The term bladder problems cover a wide range of disorders, some of which cause urinary incontinence, pain or other complications that can considerably affect the quality of life. Even though, millions of adults suffer from bladder problems, not so many of them speak of it, because it is often considered an embarrassing discussion.
The bladder is a simple organ that serves as a reservoir of urine. It is part of the urinary tract system that stores urine until it is eliminated. However, the bladder is susceptible to a variety of diseases and disorders.
Its function may also be affected by the diseases of other tissues and organs present in the body.Bladder problems can be divided in to two categories which include, Problems in the bladder itself and problems concerning bladder functions.
Problems of the Bladder Itself
1. Bladder Cancer
The cancer that forms in the tissues of the bladder is called bladder cancer. Majority of bladder cancers start from the inner lining of the bladder, called transitional cell carcinoma. Other types of cancers include squamous cell carcinoma which occurs in the flat, thin cells and adenocarcinoma that occurs in cells that secrete mucus and other fluids are also present.
Although the exact cause of bladder cancer is not known, many doctors have identified cigarette smoking as the potential cause for it. The person’s risk of developing bladder cancer increases with smoking, exposure to chemical substances, high fat diet, age, sex, race, family history of bladder cancer, cellular abnormalities, and chronic bladder inflammations.
Signs and symptoms:
Blood in urine is the first warning sign of bladder cancer. But the blood is unlikely visible to the naked eye, and can be detected through a simple urine test. Other common symptoms also include pain while urinating and changes in bladder habits.
Often bladder cancer does not show any symptoms until it reaches an advanced stage which is quite difficult to cure.
Urine sample is tested for any abnormal cells, called urinary cystography, which may sometimes give false-positive test and vice-versa. This makes urologist recommend other tests, which include imaging tests, biopsy and cystoscopy. If any cancerous cells are detected from the above tests, then chest x-rays, CT scan, MRI scan and a bone scan is conducted to determine whether the cancer is limited to its area of origin or not.
Treatment options for bladder cancer depend on its type, its advancement, general health of the patient and their preferences. Early stages of bladder cancer can be treated through surgical removal of the portion of bladder that has cancer cells.
Radical cystectomy is the procedure where the whole bladder and the nearby lymph nodes are removed surgically.
Immunotherapy, chemotherapy and radiation treatments are used in conjunction with other treatment methods to further prevent cancer development.
Cystitis, also called urinary tract inflammation is caused by a number of conditions, most commonly by the bacteria. When caused by bacteria, it is referred to as urinary tract infection. It often causes serious pain and discomfort, and affects more women than men.
Cystitis may be caused due to a number of conditions, such as individuals with short urethra, damage caused to bladder when changing urinary catheter, women using diaphragm for contraception, incomplete emptying of the bladder leading to bacterial growth, block in parts of the urinary tract system, kidney or bladder problems, and frequent or vigor sex.
Signs and symptoms:
Cystitis symptoms include blood in urine, dark or cloudy urine, pain in lower back, abdomen, and above pubic bone, frequent urination, burning sensation while urination, and older women may experience fever and feel weak.
Urine analysis and urine culture is often done to confirm the presence of bacteria. While urine analysis is performed to find out the various components of the urine including bacteria, urine culture is performed to identify the specific type of bacteria causing the infection.
For concurrent cystitis, the doctor may recommend the following tests; ultrasound scan, cystoscopy, CT scan, X-ray or blood culture is done.
Moderate to severe cystitis is treated with short course antibiotics treatment which involves using oral antibiotic drug for a period of around 3 days. For recurrent cystitis, continuous antibiotic treatment is given by the physician.
3. Bladder Stones
They are small mineral masses that form in the bladder, especially when the urine becomes thick. These stones are often called calculi.
The most common cause of bladder stones is due to the inability of the bladder to empty itself completely. Therefore, the stagnant urine which consists of urea clumps together, resulting in the formation of crystals.
The risk factors that increase the likelihood of developing bladder stones include age, weakened bladder wall, deficiency of vitamin A/B, high fat, sugar or salt diet, and people with bladder outlet obstruction, damaged nerves that controls bladder function, recurrent bladder infections, urinary catheters, or kidney stones.
Signs and symptoms:
Bladder stones do not always cause any signs or symptoms and sometimes pass on their own. It might be discovered only during tests for other problems. When symptoms occur, it may be from abdominal pain, painful, difficult or frequent urination, dark coloured urine and blood in the urine.
Urine analysis is typically the first test done to examine the presence of crystalline substance, blood and bacteria’s in the urine sample. If blood cells are seen, a cystoscopy is performed with a scope of looking into the bladder. Since most stones are made of calcium, an X-ray analysis also helps to show up these stones, but not uric acid stones.
Drinking plenty of fluids may dilute the urine and help the stone to pass. But many a times, bladder stones are due to the inability of the bladder to empty its contents completely. In such cases, other treatment procedures are performed.
Treatment of large bladder stones typically involves the surgical removal of it through an incision in the lower abdomen. For smaller stones, laser or ultrasound waves is used to break it down into smaller pieces and then washed out with normal urination. If bladder stones are due to any other diseases or abnormalities, they should be looked into first and treated immediately, in order to prevent more stone formation.
In women, the front wall of the vagina that supports the bladder weakens with age which causes it to descent into the vagina causing bladder prolapse or cystocoele. It can take in to 4 different forms depending on its severity. Bladder prolapse may lead to urinary difficulties, stress incontinence and discomfort.
Bladder prolapse is often caused sue to factors like menopause, childbirth and straining that causes damage to the pelvic floor muscles.
Signs and symptoms:
The first typical symptoms experienced by women suffering from cystocoele are the presence of tissue protruding in the vagina that gives a feel like a ball. Other common symptoms such as, difficulty in urination, pain in pelvic area, painful intercourse, bladder infections, lower back pain, stress incontinence, and a feeling that the bladder is full even after urination.
Pelvic examination is done in order to diagnose prolapsed bladder among women. Cystoscopy, x-ray examination and urodynamics are also performed to help with further diagnosis.
Treatment options for bladder prolapse depend on the severity of the condition. Non-surgical treatments include pessary, estrogen replacement therapy and kegel’s exercises. Severe conditions of cystocoele require surgery to correct them.
5. Nocturnal Enuresis
This is commonly referred to as bedwetting, which is the unintentional passage of urine during sleep. It is very common among children below 5 years. Also, it is important to note that often children learn to control their bladders ta different ages. So unless, there is any neurological problem, children eventually learn to stop bed wetting.
In most cases of bedwetting, no cause will be found. In rare cases, it may be a problem of an underlying disease which include constipation, or type I diabetes.
There is no single approach in treating the condition. Self-help techniques like restricting the amount of fluids consumed in the evening may be helpful in certain cases. Bed wetting alarms are often recommended by physician, which helps train the child to wake up once their bladder becomes full.
Problems Concerning Bladder Functions
The bladder muscles may become weak causing incomplete emptying of the bladder while urinating, and on the other hand, the bladder muscles become overactive causing incontinence or frequent urination.
1. Overactive Bladder
It is the sudden contraction of the muscles in the bladder wall causing unstoppable, involuntary urge to urinate.
Detrusor, the largest muscle of the bladder becomes too active and contracts more than normal and at inappropriate times, while the bladder is filling with urine. This causes the person to feel a sudden, overwhelming urge to urinate even when the urinary bladder is not full.
Although the reason for this contraction is not clear, it is believed that the nerve signals that runs between brain to bladder causes it.
Symptoms of overactive bladder include the overwhelming urgency to urinate, frequency of having to go to the toilet increases and there will be a strong, sudden need to go toilet.
Urodynamic tests are performed to assess the bladder function and its ability to empty itself. Other tests that helps diagnose and analyse the condition better may include uroflowmeter to measure urine flow, cystometry to measure bladder pressure, electromyography to measure bladder nerve impulses, X-ray to create images of bladder function and cystoscope to look inside the bladder to check abnormalities.
A combination of treatment strategies may be used to treat an overactive bladder. Behavioral intervention is use which include bladder training, double voiding, scheduled toilet trips, kegel’s exercise, absorbent pads and intermittent catheterizations.
Drugs are given to relax the bladder which helps to alleviate the symptoms of overactive bladder. For people with severe symptoms that do not respond to other treatment methods, surgical removal of the bladder or surgery to increase bladder capacity is done.
2. Urinary Incontinence
It is one of the most common but embarrassing problem which causes due loss of bladder control. Its severity may range from occasional leaking to a strong, sudden urge to urinate, that affects day-to-day activities.
Urinary incontinence may be caused by some physical problems like pregnancy or childbirth, aging, hysterecetomy, interstitial cystitis, enlarged prostate, bladder or prostate cancer, and neurological disorders, underlying medical conditions such as constipation and UTI, or everyday habits like alcohol, overhydration or caffeine.
Signs and symptoms:
Incontinence symptoms may include continuous leakage from the bladder, frequent or sudden urge to use toilet, loss of urine when changing positions, physical activity and loss of bladder control.
Treatment procedures for urinary incontinence include behavioral therapies and a minimally invasive procedure called urinary incontinence slings that restore urethra to its normal anatomical position.
Bladder problems can occur at any age, but elderly are more likely to suffer from it. Proper diagnosis and treatments that meet specific needs and lifestyle can helps to overcome bladder problems in a better way.