Bladder atony

Bladder atony is a condition that can have serious medical implications and is importantly deserving of attention. Although the condition may be less common and less well known than other diseases of the urinary system, it remains relevant in the context of medical practice and patient care for the following reasons:

1. Medical Complications: Bladder atony can lead to medical complications such as urinary stasis, urinary tract infections, kidney backflow, and even bladder damage. These complications can be dangerous to a patient's health.
2. Quality of Life: People suffering from bladder atony may experience a significant decrease in quality of life due to frequent urination, inability to control urination, and other symptoms.
3. Diagnosis and treatment: For patients with suspected bladder atony, proper diagnosis and treatment are important. Medical professionals must be able to recognize this diagnosis and provide appropriate treatment and care.
4. Warning: In some cases bladder atony can be prevented or managed, especially in patients with neurological disorders. Early detection and management of this condition may improve the prognosis of patients.

Thus, bladder atony remains relevant and requires attention from both health care providers and patients, especially in those at risk of developing this condition. [1]

Causes of the bladder atony

Bladder atony can have a variety of causes, including:

1. Aging: Older people are at risk of bladder atony due to the natural aging process. Increasing age can lead to decreased muscle mass and impaired bladder muscle control.
2. Nerve disorders: Damage or disease that affects the nerves that control the bladder can cause bladder atony. Examples of such disorders include stroke, spinal injury, multiple sclerosis, and diabetes.
3. Infections and Inflammation: Urinary tract infections or inflammatory conditions of the bladder can lead to atony because they can damage the muscles or nerves involved in controlling urination.
4. Consequences of surgical procedures: Some surgical procedures, such as prostate removal (prostatectomy) or bladder surgery, can affect bladder function and cause atony.
5. Use of certain medications: Some medications, such as anticholinergic drugs, can decrease bladder activity and cause bladder atony.
6. Urinary tract obstructions: The presence of obstructions or obstructions in the urinary tract, such as stones in the bladder or urethra, can lead to atony because the bladder cannot reliably squeeze urine out.
7. Other medical conditions: Some medical conditions, such as paralysis or neurodegenerative diseases, may increase the risk of bladder atony.

Pathogenesis

The pathogenesis of bladder atony may be multifactorial and include the following aspects:

1. Neurological disorders: Bladder atony may be associated with nervous system disorders such as spinal cord injuries, neurodegenerative diseases (e.g., Parkinson's disease), or multiple sclerosis. The nerves that control the bladder may be damaged, resulting in loss of normal urinary regulation.
2. Bladder muscleatony: Aging and prolonged inactivity can lead to weakened bladder muscle tone. This can occur due to lack of exercise, long-term catheter use, or other medical procedures that can affect the bladder muscles.
3. Urinary tract obstruction: Obstructions such as urolithiasis, tumors, or narrowing of the urinary tract (urethra or urethra) can make it difficult to pass urine out of the bladder. Long-term obstruction can cause bladder atony.
4. Medications and surgery: Some medications, such as antispasmodics or anticholinergics, can affect bladder muscle tone. Also, some surgical procedures, such as prostate removal for cancer, can affect bladder function.
5. Other factors: Diabetes, neurogenic disorders, chronic urinary tract infections, and other medical conditions can affect bladder function and contribute to atony.

Symptoms of the bladder atony

Symptoms of bladder atony can manifest in a variety of ways and include the following signs:

1. Frequent urination (pollyakia): Patients with bladder atony may experience frequent and involuntary urination. This may include a constant urge to urinate and a small amount of urine with each urination.
2. Failure to empty the bladder completely: Patients may feel that they cannot squeeze urine completely out of the bladder when urinating. This can cause a feeling of incomplete emptying and dissatisfaction after urination.
3. Dysuric symptoms: Urination may be accompanied by pain or discomfort in the lower abdomen, bladder area. There may also be pain when filling the bladder.
4. Incontinence (urinary incontinence): Due to loss of bladder control, patients with atony may experience urinary incontinence, which means involuntary discharge of urine.
5. Nocturnal urination(enuresis): Children and adults with bladder atony may have nocturnal urination, where control of urination is lost even in sleep.
6. Weak urine stream: Urination may be accompanied by a weak urine stream due to loss of bladder muscle tone.
7. Feelingof bladder fullness: Patients may feel that their bladder is full and unable to handle the normal volume of urine.

Symptoms of bladder atony may be nonspecific and may converge with symptoms of other conditions of the urinary system. [2]

Stages

Bladder atony can develop gradually, and its stages can vary depending on the severity and duration of symptoms. Common stages are summarized below:

1. Early stage (initial):

   • In the initial stages of bladder atony, primary symptoms such as rapid urination or difficulty initiating urination may occur.
   • The contractile function of the bladder can still be maintained, but signs of deterioration begin.

2. Progressive stage:

   • In this stage, symptoms increase and urination becomes more difficult and unsatisfactory.
   • The patient may experience increased urination and/or difficulty in retaining urine.

3. Advanced stage (complete atony):

   • In the advanced stage of bladder atony, bladder function may be severely impaired.
   • The patient may experience complete loss of urinary control and uncontrolled urine discharge (urethral discharge).
   • The bladder may overflow and increase in size.

4. Complications:

   • Long-term bladder atony can lead to complications such as urinary tract infections, bladder stones, bladder distension (stretching), and other urinary and genitourinary problems.

Treatment for bladder atony depends on the stage and cause of the condition. It may include physical therapy, medication, lifestyle changes and, in some cases, surgery. [3]

Forms

Bladder atony can take different forms depending on the nature and degree of bladder dysfunction. Here are some of the forms:

1. Axonalatonia: This form is associated with neurological disorders that affect the nerves that control bladder muscle contraction. For example, Parkinson's disease, strokes, spinal injuries, and multiple sclerosis can cause axonal atonia.
2. Myogenic atony: This form of atony is associated with a weakening of the bladder muscles, making it less able to contract. This can be caused by aging, injury, or other physical factors.
3. Functional atony: In some cases, bladder atony may be functional, meaning that there is no structural or neurological abnormality, but the patient still has difficulty urinating. This can be caused by psychological factors, stress, or decreased muscle tone.
4. Partial atony: In some cases, bladder atony can be partial, where the bladder does not completely lose its ability to contract, but its function is impaired. This can lead to partial bladder emptying and a feeling of incomplete urination.
5. Complete atony: In complete bladder atony, the patient is unable to control urination and cannot squeeze out urine on his own. This condition requires urgent medical attention.

The form of bladder atony can vary from patient to patient, and it is important to diagnose and treat with the nature and causes of this bladder dysfunction in mind. [4]

Complications and consequences

Bladder atony, if not treated or managed properly, can lead to various complications and problems. The following are potential complications of bladder atony:

1. Urinary tract infections: Constant retention of urine in the bladder can promote bacterial growth and increase the risk of urinary tract infections, including cystitis and pyelonephritis.
2. Bladder stones: Keeping urine in the bladder for a long time can contribute to the formation of stones (urinary calculi) inside the bladder.
3. Bladder distention: This condition is characterized by stretching of the bladder walls due to constant overflow of urine. Distension can cause the bladder to lose its ability to contract and squeeze out urine.
4. Spontaneous or urethral expulsion of urine: In bladder atony, urine may be excreted spontaneously despite the patient's desire, which can cause discomfort and social problems.
5. Urethral strictures: Constant stretching of the bladder and urethra can lead to urethral strictures (narrowings), which can make it difficult to urinate.
6. Symptoms of Urinary Overflow: Patients with bladder atony may experience symptoms of urinary overflow, such as frequent and painful urination, nocturnal urinary incontinence, and lower abdominal pain.
7. Increased risk of bladder rupture: In rare cases, bladder atony can lead to bladder wall rupture, which may require urgent medical attention and surgery.
8. Psychological and social problems: Problems with urination and bladder control can cause stress and depression in the patient and affect their quality of life.

Diagnostics of the bladder atony

Diagnosis of bladder atony includes a number of methods and procedures that help to determine its functional state, as well as to identify the presence of any pathologies. Here are the main methods of bladder diagnosis:

1. Ultrasound (ultrasound examination): Ultrasound of the bladder can be used to determine its size, shape, presence of stones, tumors and other abnormalities. This method is safe and does not require the administration of contrast agents.
2. Uroflowmetry: This is a test that is used to assess the rate and volume of urination. The patient urinates into a special container that measures the amount and speed of urine.
3. Urodynamic examination: Urodynamics includes a series of tests that evaluate bladder and urethral (sphincter) function. These tests may include cystometry (measuring bladder volume and pressure), urethral manometry (measuring urethral pressure), physiologic bladder filling studies, and others.
4. Cystoscopy: This is a procedure in which a flexible or rigid endoscope with a camera at the end (cystoscope) is inserted into the bladder to visually inspect the inside of the bladder. Cystoscopy can be used to detect tumors, ulcers, infections, and other abnormalities.
5. Urinalysis: Urinalysis can provide information about the presence of urinary tract infections, the presence of blood or abnormal chemicals that may be associated with bladder abnormalities.
6. Computed tomography (CT) or magnetic resonance imaging (MRI): These techniques can be used to examine the bladder and surrounding tissues in more detail, especially when tumors or other complex conditions are suspected.

Bladder diagnosis is usually performed by a urologist or urological specialist and depends on the specific symptoms and suspected abnormalities. The choice of diagnostic method depends on the clinical situation and can be adapted by the physician to the specific needs of the patient.

Differential diagnosis

The differential diagnosis of bladder atony involves identifying and distinguishing this condition from other possible causes of similar symptoms. Some of these include:

1. Urinary tract infections (Cystitis, Urethritis): Ur inary tract infections can cause pain when urinating, frequent urination, and other symptoms that may resemble bladder atony.
2. Polyps or tumors in the bladder: The presence of polyps or tumors in the bladder can cause symptoms similar to those of bladder atony, such as frequent urination and lower abdominal pain.
3. Blockage of the urethra (Urethral Constriction): Urethral narrowing can cause difficulty urinating and rapid urination, which can be similar to bladder atony.
4. Symptoms associated with neurological disorders (e.g. Myelopathy, Parkinson's disease): Some neurologic disorders can cause symptoms similar to bladder atony, such as urinary incontinence and impaired urinary control.
5. Diabetic nephropathy: Patients with diabetes may develop symptoms associated with kidney damage, including bladder problems.

The following tests and examinations may be required to accurately diagnose bladder atony:

• Ultrasonography of the bladder.
• Urography (x-ray with intravenous contrast).
• Urodynamic study (assessment of bladder function).
• Analyze urine and urine cultures for infections.

The differential diagnosis is made by a urologist or urologic specialist, and it depends on the symptoms and clinical presentation of each case.

Treatment of the bladder atony

Treatment of bladder atony depends on the specific causes and severity of symptoms. In most cases, it involves conservative methods, but in some situations, surgery may be necessary. Here are some of the treatments for bladder atony: [5]

Physical therapy and Kegel exercises

Physical therapy can be helpful in treating bladder atony, especially when combined with other treatments. Physical therapy can help strengthen bladder muscles, improve bladder tone, and restore normal function. Here are some physical therapy techniques that can be used for bladder atony:

1. Electrostimulationof the bladder: Electrostimulation can be done using special devices that send electrical impulses to the bladder muscles. This can help strengthen the muscles and improve bladder contractility.
2. Biofeedback: Biofeedback is a technique in which the patient is given feedback on their muscle activity. The patient learns to control and strengthen the bladder muscles using this feedback.
3. Physical therapy: Specially designed exercises can help strengthen the pelvic floor muscles that control the bladder. These exercises may include muscle contractions and relaxations known as Kegel exercises.
4. Transcutaneous electroneurostimulator (TENS): TENS therapy involves the use of small electrodes that are applied to the skin near the pelvic area and send electrical impulses to stimulate muscles and nerves.
5. Acupuncture: Some patients may get relief from bladder atony with acupuncture, although the effectiveness of this method may vary.

Physiotherapy should be performed under the guidance of a qualified physiotherapist or urologist. The effectiveness of physiotherapy may depend on the degree of bladder atony and the individual characteristics of the patient. Typically, physiotherapy is used in combination with other treatments such as drug therapy or surgery, depending on the severity of the condition.

Kegel exercises for bladder atony are aimed at strengthening the pelvic floor muscles and regaining control over urination. Here are five Kegel exercises, their methodology and steps to perform them:

1. Contraction and relaxation of the pelvic floor muscles:

• Method: Sit or lie down in a comfortable position. First, squeeze your pelvic floor muscles as if you were trying to stop the flow of urine. Then slowly relax.
• Implementation Stages:
  • Contract your muscles for 5 seconds, then relax for 5 seconds. Repeat 10-15 times.

2. Long flexor contracture:

• Technique: Squeeze the pelvic floor muscles as hard as possible and hold this contraction for a long time.
• Implementation Stages:
  • Contract the muscle and hold the contraction for 10-15 seconds, then slowly relax. Repeat 5-10 times.

3. Repetition of contraction and relaxation:

• Technique: First squeeze the pelvic floor muscles and hold the contraction for a few seconds and then slowly relax.
• Implementation Stages:
  • Contract your muscles for 5 seconds, then relax for 5 seconds. Repeat this cycle 10-15 times.

4. Vagina Elevator:

• Technique: Squeeze and lift your pelvic floor muscles as if you were trying to lift your vagina.
• Implementation Stages:
  • Contract and lift your vagina and pelvic floor muscles, holding the contraction for 5-10 seconds, then slowly relax. Repeat 5-10 times.

5. Reduction and retention:

• Technique: Contract the pelvic floor muscles as hard as possible and hold the contraction for a certain amount of time.
• Implementation Stages:
  • Contract your muscles and hold the contraction for 5-10 seconds, then slowly relax. Repeat 5-10 times.

Perform these Kegel exercises on a regular basis and maintain regularity. Start with shorter time intervals and gradually increase the duration of the contraction as your muscles strengthen. Consult your doctor or physical therapist for more precise recommendations and to customize an exercise program for your situation.

Medications

Your doctor may prescribe medications to improve bladder function and reduce the frequency of urination. Examples include antispasmodics, anticholinergics, and medicines that increase bladder muscle tone.

Treatment for bladder atony can include the use of various medications that can help stimulate the bladder and improve its function. But it is important to remember that treatment should be prescribed by a doctor, and the dosage, duration of use and choice of medication depend on the specific situation and medical evaluation.

Here are some of the medications that can be used in the treatment of bladder atony:

1. Cholinergic drugs: These drugs stimulate acetylcholine receptors in the bladder muscles and help increase bladder contraction. Examples include betanechol and carbachol.
2. Prostaglandins: Drugs based on prostaglandins can help relax the bladder neck muscles and improve urination. An example would be alprostadil.
3. Botulinum therapy: Botulinum toxin injections can be used to relax the bladder muscles and reduce spasms.
4. Myorelaxants: These medicines can help relax the bladder muscles and reduce bladder irritability. Examples include baclofen.
5. Anticholinergic drugs: These can be used to reduce spasms and decrease the frequency of bladder contractions. Examples are oxybutynin and tolterodine.
6. Alpha-adrenoreceptor antagonists: Some drugs in this class can help relax the muscles of the bladder and urethra. Examples are tamsulosin and terazosin.

The choice of medication and its dosage depend on the specific diagnosis and characteristics of the patient. It is important to consult with a physician to determine the best treatment plan and medication for bladder atony. In addition, the doctor can assess the benefits and risks of each medication, taking into account the patient's medical history and comorbidities.

Urodynamic procedures

Urodynamic procedures are used to diagnose and evaluate bladder and urinary tract function. They can be useful in bladder atony to determine the extent of the disorder and to choose the best treatment plan. Here are some urodynamic procedures that can be used in bladder atony:

• Cystometry: This is a test of bladder function that involves measuring bladder capacity and pressure inside the bladder while it is filling. The patient may be asked to drink a liquid or inject liquid into the bladder through a catheter, and then the pressure inside the bladder is measured at different levels of filling. This can help determine how well the bladder responds to filling and its ability to hold urine.
• Urethral profilometry: This procedure measures the pressure inside the urethra and assesses how the urethra squeezes or holds urine. It can be useful in identifying urethral problems that may accompany bladder atony.
• Bladder and pelvic floor electromyography: This test can help determine which muscles are involved in bladder control and what their condition is. Electrodes can be placed in the bladder and pelvic floor area to record electrical activity.
• Urethral urodynamics: This procedure evaluates the pressure in the urethra and its response when the bladder is filled. It can help determine if there is urethral compression and other urinary problems.

Urodynamic procedures can provide your physician with valuable information about bladder and urethral function to help develop the best treatment plan for a patient with bladder atony. You should discuss the possibility of these procedures with your doctor and clarify their purpose and process.

Lifestyle changes

Lifestyle changes for bladder atony can be an important component of treatment and can help manage symptoms. Here are some recommendations for lifestyle changes for patients with bladder atony:

1. Eat a healthy diet and avoid excessive fluid intake before bedtime to reduce the frequency of nighttime urination. Also watch the nutritional content of your food and consider your body's vitamin and mineral needs.
2. Cut back on caffeine and alcohol: Caffeine and alcohol can increase bladder irritation and contribute to increased urination. If possible, limit their consumption.
3. Regular urination: Try to urinate on a schedule, even if you do not have a strong urge. This can help prevent bladder overflow and improve urinary control.
4. Physical activity: Moderate exercise can help strengthen the pelvic floor and bladder muscles. Kegel exercises are especially helpful for improving muscle tone.
5. Avoid stress: Stress can make bladder atony symptoms worse. Try relaxation techniques such as yoga or meditation to reduce stress.
6. Medical care: Use treatment and follow your doctor's orders. This includes taking recommended medications and following other specialist recommendations.
7. Bladder care: If you have problems with symptoms worsening, take care of your bladder by trying to avoid overfilling it and preventing urinary tract infections.
8. Communication with your doctor: Consult your doctor regularly and report any changes in symptoms. Your doctor will be able to adapt treatment and recommendations depending on your condition.

Lifestyle changes can help manage bladder atony and improve quality of life. It is important to remember that the effects may differ for each individual, so it is important to individualize the approach to treatment and lifestyle changes under the advice of a physician.

Surgical treatment

Surgical treatment for bladder atony may be considered when conservative methods and lifestyle changes do not bring sufficient improvement in symptoms or when there are structural or functional abnormalities that require correction. Surgical treatment options may include the following procedures:

1. Suburethral artificial sphincter implantation: This surgical procedure involves implanting a device that helps control urination, preventing urinary incontinence. This may be useful for patients with severe urinary incontinence.
2. Implantation of interstitial nerve stimulators: Inter stitial nerve stimulators can be used to stimulate the nerves that control bladder function. This can help restore normal tone and control of urination.
3. Bladder Tone Restoration Procedures: In some cases, surgical procedures may be performed to strengthen or restore bladder muscle tone.
4. Interventional urinary tract reconstruction: If bladder atony is associated with obstructions or other abnormalities in the urinary tract, interventional surgery may be required to correct them.
5. Botulinum therapy: In some cases, botulinum therapy may be used to temporarily weaken the bladder muscles, which can improve symptoms.
6. Urinarycatheter or stoma: In rare cases, if other methods are ineffective, the patient may be offered a urinary catheter or stoma for urinary management.

The choice of surgical method depends on the individual characteristics of the patient, the cause of bladder atony and the severity of symptoms. The decision to undergo surgery should be made in conjunction with a urologist or other specialist who will consider all factors and recommendations for the individual case. Surgical treatment of bladder atony can be an effective way to improve a patient's quality of life and manage the symptoms of this condition.

The treatment of bladder atony should be individualized and developed by a doctor, taking into account specific factors and causes. It is important to discuss all available treatments with your doctor and determine the best approach for your case.

Prevention

Bladder atony prevention focuses on maintaining healthy bladder function and preventing potential problems. Here are some recommendations for preventing bladder atony:

1. Maintain ahealthy lifestyle: Maintain an active lifestyle, participate in physical activity, and watch your weight. Obesity can increase the risk of bladder atony and other medical problems.
2. Good nutrition: Eat a balanced diet, taking into account the body's need for vitamins and minerals. Follow the dietary regimen, avoiding excessive fluid intake before bedtime.
3. Avoiding excessive consumption of alcohol and caffeine: These substances can have an irritating effect on the bladder and increase the frequency of urination.
4. Strengthening the pelvic floor muscles: Do pelvic floor exercises, such as Kegel exercises, regularly. These exercises will help strengthen the muscles that control urination.
5. Avoiding tobacco smoking: Smoking can worsen bladder health and contribute to problems.
6. Timely treatment of other medical conditions: Treat and manage other medical conditions such as diabetes, neurologic disorders, and urinary tract infections that may affect bladder function.
7. Regular medical checkups: Have regular checkups with your doctor, especially if you have risk factors or symptoms that indicate bladder problems.
8. Adherence to urination: Try not to delay urination if you have the urge. Regular and timely urination can help maintain normal bladder tone.

Bladder atony prevention involves taking care of your overall health and following a healthy lifestyle.

Forecast

The prognosis of bladder atony depends on many factors, including the causes of the condition, the severity of symptoms, the timeliness of seeking medical attention, and the effectiveness of treatment. In most cases, with timely and proper treatment, bladder atony can be a controlled and manageable problem.

It is important to note that bladder atony can be a consequence of other conditions such as neurologic disorders, urinary tract infections, diabetes, and others. Therefore, the prognosis also depends on how the underlying disease is controlled and treated.

If bladder atony is not given proper attention and treatment, it can lead to worsening symptoms, including increased frequency of urinary incontinence and worsening urinary control.

Patients with bladder atony should be regularly evaluated by a physician and follow treatment and care recommendations. As the bladder condition improves under medical supervision, significant improvements in quality of life and symptom management can be achieved.

In any case, the prognosis of bladder atony treatment will be individualized and depend on the specific situation of each patient. Compliance with the doctor's recommendations and regular check-ups will allow to manage this condition more effectively and minimize its impact on the quality of life.

Literature used

• Lopatkin, N. A. Urology: National Guide. Brief edition / Edited by N. A. Lopatkin - Moscow : GEOTAR-Media, 2013.
• Disorders of bladder function in women after TVT urethropexy in the early postoperative period. Authors: Nechiporenko A.N. Russian Gazette of Obstetrician-Gynecologist. 2015;15(1): 60-63
• Mikhail Kogan: Urology. Textbook. Publisher: Practical Medicine, 2022.