What Is Bladder Neck Dysfunction?
The urinary bladder is one of the most crucial organs of the urinary system. It is a balloon-like structure connected to the kidneys on one end and the urethra on the other. The ureters are tube-like structures that connect the urinary bladder to the kidneys. The urinary bladder receives urine from the ureters. The urethra forms a connecting link between the urinary bladder and the outside world. The urine is drained from the urinary tract through the urethra. The junction where the urinary bladder meets the urethra is known as the bladder neck. It consists of muscles that contract and relax to facilitate urine drainage.
However, the problem arises when the bladder neck does not function well or is blocked and inhibits urine flow. The urine might flow back to the kidneys, increasing the risk of urinary tract infections. It is commonly seen in men above 50 years of age and needs to be treated at the earliest.
What Are the Causes of Bladder Neck Dysfunction?
If the bladder neck is blocked or fails to function, the patient experiences problems related to the urinary tract. The causes of bladder neck dysfunction have been described below:
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Benign Prostatic Hyperplasia - The prostate gland is one of the most important organs of the male reproductive system. It is located near the neck of the urinary bladder. The condition in which the gland becomes enlarged is known as benign prostatic hyperplasia. The urethra mainly traverses through the middle portion of the prostate. The bladder outlet narrows if the gland becomes enlarged or swollen, resulting in restricted urine flow.
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Prolapsed Bladder - One of the most common causes of bladder neck obstruction in females. The condition in which the bladder slips into the vagina is known as bladder prolapse. It mainly occurs when the vaginal wall becomes weak due to menopause, vaginal delivery, and multiple pregnancies.
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Presence of Scar Tissues - Scar tissue forms in the bladder or the urethra as a side-effect of radiation treatment and prostate surgery. These tissues block the neck of the bladder and make urination difficult.
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Stress Urinary Incontinence Surgery - The urine leakage before the person reaches the toilet is known as urinary incontinence. It is treated surgically by bladder neck suspension and sling surgery. The bladder neck might get damaged during the surgery resulting in severe problems in the urinary tract.
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Presence of Cysts and Tumors - A tumor is a mass formed due to uncontrolled cell division. On the other hand, cysts are multiple fluid-filled sacs that form anywhere in the body. Tumors in the rectum, vagina, and urethra might block the bladder neck as the urinary bladder is located close to these organs.
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Urethral Stricture - It is a condition in which the urethra becomes narrow. Urethral stricture blocks urine flow from the bladder and increases the risk of urinary tract infections.
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Constipation - Constipation is when the stools become hard and cannot pass through the body. These hard stools put pressure on the bladder neck, making it difficult for the muscles to work and drain the urine to the urethra.
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Congenital Defects - Bladder neck dysfunction can also be present by birth due to defects in the urinary bladder or the surrounding structures.
What Are the Symptoms of Bladder Neck Dysfunction?
Bladder neck dysfunction makes it difficult for the urinary bladder to drain urine into the urethra. The following signs and symptoms are seen in bladder neck dysfunction:
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Difficulty in starting the flow of urine.
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The patient cannot urinate completely, even after getting a strong urge.
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The presence of pain in the lower back and abdominal region is commonly seen.
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Nocturia, or the urge to pass urine at night, occurs frequently.
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The patient rushes to the toilet frequently but cannot empty the bladder at once.
What Methods Are Used to Diagnose Bladder Neck Dysfunction?
The patient presents with similar symptoms in bladder neck dysfunction, urinary tract infections, and other conditions that affect the urinary system. The methods used to diagnose bladder neck dysfunctions have been described below:
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Blood Tests - Blood test helps the physician check the infections in the body.
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Urine Culture - The patient collects urine in a container or a sterile bag provided by the hospital. The urine sample is left unattended for a few days to allow the bacteria to grow. If bacterial growth is rapid, a urinary tract infection can be suspected.
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Cystoscopy - It is one of the most effective methods used to diagnose bladder-neck dysfunction. A cystoscope is a small instrument with a camera that allows one to view the inner lining of the urinary system.
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Renal and Bladder Ultrasound - In this procedure, sound waves are sent to the kidney, and images of the kidney, ureters, and urinary bladder are obtained. The doctor looks at the images on the computer. This image will give him an idea about the presence of stones, tumors, wounds, or anything that leads to the blockage of the urinary system.
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Video Urodynamics - It is an imaging test used to detect urinary bladder problems. The doctor initiates the procedure by inserting a tube called a catheter into the urethra. Next, the contrast material or a dye is injected into the bladder through the catheter. X-rays are taken as the bladder becomes full. The patient is asked to urinate, and the X-rays are taken again. This test helps to observe bladder neck dysfunction and how the bladder works when it is obstructed.
How Is Bladder Neck Dysfunction Managed?
Bladder neck dysfunction can be treated with medications and surgery. The treatment option depends upon the cause and the severity of the condition. Both the surgical and non-surgical methods have been described below:
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Antibiotics - Prazosin and Phenoxybenzamine are mainly used to treat bladder neck dysfunction. They are alpha-blockers that work to relax the muscles of the urinary bladder. As the bladder muscles are relaxed, the urine flows out of the bladder smoothly.
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Self-Catheterization - As the name suggests, the procedure is performed by the patient. Self-catheterization is also known as clean intermittent catheterization and helps the patient to pass urine when he finds it difficult to urinate. Finally, the urine drains out of the body, and the catheter is removed. The procedure needs to be repeated several times during the day.
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Surgery - Surgical intervention is required when the medications and self-catheterization methods fail to resolve the condition. The surgery is performed under general anesthesia. First, a small cut or an incision is made in the bladder neck. Next, a tube known as a resectoscope is inserted into the urinary bladder. It contains a camera that helps to view the neck of the bladder. It also contains a tool that uses an electric current to remove the tissue blocking the bladder neck.
What Are the Complications of Bladder Neck Dysfunction?
If the bladder neck dysfunction is left untreated for a long time, the bladder becomes weak permanently. The complications of bladder neck obstruction are listed below:
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The risk of urinary tract infections increases because the urine remains in the body and becomes a potential source of bacterial infection.
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If the bladder becomes weak, a pouch known as a bladder diverticula forms in the urinary bladder.
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Hydronephrosis, or the swelling of the kidneys, occurs because of the pressure exerted by the urine. As a result, the kidneys get damaged permanently.
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The person might experience urinary incontinence (leakage of urine) for a prolonged period as bladder control is lost.
Conclusion:
Bladder neck dysfunction is when the urine does not flow freely through the bladder as the muscles are not working properly. Bladder neck dysfunction is not life-threatening but requires treatment at the earliest. It is because the bladder becomes weak if the condition is left untreated for a long. There are no home remedies available to cure bladder neck dysfunction. However, some medications relax the bladder muscles and allow the passage of urine. Surgical intervention is rarely required when the medications and self-catheterization methods fail to achieve the desired results. Hence, the patient must not worry about the condition and consult the doctor at the earliest to avoid complications.
