mechanically caused bladder voiding dysfunction, the obstruction causing the obstruction must be removed. Neurogenic bladder voiding dysfunction is usually treated with medication. Treatment with sacral neurostimulation or sacral neuromodulation is also possible.This involves implanting a bladder pacemaker that restores bladder control function by delivering weak electrical pulses.

Outlook and prognosis

The prognosis for bladder dysfunction depends on the exact type of bladder dysfunction. For example, there are cases in which full or partial return of bladder control and function can be expected and cases in which it cannot. In most cases of mechanically induced bladder dysfunction, a way can be found surgically to restore bladder function. In most cases, the defect here is in the urethra or bladder sphincter, which allows a good prognosis. Urinary retention due to an overstretched bladder can be corrected by temporarily placing a catheter to drain the urine. Urinary stones and the like can also usually be treated without difficulty. Bladder dysfunction due to inflammation will usually go away as the infection heals. In cases where bladder function is disrupted under certain conditions (pressure, stress, etc.), the prognosis depends on the ability to treat. Often medications can help. In cases where bladder function is disrupted due to nerve damage, no improvement can be expected with medication. Remedies can be provided by bladder pacemakers, but again there is no guarantee of success. Accordingly, there are those affected by bladder dysfunction who will be dependent on a catheter for the rest of their lives. This is especially true with regard to multiple sclerosis.

Prevention

Most bladder emptying disorders are very difficult to prevent. Urinary retention disorders are often the result of weak pelvic floor muscles. Targeted pelvic floor training can strengthen the pelvic floor muscles and thus prevent incontinence.

Aftercare

A number of functional disorders fall under the term “bladder dysfunction.” The extent to which follow-up care becomes necessary depends on the underlying condition. For example, cases exist in which follow-up care is not necessary because there are no longer any symptoms. This is the case, for example, with mechanical dysfunction. In this case, a surgical intervention quickly leads to the disappearance of the symptoms. In other cases, however, follow-up care becomes a lifelong issue. For example, a large proportion of multiple sclerosis patients are dependent on a catheter. Like all other sufferers, they should also pay attention to daily intimate hygiene. Certain types of tea also promise to alleviate the symptoms. Cold sitting surfaces should always be avoided. Sometimes it also helps if those affected by bladder dysfunction drink plenty of water and exercise. The discomfort of kidney stone can be reduced in this way. The situation is different if the dysfunction is caused by psychological factors. Here, regular treatment proves to be quite costly. A doctor orders psychotherapy to stop harmful lifestyle habits. According to experience, stress and pressure in everyday life occur again and again, which is why the complaints can arise again in case of upsets. Psychological and many other protracted causes are not infrequently combated with medication.

What you can do yourself

In the case of bladder dysfunction, the effective measures always depend on the cause. For example, urinary retention as a result of kidney stones can be relieved by drinking plenty of fluids and exercising, while large amounts of drinking should be avoided in the case of bladder emptying dysfunction following prostatic hyperplasia. In general, increased intimate hygiene should be observed during the disease. Affected persons can also contribute to a rapid healing of the inflammation by avoiding cold sitting surfaces and wearing warm functional underwear. Various care products from the drugstore also help to strengthen bladder function. A proven remedy from nature is horsetail. The plant can be supplied as a tea or in the form of a steam bath and has an anti-inflammatory and analgesic effect. A similar effect has couch grass tea. Herbal teas are also considered helpful for urinary tract infections or kidney gravel, as well as horseradish, corn tea and foods containing calcium. In conjunction with diuretic tea and sparing, this usually provides relief from the symptoms. Regardless of the tips mentioned, the cause of the bladder dysfunction must be determined and preferably treated medically. Together with the doctor, effective treatment steps can then be initiated.