The bladder neck is a group of muscles that connect the bladder to the urethra. The muscles constrict to hold urine in your bladder, and relax to release it through your urethra. Urinary problems occur when abnormalities obstruct your bladder neck, and prevent it from opening completely during urination.
Men over the age of 50 are more likely to suffer from bladder neck obstruction than any other group. But the condition can occur in both men and women at any age.
If treatment for bladder neck obstruction is delayed for a long period, your bladder may become permanently weakened. Bladder diverticula (bulging pouches in the weakened bladder) may form. Incontinence (involuntary leakage of urine) sometimes continues even after treatment. If left untreated, bladder neck obstruction can cause kidney damage.
What Causes Bladder Neck Obstruction?
An enlarged prostate is often responsible for bladder neck obstruction. The pressure caused by the abnormal size of the prostate strains the bladder. In some cases, bladder neck obstruction may be a side effect of surgery to remove the prostate, or radiation treatments used to treat prostate cancer. Scar tissue from these procedures also can obstruct your bladder neck.
Although bladder neck obstruction is rare in women, it can occur when the bladder prolapses into the vagina. This condition is caused by weakening of the vaginal wall. This can happen because of advanced age, menopause, excessive straining, traumatic childbirth, or multiple births.
Some cases of bladder neck obstruction lack an identifiable cause. Some may be the result of genetic flaws in the bladder structure or and its surrounding muscles and connective tissues.
What are the Symptoms?
Men and women who suffer from bladder neck obstruction experience similar symptoms, which often include the following:
- intermittent urine stream
- delayed urine stream
- incomplete bladder emptying
- increased urgency and frequency of urination
- pelvic pain (this symptom is more common in men than women)
How is Bladder Neck Obstruction Diagnosed?
Many conditions bring on similar symptoms as bladder neck obstruction. These include urinary tract infections and neurogenic bladder (communication complications between the brain and bladder muscles).
To avoid misdiagnosis, urologists often use a procedure called video urodynamics. Images of your bladder are taken in real time using X-ray or ultrasound. The urologist can observe bladder neck obstruction as the bladder fills and voids.
How is Bladder Neck Obstruction Treated?
Treatment options vary depending on the cause of obstruction and the overall health of the patient. Here is an overview:
Alpha-blocker drug therapy can help to relax the bladder muscles. In many cases, self-catheterization may also be required. Success rates with this type of treatment can vary. However, alpha-blockers, with or without self-catheterization, are usually the first step for treating obstruction.
If drug therapy does not help, you may need surgery. The procedure often involves an incision in your bladder neck. This relieves the pressure from the obstruction. This method is highly effective in eliminating uncomfortable symptoms. It usually does not eliminate the source of the obstruction. Although usually benign, the cause of the obstruction may require additional treatment.
If an incision does not relieve your symptoms, or if the bladder neck obstruction is severe, open surgery may be required to reconnect your bladder neck to your urethra.
Self-catheterization may be necessary. This depends on the condition of your bladder muscles during, and following, other treatments. Catheterization may be temporary or ongoing. The technique often requires adjustment. It is important that your catheters are sanitized and inserted properly.
Bladder neck obstruction may exist for many years with few symptoms before treatment is sought. However, once treated, symptoms typically subside.