The bladder neck is a term used to refer to a group of muscles that join the bladder to the urethra, tightening while holding urine in the bladder and relaxing while releasing it in the urethra. When these muscles do not function properly due to blockages caused because of abnormalities, the resultant condition is known as bladder neck obstruction, which does not allow the bladder neck muscles to open properly during urination. Men over 50 years of age are more likely to be affected by bladder neck obstruction, though the condition can otherwise occur in men and women of any age.
It is important to understand the bladder neck obstruction, its symptoms, causes and treatment to ensure it is effectively cured because a prolonged bladder neck obstruction problem can cause a permanently weakened bladder.
A permanently weakened bladder will lead to difficulties such as:
- Urinary tract infections
- Damage to the kidneys
- Permanent lack of bladder control
- Formation of bulging pouches in the bladder
Symptoms of Bladder Neck Obstruction
Symptoms of bladder neck obstruction are common in both genders, such as:
- Inconsistent urine output
- Incomplete emptying of the bladder
- Higher frequency of urination
- Higher urine urgency
- Lack of bladder control – the inability to control alarming urge to urinate
- Pelvic pain
It is very important to understand the symptoms of bladder neck obstruction since effective diagnosis and prompt treatment can work to minimize damage.
Causes of Bladder Neck Obstruction
A bladder neck obstruction is caused due to an enlarged prostate – a small gland in the male reproductive system responsible for producing most of the semen in men. When the prostate gland swells it pressurizes the urethra, blocking the flow of urine; the swelling can be so severe that it can cause rigid obstruction leading to no passage of urine from the bladder at all.
In other cases, a bladder neck obstruction can also be a resultant effect of surgery to remove the prostate or a side effect of radiation given to the patient with prostate cancer; also scarring from these two procedures can block the bladder neck.
That said, in women bladder, neck obstruction occurs when the bladder drops into the vagina due to weak vaginal wall because of reasons such as increasing age, menopause, problematic delivery, multiple births, etc.
In some rare cases, bladder neck obstruction can also be a genetic thing.
Diagnosis of Bladder Neck Obstruction
Bladder neck obstruction is slightly complicated to diagnose outwardly since it has very similar symptoms to that of a urinary tract infection and neurogenic bladder. Some techniques that are used to diagnose bladder neck obstruction are:
Video urodynamics is a series of test to assess the functioning of the bladder. These tests include X-rays or an ultrasound that will provide comprehensive, real-time images of the bladder. Moreover, the doctor will place a catheter inside a full bladder and will instruct the patient to empty the bladder inside. The catheter will then be used to fill fluid in the bladder to make it full. The patient will then be asked to urinate as much as possible. This will enable the doctor to examine the functioning of the bladder neck while filling and releasing urine from the bladder. Moreover, video urodynamics is also useful in analyzing any abnormalities in stricture of the bladder or urethra.
Cystoscopy involves using a thin, long, flexible tube known as a cystoscope, which is mounted with a camera and light to detect bladder neck obstruction. The cystoscope is inserted into the bladder through the urethra, and then a liquid is used to fill and stretch the bladder, enabling the doctor to get a clear view of the structure and functioning of the bladder.
Treatment of Bladder Neck Obstruction
Bladder neck obstruction can be treated with medications and surgery – the choice depends on the health condition, the severity of the problem and the reason for bladder neck obstruction. Some methods of treatment include:
Medication: The doctor will recommend certain medications to help the bladder muscle relax and function properly. Moreover, in some cases, the doctor will also suggest using a catheter to empty out the bladder along with the medications. The catheter can be inserted by the person at home, and it will help clear urine from the bladder. Self-catheterisation will be advised temporarily or for a long period, depending on the response of the symptoms.
Surgery: Surgery is the only alternative treatment when medications and self-catheterisation fail to ease the symptoms and resolve the problem. The doctor will make an incision in the bladder neck while influencing the patient with anaesthesia. Post this, a long, flexible, thin tube attached with a camera – known as resectoscope will be inserted through the urethra to get a clear view of the bladder neck. After this, the cutting instrument on the resectoscope will be used to make an incision in the wall of the bladder neck to relieve the pressure, easing the blockage and symptoms. However, the underlying cause of obstruction may not be treated through this surgery, and the patient might need additional treatment to cure the problem. When this method fails to relieve pressure or symptoms, open surgery may be the only alternative which will work to reconnect the bladder neck to the urethra.
In all, a bladder neck obstruction can be easily treated provided the symptoms are detected on time and causes identified to get appropriate medical care. Some people might have bladder neck obstruction with minor symptoms before treatment; however, all symptoms subside if treatment is sought timely. In other cases, prolonged bladder neck obstruction cases lead to a permanent weakening of the bladder.