Bladder

The bladder is part of the urinary system. The kidneys, ureters, bladder and urethra make up the urinary system. Urine is made by the kidneys continuously as they filter out waste from the blood. The urine flows down the ureters to the bladder where it is stored.

The job of the bladder is to store and pass urine (urinate or wee). The bladder holds on to urine by relaxing the muscle in its wall. At the same time, the urethra (outlet tube to the bladder) tightens, stopping urine from leaking out. When a certain amount of urine is inside the bladder, nerves in the bladder signal the urge to urinate. Urine is release by the bladder muscle contracting and the urethra relaxing.

Urine is made up of water and waste products. The amount of urine you produce depends on how much you drink. On average, you should pass urine up to six times per day and once overnight.

Common bladder conditions

Some bladder conditions include:

• Bedwetting
• Urinary incontinence
• Cystitis (bladder infection)
• Bladder stones
• Overactive bladder
• Paruresis (shy bladder syndrome)
• Cystocele
• Bladder polyps
• Bladder cancer.

Bedwetting

Children who wet the bed have difficulty waking up to go to the toilet when their bladder is full.. It is a very common condition in younger children. One in five preschoolers and around one in 20 of all children at the age of ten years still wet the bed. It can continue into adulthood with about one per cent of adults affected.

The good news is that for many, the problem can usually be fixed through fairly simple treatment. Don’t wait to grow out of it. Talk to your doctor about possible treatments.

Urinary incontinence

Urinary incontinence is any unwanted leakage of urine. It is a very common condition affecting one in four women and one in ten men. The main causes of incontinence are:

• Weak pelvic floor muscles that don’t give good support to the bladder or urethra
• An over-active bladder where the bladder muscle contracts, pushing out the urine before the person is sitting/standing at the toilet
• The bladder not emptying completely. An enlarged prostate is the most common reason for this type of problem. The prostate squeeze the urethra, preventing the bladder from emptying fully. It can happen with some chronic health problems such as diabetes.

Incontinence can be prevented, treated and cured. Talk to your doctor if you are having problems with bladder control.

Cystitis

This is a bladder infection usually caused by bacteria that travel up the urethra and inflame the bladder lining. Most women will experience cystitis at least once in their lives. While it is painful and annoying, it isn’t dangerous or contagious, and the infection can’t be passed on during sex. Treatment includes antibiotics. If left untreated, cystitis may cause a kidney infection, which can be serious.

Bladder stones

Bladder stones are small stones made from the proteins and minerals that occur naturally in urine. The stones have rough surfaces that may scratch the bladder lining and can cause bleeding and infection.

Risk factors for bladder stones include:

• Gender – men are at increased risk
• Advancing age
• Living in a hot climate
• Chronic (ongoing), mild dehydration
• Certain hormonal imbalances
• Underlying urinary tract disorder such as an enlarged prostate.

Overactive bladder

An overactive bladder is a condition that results from sudden, involuntary contraction of the muscle in the wall of the bladder. Overactive bladder causes a sudden and unstoppable need to urinate (urinary urgency), even though the bladder may only contain a small amount of urine.
Although it can happen at any age, overactive bladder is especially common in older adults. It should never be considered a normal part of aging. Pelvic floor exercises in combination with bladder retraining are the main form of treatment. Sometimes medication will also be prescribed.

Paruresis

A person with paruresis finds it difficult or impossible to urinate when other people are around. Paruresis is believed to be a common type of social phobia, ranking second only to the fear of public speaking. The condition is also known as shy bladder syndrome.

Cystocele

A cystocele occurs when the wall between a woman's bladder and her vagina weakens and allows the bladder to bulge into the vagina. This condition may cause discomfort and problems with emptying the bladder. Other names for cystocele include prolapse of the bladder, ‘fallen’ bladder and anterior vaginal wall prolapse.

Risk factors include:

• Childbirth
• Straining on the toilet to pass bowel motions
• Obesity
• Cigarette smoking
• Chronic (ongoing) coughing.

These risk factors all cause the pelvic floor muscles to weaken so that the bladder and the urethra are not given enough support.

Bladder polyps

Bladder polyps are abnormal growths in the bladder lining that may be benign or cancerous. Risk factors include cigarette smoking and gender (since men are more commonly affected). Usually, bladder polyps don’t cause any symptoms.

When symptoms occur, they may include:

• Painful urination
• Blood in the urine
• Frequent urination.

Bladder cancer

Most bladder cancers are found in the cells of the bladder lining called transitional cells, so it is known as ‘transitional cell bladder cancer’.

The two main types include:

• Superficial bladder cancer – the cancer has not spread beyond the lining of the bladder. This condition is also known as papillary bladder cancer.
• Invasive bladder cancer – this means that the cancer has spread into the muscle layer of the bladder or further.

Treatment options include surgery, immunotherapy and chemotherapy.

Where to get help

• Your GP (doctor)
• Urologist
• Gynaecologist
• Kidney Health Australia. Helpline Tel. 1800 454 363
• National Continence Helpline Tel. 1800 33 00 66
• NURSE-ON-CALL Tel. 1300 60 60 24 – for expert health information and advice (24 hours, 7 days)