The Atonic Bladder - Its Causes And Treatments

What is an atonic bladder? A weak bladder would be a correct answer, but a somewhat misleading one. When we think of a weak bladder, we think of a bladder that empties itself too easily, a bladder we don't have full control over. In medical terminology, atonic pertains to the muscles, and in particular to weakness or a lack of muscle tone.

The Mechanics Of  Bladder Elimination

An atonic bladder however, is not one that empties itself too easily, but instead is a bladder that is unable to empty itself when it's full. Normally, when the bladder is becoming filled, the nervous system sends a message to the brain telling it that it's time for the bladder to be emptied. The brain in turn makes that fact known to the person whose bladder is filling up. That person would normally have control over just when to empty the bladder, and when he or she decides to do so, the brain sends a signal through the nervous system telling the muscular wall of the bladder to contract, just like one squeezes one's fist, and the bladder empties. In the case of an atonic bladder, there is little or no squeezing taking place, since the muscle responsible for doing so, the detrusor muscle, is too weak. Thus, the bladder remains full, or nearly so. Meanwhile, the nervous system keeps sending its message to the brain, making the person with the atonic bladder more and more uncomfortable, since the urge to empty the bladder will not go away.

Even if the bladder is unable to empty itself, some urine may leak out if the pressure becomes high enough, since the urinary sphincter, which is responsible for keeping the bladder closed, may not be able to withstand the pressure and will allow some urine to escape. This is not quite the same as incontinence, where a bladder may leak when it is nowhere near full, because the sphincter itself is weakened.

More Than One Cause

It isn't always a weak muscle that's the problem,  even though the definition of atonic might seem to dictate it should be. There are other things that can prevent the bladder from emptying. In other words, there can be a number of different causes, although the primary symptom remains the same -  discomfort.

One  cause would be where the nervous system has been damaged, and the brain may not be able to get the message through to the  bladder to empty itself, even though it received a signal that the bladder needs to be emptied. Another cause could be a gallbladder stone blocking the exit from the bladder, and not allowing it to empty, or at least to empty efficiently. In men, an enlargement of the prostrate can have a similar effect, physically blocking the bladder and keeping it from emptying.

If the blockage is more or less complete, or if there is no signal being sent from the brain telling muscles of the bladder to contract, the bladder will eventually become overfull, and may become distended. This can of course give rise to a number of problems which are well beyond the immediate problem of  discomfort.

Treatments And Remedies

One possible solution is to apply external pressure to the bladder. Pressing the lower abdomen with a hand or fist will often work, if the pressure can exceed the pressure causing the blockage. This approach may have to be done time and again, depending upon the cause of the problem, or it may not work at all, in which case the bladder will have to be drained by a medical procedure, and some other solution will needed. In any event, if the bladder can't be emptied, it's important to get medical help quickly, not just to relieve the pressure and the discomfort it is causing, but to prevent any damage from being done to the urinary system.

Sometimes a person can learn how to use the muscles in the lower abdomen to apply enough pressure to the bladder to enable it to empty itself. This would in most cases be a preferred method, as opposed to applying pressure by the hands or fists, and would seem to be a more natural one. There are several medical procedures, including several currently under study, which address this issue. There is always the possibility of surgery, although most doctors regard surgery as a last resort. Once such procedure, still under study, is to mimic the function of the nervous system by means of injections, which in effect tell the bladder when it is time to empty. It is not yet completely clear how this method would actually work, or indeed if it is at all practical. Electrical stimulation therapy is yet another approach which  shows some promise. In this case the detrusor muscle is electrically stimulated to contract, allowing the bladder to empty itself naturally. This method does not simply shock the muscle into performing its task. Instead, it the electrical stimulation exercises the muscle,  thereby strengthening it to the point where it can function correctly on its own.