Bladder emptying disorder
The emptying of the bladder (micturition) takes place through a highly complex interaction of different muscles groups controlled by several components of the nervous system. The filling of the bladder and emptying of urine offer ample room for functional disorders of the bladder. Constrictions in the prostate or the urethra can be the cause of bladder emptying disorder. Neurological disorders, metabolic diseases, or side effects of medication can also lead to issues. Evaluation of symptoms can be very complex and may include laboratory examinations, such as a bladder pressure measurement (urodynamic tests).
Questions about bladder emptying disorder
A bladder emptying disorder, also known as a “micturition disorder” in technical jargon, is not a disease in itself, but merely a collective terms for a variety of symptoms that can have many different causes. Often there are nerve-related (neurological) causes, which are known as neurogenic bladder emptying disorders. These can occur when the nerve connection between the brain and the bladder is damaged, as can be the case after a stroke or paraplegia.
Mechanical causes such as urethral stenosis or prostate enlargement form the second large group of bladder emptying disorder. However, there are many other causes of bladder emptying disorder, such as diabetes, chronic alcohol consumption, or congenital diseases.
Symptoms include involuntary loss of urine (urinary incontinence), very frequent or too frequent emptying of the bladder, a very strong urge to urinate even when the bladder is only slightly full, pain when urinating, or incomplete emptying of the bladder. The latter is a common symptom and is also called residual urine.
If emptying of the bladder is incomplete, this is called residual urine formation. This means that the bladder is not properly empty even after going to the toilet.
In adults, the bladder does not have to be emptied to the very last millilitre; however, even relatively low values above 50 millilitres require clarification.
A sudden inability to urinate is often associated with severe pain. This is called urinary retention, or acute urinary retention. The first remedy for this medical emergency is a urethral catheter so that the urine can drain.
Only in some cases is residual urine actually felt. Often, increasing amounts of residual urine develop gradually over years and are then no longer noticed, even when the bladder is extremely full (chronic urinary retention). Warning signs of a permanently overfilled bladder can be a constant urge to urinate or incontinence. To prevent such a development, regular urological check-ups are recommended.
Even small amounts of residual urine can lead to urinary tract infections (UTI), as bacteria are never completely flushed out of the bladder. Complications such as prostatitis or epididymitis typically develop in men and women may experience inflammation of the renal pelvis. Sometimes stones form in the bladder and have to be surgically removed. Diverticula (bulges in the bladder wall caused by overstretching) may also require surgical treatment. If the bladder is extremely overfilled, urine can back up to the kidneys, which can leads to life-threatening kidney failure.
In addition to a detailed conversation and a physical examination, the amount of residual urine can be determined with an ultrasound examination. A urine stream measurement provides information on the strength of the urine stream. A cystoscopy is often performed to assess the urethra and bladder. In unclear cases, a bladder pressure measurement (urodynamics) is also carried out.
The pressure in the bladder and abdomen is measured via different catheters while the bladder is slowly filled. The recorded curve gives the urologist precise information on the cause of the bladder emptying disorder.
bladder emptying disorder should always be diagnosed, as they usually do not improve on their own. An examination by an experienced urologist who has a wide range of diagnostic procedures at their disposal is necessary if the patient has the symptoms mentioned. There is no general recommendation what exact treatment is best for bladder emptying disorder. The variety of causes determines the wide range of possible treatments, such as medication, surgery, electric stimulation, or biofeedback treatment. In the case of pronounced problems, catherization may be necessary, which is either carried out several times a day by the patient or as a permanent drainage solution.