Bladder Problems

What are common bladder problems?

The most common bladder problems are urinary tract infections, urinary incontinence, and bladder stones.

A urinary tract infection (UTI) involves the organs of the urinary tract that produce and carry urine out of the body. These include the kidneys, ureters (the long, slender tubes connecting the kidneys to the bladder), the bladder, and the urethra. UTIs typically occur when bacteria that normally live in the gastrointestinal tract invade the urinary tract.

Women get UTIs more often than men because women have shorter urethras, which makes it easier for bacteria to pass through the urethra into the bladder. Bacteria can also spread to the urethra during sexual activity.

Doctors often classify UTIs into two types — lower tract infections and upper tract infections.

Lower tract infections: These are also known as bladder infections (cystitis). Bacteria usually found in the intestine are the leading cause of lower urinary tract infections. These bacteria spread from the anus to the urethra and bladder, where they grow, invade the tissue, and cause infection.

Upper tract infections: These infections, which involve the ureters and kidneys, are called pyelonephritis or kidney infections. Upper urinary tract infections usually occur when bacteria travel from the bladder to the kidney. Sometimes, they occur when bacteria travel from other areas of the body through the bloodstream and settle in the kidneys.

Urinary incontinence is the loss of reliable bladder control that results in urine leakage. There are several types of urinary incontinence: stress, urgency, mixed, overflow, functional, and reflex. For women, the most common cause of incontinence is loss of pelvic floor muscle strength from advancing age or childbirth. Prostate-related issues raise the risk of urinary incontinence in men. Other causes that affect both sexes include tumors, bladder stones, scar tissue, nerve damage from injuries, past surgeries, diabetes, multiple sclerosis, and shingles.

Bladder stones. Bladder stones develop when urine becomes concentrated, causing the minerals in the urine to harden, forming solid, crystallized stones similar to kidney stones. People who have trouble completely emptying their bladders are at increased risk for bladder stones. Small bladder stones can pass on their own. If they grow too large and block urine flow, they must be broken up with ultrasound or surgically removed.

What causes bladder infections? What are the symptoms and how are they treated?

Bladder infections, also called cystitis, are a type of urinary tract infection (UTI). They are caused by an abnormal growth of bacteria inside the bladder, the balloon-like organ that stores urine. More women than men get bladder infections.

Infections are classified as either simple or complicated.

Simple bladder infections. Simple bladder infections develop when bacteria migrate into the bladder. Because of the structure of the female urinary system, women are far more likely than men to get these infections. In women, the opening to the urethra (the tube through which urine exits the body) is close to the rectum. Bacteria can easily migrate from the rectum, where bacterial counts are high, to the area around the vagina and urethra. From there, it is a short trip (less than 2 inches) through the urethra to the bladder. Sexual intercourse can also propel these bacteria into the urethra. Older men are at increased risk of getting simple bladder infections.

Complicated bladder infections. Bladder infections are considered complicated when symptoms such as fever, flank pain, chills, or fatigue suggest the infection has passed beyond the bladder. In men, pain in the area between the genitals and anus can also suggest a complicated bladder infection.

Bladder infection causes inflammation of the bladder and urethra and prompts one or more of the following symptoms:

• The need to urinate more often than normal (although only small amounts are passed each time)
• An urgent need to urinate
• Pain and burning while urinating
• The need to urinate during the night
• Pain in the lower abdomen
• Blood in the urine
• Cloudy urine with an unpleasant odor

People with complicated bladder infections may also develop symptoms like fever, chills, nausea, vomiting, flank pain, back pain, or confusion.

Simple bladder infections in women usually are treated with antibiotics such as nitrofurantoin (Macrobid), trimethoprim and sulfamethoxazole (Bactrim, Sulfatrim), or fosfomycin (Monurol). Women with recurring bladder infections (more than two per year) may benefit from preventive antibiotics.

While some studies suggest cranberry juice or cranberry pills may help with UTIs, the evidence is still inconclusive. Most medical professionals believe cranberry juice or supplements are unlikely to be harmful, but more research is needed to confirm whether they can treat or prevent UTIs.

Complicated bladder infections are more challenging to treat. The choice of antibiotic, the medication's strength, and the treatment length vary depending on the circumstances. Often, antibiotics need to be taken for seven to 10 days. People with severe symptoms (confusion, profound dehydration) will need to be treated in a hospital.

What causes urinary incontinence and how is it treated?

Millions of Americans suffer from urinary incontinence—the loss of reliable bladder control. There are several types.

Stress incontinence. Urine leaks out during activities that increase abdominal pressure, like jumping, coughing, sneezing, laughing, running, or lifting heavy objects. Stress incontinence develops when the urethral sphincter, the pelvic floor muscles, or both become weak or damaged and cannot dependably hold in urine. Women who have delivered a baby vaginally are more likely to develop stress incontinence. Also, as women age, their pelvic floor and urethra muscles weaken. The most frequent causes in men are urinary sphincter damage (such as damage resulting from prostate surgery or a pelvic fracture) or neurological problems in the lower spine (like a spinal cord injury).

Urgency incontinence. Often referred to as overactive bladder, urgency incontinence involves an overwhelming urge to urinate, usually followed by loss of urine before you can reach a bathroom. Postmenopausal women tend to develop this condition, perhaps because of age-related changes in the bladder lining and muscle. In men, a common cause is an enlargement of the prostate (known as benign prostatic hyperplasia, or BPH). Surgery for prostate cancer or BPH also can trigger symptoms, as can prostate cancer treatments like radiation seed treatment (brachytherapy) and external beam radiation. Other causes that affect both sexes are urinary tract and bladder infections.

Mixed incontinence. This type is a combination of both overactive bladder and stress incontinence. Most women with incontinence have both stress and urge symptoms. Mixed incontinence also occurs in men who have had prostate removal or surgery for an enlarged prostate and in frail older people of either sex.

Overflow incontinence. Overflow incontinence occurs when something blocks urine from flowing normally out of the bladder. It can also happen in people who do not feel the urge to urinate. Eventually, the bladder becomes overfilled, and urine leaks out. 

Men are more frequently diagnosed with overflow incontinence than women because it is often caused by prostate-related conditions, like an enlarged prostate. In women, the problem can occur in response to a severe prolapse of the uterus and vaginal wall, which can pull the bladder down and create a kink in the urethra that interferes with the flow of urine, much like a bent garden hose can stop the flow of water.

Other causes that affect both sexes include tumors, bladder stones, scar tissue, nerve damage (from injuries), childbirth, past surgeries, radiation treatment, or diseases such as diabetes, multiple sclerosis, and shingles.

Functional incontinence. If your urinary tract is normal, but other illnesses or disabilities prevent you from staying dry, you might have what is known as functional incontinence. For example, if medication, a mental illness, or dementia render you unaware or unconcerned about the need to find a toilet, you may become incontinent.

Reflex incontinence. Reflex incontinence usually occurs in people with neurological impairment from multiple sclerosis, spinal cord injury, or damage from surgery or radiation treatment. In this situation, the nerve signals that generally warn the brain that the bladder is filling are interrupted. Involuntary emptying occurs (often in large amounts) without any warning or urge.

Depending on the type and severity, various treatment options for urinary incontinence exist. They may be different for men and women. Examples include bladder training, fluid management, pelvic floor physical therapy, biofeedback, lifestyle changes, medications, and surgery.