Many patients present to the offices of Urologist in Hameed Latif Hospital with complains of incontinence, the cause behind which is often bladder atony. What exactly is this bladder atony and how do healthcare providers manage it, read on to find out:
What Is Bladder Atony?
Atonic or flaccid bladder is one that doesn’t contract fully and expel urine as a normal bladder would. This condition is also called ‘neurogenic bladder’.
Normally, the bladder fills with urine and signals to the higher centers with the urge to urinate. This is followed by the motor signals, causing relaxation of the bladder sphincters and contraction of the bladder wall to fully expel the urine.
In someone with atonic bladder, the bladder wall is unable to contract due to any number of reasons, causing overflow incontinence and leakage.
What Are The Causes Of Bladder Atony?
Bladder atony is caused by neurological conditions, obstructions and traumatic injuries to the bladder.
Neurological conditions: damage the sensory nerves from the bladder to the spinal cord, thereby interrupting the stimulus which produces the urge to urinate. This is common in disorders like diabetes, heavy metal poisoning, infections, multiple sclerosis and spina bifida.
Obstructions: can make it difficult for the bladder to contract. This can include enlarged prostate, tumor in the pelvis or narrowing of the urethra. These obstructions also hinder the natural flow of urine.
Injury: falls, collision accidents and pelvic surgeries can end up causing injury to the bladder causing atony.
What Are The Symptoms Of Bladder Atony?
Neurogenic bladder presents with recurrent urinary tract infections (UTIs), overflow incontinence, increased urinary urgency, dribbling of urine, kidney stones, and loss of feeling that the bladder is full.
How Is Bladder Atony Diagnosed?
The diagnosis of neurogenic bladder is based on the clinical assessment of the healthcare provider, along with relevant investigations. These include:
- Imaging of the bladder, kidney and ureters.
- X-ray of the skull and the spinal cord to make image of the organs and any tumorous growths around the spine
- Cystoscopy is also done to view the bladder from the inside to check for structural changes, blockages or stones inside the genitourinary tract. The camera is inserted from the urethra and can also be used for treatment purposes.
- Ultrasound of the bladder, kidneys and ureters also creates images of the genitourinary system through sound waves.
- Urodynamic investigations are done to check how well the bladder holds and voids the urine.
- Pelvic MRI helps to check for damages to and around the spinal cord, along with any soft tissue growth.
How Is Bladder Atony Treated?
The management of bladder atony is centered around dealing with the causative factors. The idea is to treat the cause and the symptoms of bladder atony would get better with minimal damage, however, there is no complete cure.
Treatment options include:
This treatment involves inserting a catheter in the bladder by the patients themselves at regular intervals. Usually, it is done four to eight times a day.
Overflow incontinence is managed by making lifestyle changes like avoiding carbonated drinks, relieving at regular intervals and wearing absorbent undergarments.
If the patient is unable to use the catheter, a suprapubic incision is made and a permanent catheter is inserted in the bladder. This is attached to a urine bag that is to be emptied through the day.
Cystoplasty is another surgical procedure that enlarges the bladder, allowing it to hold more urine. This allows the patient to empty the bladder less often. It also reduces the incidence of overflow incontinence in patients.
Urologist in Bahria International Hospital can also advice urinary diversion to create a new path for the urine to leave the body.