Bladder Disorders

The urinary bladder is a muscular pouch that can expand to hold about a pint of urine. When almost half full, the bladder begins signaling a feeling of fullness. During urination, the bladder muscle contracts to release urine in such a way that it cannot flow back into the ureters, the tubes linking the kidneys and bladder.

Bladder disorders may occur as a result of an injury, disease, or an inherited condition. Anatomical differences between men and women predispose them to different bladder problems. Women are much more prone than men to bladder and urethral infections, because their urethra is very short and located close to the anus and the vagina, sites that often harbor bacteria that can invade the bladder. Prostate gland disorders account for many of the male bladder problems.

The most common bladder disorder is cystitis. Below are some of the other problems that are frequently encountered. Bladder stones, or urinary bladder calculi, are comprised of calcium oxalate or calcium phosphate crystals or, in a small percentage of cases, uric acid or cystine crystals. They vary in size from microscopic to several centimeters in diameter.

Some bladder stones appear spontaneously, without any apparent cause. Others may be precipitated by over-excretion of calcium or uric acid, reduced excretion of urine due to an enlarged prostate or some other structural abnormality, or a urinary tract infection.

Sometimes, no reason can be discovered for the production of bladder stones. Small ones may be passed without symptoms, but a large stone can cause excruciating pain in the lower back, abdomen, or pubic area, as well as blood in the urine and a sudden interruption in urinary flow. There may also be fever and chills, especially if the urinary tract is infected.

Urethritis is an inflammation of the urethra, the narrow tube in which urine and, in men, semen passes out of the body. Women are especially susceptible to urethritis that is caused by a bacterial infection. The disorder in men is more often due to an enlarged or inflamed prostate gland or a sexually transmitted disease, such as chlamydia or gonorrhea. Symptoms include pain or a burning sensation during urination or ejaculation, a feeling of urgency when urinating, and, in males, an abnormal discharge from the penis.

Urinary fistulas are abnormal passages that link the bladder or urethra to another organ. In women, a fistula sometimes develops between the bladder and vagina. The most common symptom is a flow of urine from the vagina. Trauma during childbirth is the most frequent cause, although a urinary fistula may also develop as a result of radiation therapy and tumors.

Urethral stricture in men is caused by a narrowing or blockage of the urethra within the penis; in women, it may be secondary to repeated bouts of cystitis. Urinary tract injuries or infections can produce scar tissue that obstructs the urethral passage. Symptoms include pain and difficulty in urinating.

Vesicoureteral reflux (VR) is a backup of urine into the ureters caused by a malfunction of the one-way valve that leads from the ureter into the bladder. The backup occurs when the bladder contracts to release urine. Then, as the bladder relaxes, the urine flows back into it. The result is a buildup of stagnant urine, which increases the risk of infection and inflammation.

The most common urinary tract problem among children, VR is usually caused by congenital structural anomalies, although it may be due also to an obstruction of the bladder outlet, a urinary tract infection, or other disorders. VR is often asymptomatic; when symptoms do occur, they are usually the result of a secondary infection and may include painful urination, pain in the abdomen or side, increased urinary frequency and urgency, blood in the urine, and fever.

Diagnostic Studies and Procedures

If bladder stones are suspected, a physician or urologist will perform a complete physical examination and seek confirmation of the diagnosis through urinalysis, a special X-ray procedure called intravenous urography, and possibly a bladder ultrasound evaluation that employs sound waves to identify the site and size of stones.
Urethritis is diagnosed by analyses of: urine and vaginal or penile discharge to determine whether an infection is present and, if so, what type.

To diagnose a urethral stricture or a ;-urinary fistula both the urethra and bladder will be examined with a cystoscope, a narrow, flexible viewing tube, inserted into the urethra. If a fistula is confirmed, its opening can be tracked by inspecting the vagina after infusing the bladder with an opaque dye.

If VR is suspected, the urologist may order intravenous urography and a filling and voiding cystourethrogram, an X-ray study to determine whether urine stays in the bladder or flows back toward the kidney. If reflux is found, a kidney ultrasound evaluation or intravenous pyelogram (X-rays taken after a dye is injected into the renal circulation) may be done to detect possible kidney damage. Cystoscopy also can confirm certain structural problems that may be causing VR.

Medical Treatment

Bladder stones. If the bladder stones are small, they do not require medical therapy other than monitoring to make sure that they are expelled during urination. Depending upon the cause and symptoms, antibiotics and painkillers may be prescribed.

If stones are large and obstructing the flow of urine, immediate treatment is necessary. Depending on their size, composition, and location in the urinary tract, stones may be removed by one of several methods: extraction through a flexible tube or cystoscope; crushing with sound waves in a process called extracorporeal shock-wave lithotripsy; or medication to promote dissolution. In severe cases, surgical removal may be needed.

If the composition of the stones or their cause can be determined, further steps may be taken to reduce the risk of recurrence. Procedures might include alleviating prostate enlargement, prescribing diuretics, modifying the diet, or treating an underlying disease. Urethritis. If the underlying cause is chlamydia, it is generally treated with 10 days of tetracycline or erythromycin; gonorrhea is treated with a cephalosporin plus doxycycline; other bacterial infections may require sulfa drugs. If a sexually transmitted disease is involved, partners should also be tested and treated.

Urethral stricture. A physician may try to widen the narrowed area by inserting a thin instrument into the urethra after giving a local anesthetic. If this does not work, the stricture can be widened surgically, through a cystoscope or an open incision.

Urinary fistula. Surgical closure of the fistula is the first-choice treatment. If this is not possible, the flow of urine may be diverted to bypass the fistula.

Vesicoureteral reflux. Mild reflux often improves or disappears as a child grows. In the meantime, prophylactic antibiotics may be given to keep the urine, bladder, and kidneys free of infection. Urine samples should be checked periodically to make sure that the urine is bacteria-free. For children with moderate or severe reflux, surgery may be recommended because of the risk of kidney damage.

Alternative Therapies

Some alternative approaches may help promote the natural passage of small bladder stones and also prevent their recurrences (large, obstructive stones require prompt medical attention). Otherwise, alternative therapies are useful primarily for symptomatic relief. Acupuncture. Stimulation of points along the urinary bladder, kidney, and stomach meridians may ease pain and facilitate the passage of stones. Similarly, acupuncture needles placed along the bladder, liver, kidney, and spleen meridians are said to help relieve pain.

Herbal Medicine. Herbalists recommend a tea made from uva-ursi (bear-berry) leaves to treat bladder stones and other urinary disorders. Other herbal remedies include teas made from goldenrod, watermelon seeds, or marsh mallow root.

Nutrition Therapy and Naturopathy. For bladder stones, a therapist may advise taking daily supplements of 10 milligrams of magnesium and 10 milligrams of vitamin B6 to reduce calcium oxalate, a substance found in some stones. To reduce the formation of oxalate stones, she might suggest adopting a low-salt diet and not taking vitamin C supplements. Limiting such oxalate-rich foods as spinach, chard, beet greens, and rhubarb, as well as tea and chocolate, also may help.

To help prevent urethritis, naturopaths suggest a regular intake of citrus fruits and juices to acidify the urine, which may help stop bacterial growth. Blueberry and cranberry juices also contain a compound that inhibits the growth of bladder bacteria.

Self-Treatment

Self-care can play a significant role in both the treatment and prevention of bladder disorders. Its a good idea to increase consumption of water and other nonalcoholic fluids to at least 10 glasses a day. Extra fluids dilute the urine, helping to prevent urethritis as well as bladder stones, and also to pass those that may have formed.

If you have high levels of uric acid, talk to your doctor about dietary changes that may reduce its formation. Avoiding legumes, organ meats, and other foods high in purine may help.

If bladder stones contain calcium, lowering calcium intake may be a good idea, but this should be done only under a doctor's supervision, because too link calcium can contribute to osteoporosis. In any event, avoid high-dose calcium supplements and calcium-based antacids. Inactivity can also increase calcium in the urine. Walking and other physical activity that exercises the back, legs, and other weight-bearing bones enables the body to absorb and store calcium rather than excrete it, possibly lowering the risk of recurrent bladder stones.

Other measures to alleviate bladder problems include the following:

• Try heat to soothe the pain of urethritis; sitting in a warm bath or using a heating pad may help.
• Don't delay urination. Holding urine increases bladder irritation.
• Bathe daily, but avoid perfumed soaps, bubble baths, genital deodorants, and feminine hygiene products, which can irritate the genital area and set the stage for urethritis. Scented toilet paper may also be irritating.
• Empty the bladder before sex. Afterwards, drink a glass of water and wait an hour to urinate again. This allows the bladder to fill enough to flush out bacteria. Using a mild, unsecured, and water-soluble lubricant or contraceptive foam or jelly (which is bactericidal) during intercourse can make penetration easier and lessen trauma to the urethra and bladder.

Other Causes of Bladder Problems

Cystitis, caused by infection and/or inflammation of the bladder, produces symptoms similar to those of urethritis; frequently, the two conditions coexist.

Interstitial cystitis, marked by inflammation of the bladder wall without an active infection, can also cause chronic, debilitating bladder pain, especially in women. In men, an enlarged or inflamed prostate (prostatitis) may cause similar problems. Stress, too, can manifest itself in urinary tract problems, especially an irritable bladder.

Following menopause, many women experience increased urinary urgency, even when the bladder is relatively empty. This is caused by thinning of tissues in the lower urinary tract due to lack of estrogen. Incontinence, the inability to control urination, may be caused by these and other bladder problems, as well as nerve disorders.