Atonic bladder, or flaccid bladder, occurs when the bladder becomes dilated and fails to empty properly. Atonic bladder differs in this regard from most other bladder problems, where the bladder tends to be overactive. The dilated bladder can be stretched by excess urine buildup, leading to overflow leakage and damage to the bladder walls. Other bladder problems such as urinary tract infections can occur because of urine pooling and subsequent bacterial growth in the flaccid bladder.

Flaccid bladder can often be traced to neurogenic problems: The bladder nerves fail to send appropriate messages to the brain. Multiple sclerosis and spinal cord injuries can both lead to a dilated bladder. Diabetes is also associated with atonic bladders.

 

Obstruction of the urinary canal may cause flaccid bladder. Bladder stones are the typical causes of obstruction, but a man with an enlarged prostate can develop atonic bladder if the prostrate creates an obstruction of the urinary system.

Management of atonic bladders centers around the need to empty the bladder before overflow leakage or stretching occurs. Catheterization on a regular basis is often used. Patients learn to self-catheterize, and may have to wake up at night to use the catheter.

 

For patients who cannot self-catheterize, other options exist. Credé is a bladder voiding technique in which the patient manually presses down on the bladder. In effect, this squeezes the urine out of the bladder. Valsalva, another technique, works by using the abdominal muscles as if having a bowel movement. This puts pressure on the bladder, and forces urine out.

 

Surgical interventions are limited, but available. Bladder augmentation increases the bladder's storage capacity, lengthening the time periods between catheter use. A portion of the large intestine is removed and fitted onto the bladder to create additional capacity.

 

Another surgical procedure called Mitrofanoff creates a passage using the appendix so that catheterization may be performed through the abdomen rather than the urethra. This makes self-catheterization easier for some patients.

 

Researchers are currently evaluating the effect of botulinum toxin A injections into the detrusor muscle. Results are promising.

 

Beers, M.H. & Berkow, R. (ed). Neurogenic bladder [electronic version]. The Merck Manual of Diagnosis and Therapy, 17th Edition. Merck Research Laboratories, NJ, 1999.

 

Northwest Regional Spinal Cord Injury System. (1998).
Staying healthy after a spinal cord injury: Bladder management. Retrieved March 8, 2002, from depts.washington.edu/rehab/docs/sci/bladder_manage.pdf.

 

Stein, J. (2003, May 2). AUA: Botulinum toxin injections improve detrusor hyperreflexia and neurogenic incontinence.
Retrieved April 28, 2004, from www.pslgroup.com/dg/2319fe.htm.