What Is Bladder Neck Obstruction?
The bladder neck is a group of muscles that connect the bladder
to the urethra. The muscles tighten to hold urine in the bladder, and relax to
release it through the urethra. Urinary problems occur when abnormalities block
the bladder neck and prevent it from opening completely during urination.
Men over age 50 are more likely to develop bladder neck
obstruction than any other group. However, the condition can occur in both men
and women at any age.
The bladder can become permanently weakened if treatment for
bladder neck obstruction is delayed for an extended period of time. A weakened
bladder may lead to complications such as:
- kidney damage
- bladder diverticula, which are bulging pouches
that can form in the bladder
- long-term incontinence, which is a lack of
Call your doctor if you believe you have bladder neck
obstruction. Prompt treatment will relieve your symptoms and prevent
complications from developing.
What Are the Symptoms of Bladder Neck Obstruction?
Men and women who have bladder neck obstruction experience
similar symptoms, which often include the following:
- an irregular output of urine
- incomplete bladder emptying
- increased urinary frequency
- increased urinary urgency
- an inability to control the urge to urinate
- pelvic pain, which is more common in men than in
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
How Is Bladder Neck Obstruction Diagnosed?
The symptoms of bladder neck obstruction are similar to those of several
other conditions, including urinary tract infections and neurogenic
To make the correct diagnosis, your doctor will likely use video
urodynamics. This is a series of tests that are performed to evaluate bladder
During video urodynamics, X-rays or an ultrasound
will be used to take detailed images of your bladder in real time. A thin tube
called a catheter will be inserted into your bladder to empty any urine inside. The catheter will then be
used to fill your bladder with fluid. Once the bladder is full, you may be
asked to cough and then to urinate as much as possible. The resulting images
allow your doctor to observe bladder neck obstruction as the bladder fills and
empties. Video urodynamics can
also help them detect any structural problems in the bladder or urethra.
may also be used to diagnose bladder neck obstruction. This involves the use of
a device called a cystoscope to look inside the bladder. A cystoscope is a long,
thin tube with a camera and light attached at the end. During the procedure, your
doctor will insert the cystoscope through the urethra and into the bladder. A
liquid may be used to fill and stretch the bladder so your doctor can get a
How Is Bladder Neck Obstruction Treated?
Bladder neck obstruction may be treated with medication or
surgery. Your specific treatment plan will depend on your overall health and
the cause of your condition.
Alpha-blocker drug therapy is usually the first step in treating
bladder neck obstruction. Alpha-blockers, such as prazosin
can help to relax the bladder muscles.
In some cases, self-catheterization will need to be used along
with alpha-blocker medications. Self-catheterization is a safe, painless
procedure that will help you empty your bladder of urine. Catheterization may
be temporary or ongoing. It often depends on the severity of your condition and
on how well your symptoms are responding to medication. Your doctor can show
you how to insert the catheter into your bladder and how to keep it clean.
You may need surgery if your condition doesn’t improve with
medication and self-catheterization. Surgery for bladder neck obstruction often
involves making an incision in your bladder neck. It’s performed using
anesthesia so you don’t feel any pain.
During the procedure, a resectoscope will be inserted through the
urethra. A resectoscope is a long, thin tube with an attached camera that
allows your doctor to view the bladder neck more easily. Once the resectoscope
is inserted, a cutting instrument attached to the resectoscope will be used to
make a small incision in the wall of the bladder neck.
Although surgery usually doesn’t treat the cause of the
obstruction, it can relieve the pressure from the blockage and ease the symptoms.
You may need additional treatment to fix the underlying cause of bladder neck obstruction.
If an incision doesn’t relieve your symptoms or if the
obstruction is severe, open surgery may be required to reconnect your bladder
neck to your urethra.
What Is the Long-Term Outlook?
Bladder neck obstruction may exist for many years with few
symptoms before treatment is sought. However, once it’s treated, the symptoms of
bladder neck obstruction typically subside.