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Urology

General Urology/Wellness

Common Bladder Conditions

How The Bladder Works

Storage

The bladder has two basic functions, the most important is the storage of urine. The organ is a hollow muscle with a lining that helps hold urine. Most of the time, the muscle is relaxed allowing for low-pressure storage of the fluid. A second muscle called the sphincter is wrapped around the outflow tube (urethra) and keeps the urine from running out. Pressure increases and may eventually cause damage to the kidneys if the bladder storage function is poor.

Emptying

Once the bladder is full, it sends a signal to the brain informing you that it is time to find a bathroom. No pressure is generated yet so the bladder remains relaxed until you actually give the command to empty.

Two things happen when our brain gives the command ‘to go.’ First, the closure mechanism (sphincter) relaxes, followed by contraction of the bladder muscle which pushes urine out of your body.

All of these functions are coordinated by the brain, with the commands sent to the bladder by a network of nerves traveling through the spinal cord.

Common Conditions

Common bladder conditions include Incontinence and Urinary Tract Infections

Incontinence

What is Incontinence?

Incontinence is defined as any uncontrolled loss of urine. This is an extremely common problem and affects women more than men. It also becomes more frequent with age. There are many causes for incontinence and education is important in the treatment process. There are two types of urinary leakage: stress incontinence and urgency incontinence. It is important to understand the difference and the function of the bladder.

Diagnosis: Finding out What’s Wrong

A test called urodynamics is done at your physician’s office. This involves measuring pressure while the bladder is slowly filled. Along with this, muscle activity of the sphincter is monitored. During emptying, the rate of flow is recorded. Careful review of these measurements allows your urologist to find out what’s wrong with the function of the lower urinary tract, and how to address it.

Bladder Function in Incontinence

There are two functions of the bladder which can lead to incontinence. Normally, when the bladder is relaxed it is filling with urine. Once it is full, the bladder sends a signal to the brain, and that is our cue to find a bathroom. Once it begins to empty, the detrusor muscle (lining of the bladder) contracts to create pressure to push out the urine. The second part of bladder function is its closure mechanism. This is a circular muscle wrapped around the bottom of the bladder. It is called the sphincter muscle. Unlike the bladder, it is contracted most of the time and only relaxed while emptying. Incontinence happens when either muscle does not work properly.

Types of Incontinence

  • Stress incontinence is caused by strain such as coughing, sneezing, or lifting something heavy. This strain creates pressure in the abdomen which puts stress on the sphincter muscle that holds urine in.
Urgency urinary incontinence occurs when the bladder fails to do its most important job: to store urine without contracting unless you want it to. The unexpected onset of contracting is called urgency. When we do not reach the bathroom in time, leakage happens.

Other Bladder Conditions

Neurogenic Bladder

Neurogenic bladder is when the bladder does not hold urine because its nerve control is damaged. Bladder functions are coordinated by the brain, with the commands transmitted to the bladder by means of nerves traveling though the spinal cord. Imagine what happens if something happens to any of these structures: the bladder and sphincter cannot do their job properly.Neurogenic bladder causes a wide variety of symptoms. If the bladder fails to store urine properly, you may need to use the bathroom all the time. You may need to get up often throughout the night, or you may experience involuntary loss of urine (or urinary incontinence).

Brain, spinal cord, or nerve injury

The brain may get hurt in multiple ways. Trauma, stroke, or diseases such as multiple sclerosis or Parkinson’s disease will lead to problems with normal bladder function. Depending on severity and location of the brain damage, the urinary tract may still function normally, however without your control. This this leads to bladder emptying at inappropriate times. Treatment may include using a catheter.

Spinal Cord Injury

Two stretches of nerves connect the brain and bladder. One connects the brain to a control center in the spine at about waist level and the second nerve connects this control center to the bladder. The bladder will fail to empty if the nerves connecting the brain and spinal center are damaged. The muscle tone of the sphincter will still be intact, which holds urine back, yet the bladder remains relaxed, causing the inability to pass urine. In this phase, bladder emptying must be helped, usually with a small tube inserted into the bladder several times a day.

Over time, without nerve input inhibiting the spinal bladder control center, the bladder becomes spastic and overactive. Fewer triggers cause the bladder to contract, it to become very small and may cause kidney damage. Peripheral Nerve Damage

Nerves from the spine to the bladder are called peripheral nerves as they are located away from the brain and spine. Injury or conditions such as diabetes or mellitus may damage the peripheral nerves, leading to an inability to empty the bladder. This may cause urinary retention, with can lead to chronic urinary tract infections, or kidney failure. Therefore early detection and treatment is necessary to keep the kidneys healthy and to improve/maintain your quality of life.

Urinary Tract Infections

The urinary tract is the body’s system to eliminate toxins in the urine. It originates with the kidneys which produce urine, which flows down to the bladder in two tubes called ureters. Once in the bladder, the fluid is stored until it is released through the tube called urethra when we urinate.

What is a Urinary Tract Infection (UTI)?

An infection of this system most commonly only involves the bladder. Bacteria enter it by climbing back through the urethra, and once there, multiply in numbers. When the body tries to fight this, inflammation occurs.

What are the symptoms of an uncomplicated UTI?

Normally, bacteria only reach the urethra and the bladder. This causes symptoms of having to go often (even at night), having to go very urgently, and pain during urination.

Difference between men and women

In women, infections of the urinary tract can occur more frequently than in men. This is simply because the distance between the outside and the bladder is fairly short, only about one to two inches. This makes a UTI a fairly common and benign condition, which is simply treated with a course of antibiotics. In men, however, the distance to the bladder is longer and infections occur less often.

More serious infections

When treating these infections, it must be determined whether the infection reaches the kidneys. If so, a minor bladder infection becomes a potentially life-threatening kidney infection, or pyelonephritis. The latter is more severe because it involves a solid organ meaning that there is the possibility of the infection spreading into the blood and on to the entire body.

Any fever, chills, lower back pain or fatigue which occurs with urinary tract symptoms may point to this serious condition and needs to be addressed right away. A urine culture is completed and a CT may be done to determine how serious the infection is. Causes for UTIs: Persistent or Recurrent Infections

Most urinary tract infections are harmless, as explained above, and no further workup looking into why infections occurred is necessary. Persistent or recurring infection should be evaluated.

  • Incomplete Bladder Emptying
  • Kidney and Bladder Stones
  • Neurogenic Bladder

Erectile Dysfunction (ED)

Erectile dysfunction is the inability of an adult male to achieve and maintain an erection sufficient for sexual intercourse. While it can affect men of any age, it is typically seen in men over age 60. It can be embarrassing and difficult to talk about. Fortunately, there now are many ways to address erectile dysfunction.

Erectile dysfunction is caused by a combination of damage to nerves and blood vessels:

  • atherosclerosis (plaque buildup in blood vessels)
  • nerve damage caused by surgery of the pelvis
  • spinal cord injury
  • diabetes mellitus damage to small blood vessels and nerves
  • hormonal deficiencies such as lack of sufficient testosterone.

Treatment:

  • prescription pills (Viagra, Levitra, Cialis) are typically the first treatment
  • injections or suppositories to address nerve damage
  • vacuum erection device for tissue that is nonfunctional
  • implantable penile prosthesis

There is a way to treat erectile dysfunction on many different levels, depending on the type and severity of ED.

Hypogonadism

This is a condition affecting men where the body does not produce enough testosterone. Most men never come forward about this issue because what is happening to them is similar to what happens as people 'get older,' feeling tired all the time, and things are just not as fun as they used to be. Sexual function or disinterest may occur.

Epididymitis

Epididymitis is inflammation of the epididymis-the coiled tube that collects sperm from the testicle and passes it on to the vas deferens. There are two forms of this disease, acute and chronic. Acute epididymitis comes on suddenly with severe symptoms and subsides with treatment. Chronic epididymitis is a long-standing condition, usually of gradual onset, for which the symptoms can be improved with treatment but may not completely be eliminated. Most cases of epididymitis occur in adults.

Symptoms include urethral discharge and urethral pain or itching, pelvic pain and urinary frequency, urgency or painful/burning urination, fever, perineal pain, and lower back pain. In some cases, pain in the scrotum from the local infection is the only noticeable symptom.

Most cases are caused by bacterial infection and include at least two weeks of antibiotics. Most cases can be treated with oral antibiotics as an outpatient.

Tuberculous epididymitis is often treated with anti-tuberculous medications and in some cases surgical removal of the testicle is required because the damage is so severe. Cases of severe infection, with constant pain, vomiting, very high fever or overall severe illness, may require a hospital visit.

Infertility

Male factor infertility accounts for 40 percent of infertility cases. This diagnosis is often seen in men who have an enlarged vein in the left testicle. It can also occur as a result of trauma or surgery to the testicles. Recent scientific studies have also shown that in some cases of male infertility, there may be a significant genetic component. Despite some causes, a significant portion of male infertility is unexplained. The following infertility tests will help to pinpoint a possible cause and/or your form of treatment:

  • semen analysis
  • anti-sperm antibodies
  • infectious screening
  • karyotype
  • Y chromosome testing
  • sperm chromatin structure
  • Cystic Fibrosis genetic screening

Pediatric Urology

We treat children with many pediatric urological conditions including urinary tract infections, urinary reflux, incontinence, bed wetting, hernias, hydroceles, phimosis and hypospadias.