Monday, January 23, 2023

Bladder Outlet Obstruction In Females

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What Questions Should I Ask My Healthcare Provider About Boo

#23260 Defining Bladder Outlet Obstruction and Detrusor Underactivity in females with overactive…
  • Whats the cause of my bladder outlet obstruction?
  • Whats the best treatment option for me?

A note from Cleveland Clinic

If you have symptoms of a bladder outlet obstruction, dont hesitate to see your healthcare provider. Pay attention to your pee. Is your urine stream normal? Or does very little pee come out, despite your fluid intake? Are you peeing slower than normal? Or do you have trouble starting to pee, no matter how hard you try? Are you in pain? All of these are reasons to get checked out by your healthcare provider to avoid kidney and bladder complications.

Last reviewed by a Cleveland Clinic medical professional on 02/09/2022.

References

Final Thoughts On Bladder Outlet Obstruction

Bladder neck obstruction may be a problem for many years with few symptoms before a diagnosis and treatment are pursued. But, when bladder neck obstruction is treated, the symptoms typically disappear.

The treatment of bladder outlet obstruction will often depend on the cause, and sometimes, surgery may be required to help improve symptoms. Medication or natural remedies can help treat the cause of bladder neck obstruction.

Other ways to improve bladder health include double-void urination, scheduling bladder trips, watching water intake, avoiding dietary triggers, quitting smoking, and trying kegel exercises to help relax the bladder.

Also Read:

Management Of Female Bladder Outflow Obstruction

The sensitivity of the bladder and the urethra to the action of oestrogens has long been recognized. It is postulated that the female urethra may be susceptible to atrophic senile urethritis compared to senile vaginitis as a result of oestrogen deprivation. It is also generally believed that the relative loss of Urethral Wall compliance may be responsible for obstruction in the urethra in postmenopausal women. However there is no conclusive evidence that the Hormone Replacement Therapy either systemic or topical has any significant role in the management of Bladder outlet Obstruction in females.

Sheer mechanical dilatation of the urethra can offer relief of a stricture in the short term but has a high recurrence rate. Empirical urethral dilatation is a popular mode of treatment but has no evidence of support in the literature.

Urethral obstruction arising from iatrogenic reasons such as surgery for stress urinary incontinence deserves a special mention. Colposuspension procedures such as Marshall Marshetti and Krantz operation had a higher incidence of producing bladder outlet obstruction, presumably due to the element of fixity of the urethra to the back of the Symphysis Pubis. Incidence of obstruction occurring after Burch procedure is comparatively low, since the Urethra remains significantly mobile. In either case, obstruction must be dealt with by removing the offending sutures.

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Symptoms Of Bladder Outlet Obstruction

Women and men with bladder outlet obstruction have similar symptoms. Lower urinary tract symptoms involve the urinary sphincter, urethra, bladder, and prostate in men. The preferred term for lower urinary tract symptoms in men is prostatism.

Some of these symptoms include:

  • Incomplete bladder emptying

Acute and chronic kidney failures are also common complications of urinary obstruction.

Open Fetal Surgery For Vesicostomy

BLADDER OUTLET OBSTRUCTION

This operation is offered to carefully selected patients with bladder outlet obstruction, severe oligohydramnios and favorable prognostic tests of renal function. Vesicostomy is the most definitive means of decompressing the urinary tract to prevent ongoing injury to the developing kidney. In fetal vesicostomy, the fetal abdomen is opened below the umbilical cord insertion. The bladder is opened and sutured to the fetal skin, allowing for complete urinary diversion.

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What Is Pediatric Bladder Outlet Obstruction

Bladder outlet obstruction is a blockage of urine flow in the tube that carries urine from the bladder to exit the body. When bladder outlet obstruction happens during fetal development, it can cause urine to back up into the babys bladder and kidneys. This causes normal levels of amniotic fluid to decrease, which can lead to several problems, including bladder and kidney damage, and underdeveloped lungs at birth.

Diagnosis Of Bladder Outlet Obstruction

How is bladder outlet obstruction diagnosed? Your doctor will first get a full picture of your symptoms since signs of bladder outlet obstruction are often similar to several other conditions, such as neurogenic bladder, urinary tract infections, abdominal growth, enlarged bladder, or an enlarged prostate in men.

To help make the correct diagnosis, your doctor likely will use video urodynamicsa series of tests that help evaluate bladder function. During this process, an ultrasound or X-rays help detail real-time images of the bladder.

A catheter is then inserted into the bladder to empty urine and later fill the bladder with fluid. When the bladder is full, you are asked to cough and urinate. Images then allow the doctor to observe bladder outlet obstruction during the bladder filling and emptying.

A cystoscopy is another diagnostic method that uses a cystoscope device to look inside the bladder and determine whether the urethra has narrowed.

Other diagnostic tests that help determine bladder outlet obstruction include uroflowmetry that determines how fast urine flows from the body, urinalysis to check for blood or infections in the urine, urine cultures that check for infections, and blood chemistries that look for kidney damage signs.

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Structural Anatomy Of The Female Bladder Outlet

Anatomy of the female urethra: Linear diagram

Bladder neck is a weak link in the continence mechanism and can be shown to be incompetent even in nulliparous women.

External sphincter complex is composed of three components as in the females. The innermost intrinsic smooth muscle sleeve has a longitudinal orientation, and is noradrenergically innervated. Its role in the continence mechanism remains debatable to date.

The striated urethral sphincter or the so called Intrinsic Rhabdosphincter is a definite mass of striated muscles which have a circular orientation. This is thickest in the central portion of the urethra and its thickness tapers of towards the bladder neck and towards the external urethral meatus.

Indeed this muscle is made of slow twitch striated fibers, which are capable of prolonged contraction. The reason this muscle is thickest anterierly is because it is oriented in a number of bundles and some of its bundles wrap the urethra from the sides and then become incorporated into the anterior and lateral vaginal walls.

Although it’s an intrinsic urethral muscle, it is supplied entirely by the pudendal nerve. The third component is of course the muscle mass of the pelvic floor which essentially surrounds the external rhabdosphincter but is made mainly of fast twitch fibers like other skeletal muscles.

How Is A Bladder Outlet Obstruction Treated

Female Bladder Outlet Obstruction || Urology || LUTS ||

The type of treatment depends on whats obstructing your bladder. For example, bladder stones are treated differently than prostate cancer.

Some BOO blockages can be treated by:

  • Inserting a thin, flexible tube called a catheter through your urethra and into your bladder.
  • Inserting a catheter into your bladder through an incision in your lower abdomen.
  • Medications.
  • Surgical procedures to remove the obstruction.

Its important to get treatment as soon as possible. If you dont, there could be complications.

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Bladder Outlet Obstruction Is A Blockage At The B

BOO Lower urinary tract obstruction Prostatism Urinary retention BOO

Causes

This condition is common in aging men. It is often caused by . and are also more commonly seen in men than women. As a man ages, the chances of getting these diseases increase greatly.

  • Pelvic tumors
  • out of the body from the bladder , due to scar tissue or certain birth defects
  • Cystocele
  • Foreign objects
  • Urethral or pelvic muscle spasms
  • Inguinal hernia
  • Abdominal pain
  • Continuous feeling of a full bladder
  • Frequent urination
  • Problems starting urination
  • Slow, uneven urine flow, at times being unable to urinate
  • Straining to urinate
  • Waking up at night to urinate

Exams and Tests

Immediate Treatment For Bladder Outlet Obstruction

Left untreated, bladder outlet obstruction can harm the bladder or kidneys as the pressure of the urine builds up in the upper urinary tract. In order to minimize this type of damage, the most important first step during treatment is to relieve the pressure caused by the blockage.

In most cases, a tube is inserted into the urethra to remove the urine from the bladder. Sometimes, however, a tube is inserted through the stomach and into the bladder . This may be done when the catheter cannot go through the urethra, such as when there is damage to the urethra from a previous surgery.

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Bladder Outlet Obstruction Causes

Bladder outlet obstruction can be caused by several conditions, most commonly:

  • Enlarged prostate : The bladder rests on top of the prostate gland, and the urethra passes through it. When the prostate is enlarged, it can press against the bladder outlet or compress the urethra, both of which may obstruct the flow of urine.
  • Bladder cancer or other pelvic cancers: In certain locations, a tumor can block the opening of the bladder or compress the urethra.
  • Bladder stones: These hard deposits of crystallized minerals can form when the urine remains in the bladder too long. If the stones become too large to pass naturally from the bladder into the urethra, they can block the bladder’s outlet.
  • Scarring of the urethra: Scarring from previous surgery or injury can narrow the urethra and cause urine to back up into the bladder.

The frequency of bladder outlet obstruction in the general population is unknown, but studies have found that it occurs in 20 to 35 percent of elderly men, often due to BPH. In young and middle-aged men, bladder stones tend to be the cause. In women, gynecologic surgery, pregnancy and cancers of the pelvic organs can all lead to bladder outlet obstruction.

Whats Bladder Outlet Obstruction In Utero

Bladder Outlet Obstruction in Women

Bladder outlet obstruction in utero is also called fetal bladder outlet obstruction or fetal lower urinary tract obstruction . This rare condition is where a developing babys pee is blocked, which reduces the amount of amniotic fluid, increases the size of their bladder and can cause many other problems.

Also Check: Whats The Difference Between A Uti And A Bladder Infection

What Are The Symptoms Of Bladder Outlet Obstruction

You may have BOO if you:

  • Have trouble starting your urine stream.
  • Feel like you have a full bladder but cant empty it completely.
  • Pass pee frequently during sleeping hours.
  • Have pain in your lower abdomen.
  • Have a pee flow that starts and stops or is very slow.
  • Void often, but very little pee comes out.
  • Feel pain when passing pee.

What Causes Bladder Neck Obstruction

An enlarged prostate is often responsible for causing bladder neck obstruction. The prostate is a small gland in the male reproductive system. It surrounds the urethra and produces most of the fluid in semen. When the prostate gland becomes swollen, it squeezes the urethra and restricts the flow of urine. The obstruction can become so severe that no urine will be able to leave the bladder at all.

Bladder neck obstruction may also be a side effect of surgery to remove the prostate or of radiation treatments used to treat prostate cancer. Scar tissue from these procedures can block the bladder neck.

Although bladder neck obstruction is rare in women, it can develop when the bladder drops into the vagina. This usually occurs as a result of a weakened vaginal wall. The vaginal wall may become weak due to:

  • advanced age
  • a difficult delivery
  • multiple births

In some cases, bladder neck obstruction might even be caused by a genetic flaw in the bladder structure or its surrounding muscles and connective tissues.

The symptoms of bladder neck obstruction are similar to those of several other conditions, including urinary tract infections and neurogenic bladder.

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How Can I Prevent A Bladder Outlet Obstruction

If the condition that blocks your bladder neck is preventable, then the bladder outlet obstruction might be preventable, too.

What medications can I take to reduce my risk of a bladder outlet obstruction?

Talk to your healthcare provider about medications that could reduce your risk of the different conditions that cause an obstruction.

Urodynamic Parameters For The Diagnosis Of Bladder Outlet Obstruction In Women

#23174 Clinical and Urodynamic characteristics of female bladder outlet obstruction accompanied …

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How Is A Bladder Outlet Obstruction Evaluated And Diagnosed

Tests may include:

  • Blood tests to check for kidney damage.
  • Urine cultures to test for infection.
  • Ultrasound of your kidneys and bladder to find where the pee blockage is occurring.
  • Urine testing to look for blood in your pee.
  • A scope to look for narrowing of your urethra.
  • Urodynamic evaluation .
  • Ultrasound .

Whats Bladder Outlet Obstruction

Bladder outlet obstruction is when the neck at the very bottom of your bladder gets blocked. The neck is where your bladder connects to your urethra, which carries urine out of your body. A blockage stops or slows down the flow of pee. Possible blockages include scar tissue, bladder stones, a large gland, cancer or a tumor.

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Causes Of Bladder Outlet Obstruction

What are the causes of urinary bladder outlet obstruction?

An enlarged prostate, or benign prostatic hyperplasia , is one of the main causes associated with bladder neck obstruction.

The prostate is a male reproductive gland that surrounds the urethra. When the prostate becomes swollen, this restricts urine flow. The urinary obstruction can grow so severe that it leads to urinary retention. In other words, no urine is able to empty from the bladder.

Bladder neck obstruction can also result from radiation treatment for prostate cancer or as a side effect of prostate removal surgery. Urethral stricture from each procedure can lead to bladder neck blockage.

Although rare in women, bladder neck obstruction can develop when the bladder and urethra descend into the vagina, often due to a weakened vaginal wall. This sometimes results from multiple births, a difficult delivery, menopause, or advanced age.

In some cases, a genetic flaw in bladder structure or its surrounding connective tissues and muscles may even cause this urinary obstruction. Other potential causes of bladder outlet obstruction include bladder stones, bladder tumors , and pelvic tumors .

Treatments For Bladder Outlet Obstruction

(PDF) Bladder outlet obstruction in women

The treatment for bladder neck obstruction will depend on its cause.

Most of the time, surgery is needed for long-term bladder neck obstruction, and it involves making an incision in the bladder neck. A resectoscope is then inserted through the urethra to view the bladder neck, and an instrument attached to the device will then make a small incision into the bladder neck wall.

Although surgery doesnt treat the cause of bladder outlet obstruction, it does relieve pressure from the bladder blockage to help with the symptoms.

If the incision doesnt improve symptoms or the bladder neck obstruction is severe, open surgery may be needed to reconnect the bladder neck to the urethra.

That being said, many of the conditions that cause bladder neck obstruction can be treated with medications or natural remedies before surgery is necessary.

The first step in treating bladder neck obstruction is the use of alpha-blockers like phenoxybenzamine or prazosin, which help the bladder muscles relax.

Other times, self-catheterization will be needed alongside alpha-blockers. Self-catheterization is a painless procedure that helps empty urine from the bladder.

From a natural perspective, herbal supplements that help treat bladder neck obstruction due to BPH include saw palmetto and stinging nettle root.

Research also shows that urinary flow rate gradually improves significantly with pumpkin seed oil in enlarged prostate patients after six months of treatment.

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Bladder Outlet Obstruction In Women

  • 8. 16. Hong B, Park S, Kim HS, Choo MS. Factors predictive of urinary retention after a tension free vaginal tape procedure for female stress urinary incontinence. J Urol 2003 170:852-6. 17. Fowler CJ, Kirby RS. Abnormal electromyographic activity in the striated muscle of the urethral sphincter in 5 women with persisting urinary retention. Br J Urol 1985 57:67-70. 18. Datta SN, Chaliha C, Singh A, Gonzales G, Mishra VC, Kavia RB, et al. Sacral neurostimulation for urinary retention: 10-year experience from one UKcentre. BJU Int 2008 101:192-6. Source of support: Nil. Conflict of Interest: None declared.
  • Who Is Most Likely To Have A Bladder Outlet Obstruction

    BOO is most common in those over age 65 and people designated male at birth and is often linked to prostate problems. More men than women get it. Women and people designated female at birth with cystocele are more likely to have a bladder outlet obstruction than other women. Children and babies, including developing fetuses, can also get BOO.

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    Outlook For Bladder Outlet Obstruction

    Most cases of bladder outlet obstruction can be treated successfully if caught early. If treatment is delayed, however, the bladder or kidneys can be seriously damaged.

    In general, recovery is lower with longer blockage times. If the kidneys were damaged as a result of the obstruction, they will start working properly again within 3 weeks to 5 months. Again, this depends upon the severity of the damage done.

    References

    Gerber GS, Brendler CB. . Evaluation of the Urologic Patient: History, Physical Examination, and Urinalysis. Campbell-Walsh Urology, 10th ed.

    Zeidel ML. . Obstructive uropathy. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier chap 125.

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