Bladder emptying disorder
The bladder is emptied (micturition) through a highly complex interplay of different muscle groups, regulated by several components of the nervous system. The filling of the urinary bladder and the emptying of urine leave plenty of room for functional disorders of the urinary bladder. Narrowing in the area of the prostate or the urethra can be the cause of bladder emptying disorders. Neurological disorders, metabolic diseases or side effects of medication can also be considered. Clarification can be very complex and can also include instrument-based examinations such as bladder pressure measurement (urodynamics).
Questions about bladder emptying disorders
A bladder emptying disorder, medically known as a "micturition disorder", is not a disease in itself, but merely an umbrella term for a large number of symptoms that can have many different causes. Nerve-related (neurological) causes are common, which are then referred to as neurogenic bladder emptying disorders. These can occur when the nerve connection between the brain and the bladder is damaged, as is the case, for example, after a stroke or in paraplegia.
Mechanical causes such as a urethral stricture or an enlarged prostate form the second large group of causes of bladder emptying disorders. There are also many other causes, such as diabetes, chronic alcohol consumption or congenital diseases, which cause a bladder emptying disorder.
Symptoms include involuntary loss of urine (urinary incontinence), very frequent or too infrequent bladder emptying, a very strong urge to urinate even when the bladder is only slightly full, pain when urinating or incomplete bladder emptying. The latter is a common symptom and is also referred to as residual urine.
If the bladder is not emptied completely, this is referred to as 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 down to the very last millilitre; however, even relatively low values above 50 millilitres require investigation.
If you suddenly cannot urinate any more, this is usually associated with severe pain. This so-called "urinary block" is also referred to as acute urinary retention. In this medical emergency, a urethral catheter initially provides relief so that the urine can drain again.
Residual urine can only actually be felt in some cases. Increasing amounts of residual urine often develop gradually over years and are then no longer perceived at all, 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 screening examinations are advisable.
Even small amounts of residual urine can lead to urinary tract infections, as bacteria are never completely flushed out of the bladder. As a complication, men typically develop prostatitis or epididymitis, and women develop pyelonephritis. Sometimes stones form in the bladder, which have to be removed surgically. Bulges in the bladder wall (diverticula) caused by overstretching may also require surgical treatment. If the bladder is extremely overfilled, urine can back up into the kidneys, which can lead to life-threatening kidney failure.
In addition to a detailed consultation and a physical examination, the amount of residual urine can be determined with an ultrasound examination. A urine flow measurement provides information about the strength of the urine stream. A cystoscopy is often performed to assess the urethra and bladder. In unclear cases, bladder pressure measurement (urodynamics) is also carried out.
The pressure in the bladder and in the abdominal cavity is measured via various catheters while the bladder is slowly filled. The curve recorded in the process gives the urologist precise information about the cause of the bladder emptying disorder.
Bladder emptying disorders should always be investigated, as they generally do not improve on their own. An examination by an experienced urologist, who should have a wide range of diagnostic procedures at their disposal, is necessary in any case with the symptoms mentioned. There is no general recommendation as to what can be done about bladder emptying disorders. The variety of causes means a wide range of possible therapies, e.g. medication, surgery, electrical stimulation or biofeedback treatment. In the case of pronounced problems, catheterisation may be necessary, which is either carried out by the patients themselves several times a day or takes the form of permanent drainage.
Further information in the videos:
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Functional bladder emptying disorder
Here you will learn everything important about functional bladder emptying disorder. This is present when the bladder does not empty properly despite normal anatomy (no prostate enlargement or urethral stricture).
- Cause: Disturbed reflex: during urination, the external sphincter contracts in an uncoordinated manner, interrupting the urine stream.
- Consequences:
- Weak, interrupted urine stream
- Frequent urge to urinate
- Overloading of the bladder wall (the bladder muscle thickens)
- Increased risk of cystitis
- Diagnosis:
- Exclusion of anatomical causes by endoscopy
- Bladder pressure measurement to check the coordination between the bladder wall and the sphincter
- Treatment:
- Medication that prevents the pelvic floor from contracting (only temporarily effective)
- Biofeedback therapy: training for targeted relaxation of the pelvic floor during urination – effective in the long term
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Everything you need to know about the bladder catheter
In this video, you will learn everything important about the bladder catheter. This is a tube that is inserted into the bladder via the urethra in order to drain the urine.
- Definition: The bladder catheter enables controlled drainage of urine, e.g. in the case of impaired bladder emptying, severe prostate enlargement, urinary retention or incontinence. It is also used during operations or in intensive care units.
- Insertion: It is inserted under sterile conditions with lubricant and, if necessary, local anaesthesia. In men, the anatomical curves of the urethra must be taken into account. The catheter is held in place in the bladder by a balloon so that it does not slip. The urine flows via a connection into a urine bag, attached either to the bed or to the leg.
- Removal and care: The balloon is emptied before removal. Bladder catheters carry a risk of infection, especially if left in place for a long time, which is why a monthly change is recommended. As long as the urine drains freely, bacteria usually do not cause any problems.
- Alternatives: One option is the suprapubic catheter, which reaches the bladder directly through the abdominal wall. Advantages: less discomfort in the urethra and a sex life remains possible.
- Goal: Safe and hygienic urine drainage, avoidance of infections or injuries, regular changes to protect against blockage.
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Facts about the suprapubic catheter
Discover the alternative to transurethral bladder catheterisation – direct urine drainage through the abdominal wall, especially for men with permanent bladder emptying disorders or incontinence.
- Procedure: The bladder is filled with 300–500 ml of fluid, the catheter is inserted through a hollow needle under ultrasound guidance and fixed with a balloon or a suture. It is changed monthly, initially over a guide wire.
- Advantages: The suprapubic catheter spares the urethra, offers a comfortable long-term solution and is easy to change after an initial period of getting used to it.
- Special features: Ultrasound guidance reduces the risk of bowel injuries. A suprapubic catheter is also possible in women, but the benefit is lower.
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Cystoscopy
How it works
In this video, you will learn everything important about cystoscopy – an endoscopic examination of the urinary bladder in men and women.
- Purpose: Clarification of subtle changes in the bladder wall, e.g. in the case of blood in the urine, suspected tumours, bladder stones or emptying disorders.
- Procedure: Examination under sterile conditions with lubricating gel and local anaesthesia.
- In women: Use of a rigid endoscope – the short, straight urethra allows a simple examination.
- In men: Use of a flexible endoscope that adapts to the natural curves of the urethra – making it low-pain and gentle.
- Technology: Modern video optics ("chip-on-the-tip") provide clear images; if necessary, minor procedures or tissue sampling can be carried out directly.
- Advantages: Reliable diagnostics, precise assessment of the bladder wall, practically painless today.
Paraplegia and the bladder
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Bladder emptying disorder in paraplegia
In this video, you will learn how the nervous system controls bladder emptying, which forms of bladder paralysis are distinguished and why residual urine, cystitis, bladder stones or hydronephrosis can lead to loss of kidney function.
- Basics of bladder emptying disorders
- How the nervous system controls the bladder
- What happens in paraplegia?
- Reflex bladder emptying explained
- Understanding flaccid bladder paralysis
- Complete vs. incomplete nerve lesion
- Risks: residual urine, infections and bladder stones
- Danger to the kidneys and urinary retention
- Modern diagnostics and treatment options
- When operations become necessary
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Paraplegia
Treating a reflex bladder with surgery!
In this video, urologist Prof. Sven Lahme explains clearly why high bladder pressure can become dangerous and why bladder function should be checked regularly.
- What is neurogenic bladder dysfunction?
- The reflex bladder simply explained
- Why high bladder pressure is dangerous
- Consequences for the bladder wall, ureters and kidneys
- Goal of treatment: lowering the pressure in the bladder
- How the operation works
- Why bladder augmentation reduces the pressure
- Life after the operation: catheterisation explained
- Summary: protecting the kidneys is the main focus
About this page:
Author
Medical director of the Goldstadt-Privatklinik.
Specialist for Urology, Mini-PCNL and robot-assisted da Vinci procedures.
Member in Scientific Societies and Reviewer of scientific journals.
