Located in the lower abdomen, the bladder is a collection organ that receives the waste product called urine excreted by the kidneys. A healthy and normally functioning bladder is flexible but strong enough to store urine until voluntarily emptied. Bladder failure is the inability to properly retain or empty urine. Symptoms including pain, difficulty urinating and leaking urine at unexpected times. Bladder failure can severely diminish quality of life and limit daily activities.
Understanding the mechanics and function of the bladder is important to identify possible causes of failure. The bladder is capable of changing in size, expanding into the abdominal cavity as it fills with urine then shrinking considerably upon voiding. The bladder is made up of its own set of muscles, distinct from the abdominal wall. Some of these muscles cause the bladder to change in size, while others regulate the bladder's ability to hold or expel urine.
Difficulty Emptying the Bladder
Urinary retention is a failure of the bladder muscles to coordinate the act of voiding. When internal pressure reaches a certain level, specific muscles of the bladder relax so as to open the urethra. At the same time, other bladder muscles must contract to push the urine through the now-relaxed urethra. Failure of any of the muscles to either relax or contract correctly can result in an inability to empty the bladder completely.
Similar to the problems of urinary retention, incontinence is also the failed coordination of the bladder muscles. The muscle which contracts to expel urine is balanced by the strength of the urethra-related muscles. The pelvic floor muscles support the urethra muscles, and their weakness can allow the urethra to sag downward, exerting pressure to the point where urine leaks. Also, an overactive contractor muscle can spasm involuntarily and overwhelm the ability of the urethra to hold urine, causing leakage.
Painful or Difficult Urination
Known as dysuria, pain during urination is also a symptom of bladder failure. The pain may be burning or stinging, often resulting in a difficult, slow and halting urine flow. The most common cause of dysuria among women is cystitis, caused by bacteria in the urethra. Spasms of the pelvic muscles can also cause pain at the end of urination. Men may experience urination difficulty due to an enlarged prostrate, which blocks the flow through the urethra.
"Interstitial cystitis" is another name for pain in and around the bladder area. This pain can range from a dull ache to an intense pain that increases as the bladder fills. The interior wall of the bladder may develop ulcers or stiffen. Symptoms can include an overwhelming urge to urinate or a sensation of pressure even when the bladder is empty. Women may find the pain worsening with intercourse or during their menstrual cycle.
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