The Human Bladder: Anatomy, Physiology, Disorders & Treatment Guide

1. Introduction

• The bladder is a hollow, muscular organ that stores and controls the release of urine.
• It plays a crucial role in the urinary system, ensuring waste elimination.
• Common bladder disorders include infections, incontinence, and bladder cancer.

2. Anatomy of the Bladder

• Location: Lower abdomen, behind the pubic bone.
• Structure:
  • Layers: Mucosa (inner lining), Detrusor muscle (muscular wall), Serosa (outer layer).
  • Sphincters: Internal (involuntary) and External (voluntary) sphincters control urine release.
• Connected Structures: Ureters (bring urine from kidneys), Urethra (carries urine out of the body).

3. Physiology of the Bladder

• Urine Storage: Expands to hold 400–600 mL of urine in adults.
• Urine Elimination: Controlled by the detrusor muscle and sphincters.
• Nervous System Regulation: Parasympathetic (urination) and sympathetic (storage) control.

4. Common Disorders & Pathophysiology

A. Urinary Tract Infections (UTIs)

• Cause: Bacterial infection (often E. coli).
• Risk Factors: Female gender, poor hygiene, catheter use, dehydration.

B. Overactive Bladder (OAB)

• Cause: Excessive detrusor muscle contractions.
• Symptoms: Urgency, frequent urination, nocturia.
• Risk Factors: Aging, obesity, nerve disorders.

C. Bladder Incontinence

• Types: Stress (leakage during coughing/sneezing), Urge (strong need to urinate), Overflow (incomplete emptying).
• Risk Factors: Pregnancy, menopause, prostate issues, nerve damage.

D. Bladder Cancer

• Types: Urothelial carcinoma (most common).
• Risk Factors: Smoking, chronic infections, occupational exposure to chemicals.

E. Bladder Stones

• Cause: Concentrated urine leading to mineral crystallisation.
• Risk Factors: Dehydration, urinary retention, infections.

5. Signs & Symptoms of Bladder Disorders

• Early Symptoms:
  • Increased urination frequency.
  • Burning sensation during urination.
• Advanced Symptoms:
  • Blood in urine (haematuria).
  • Urinary retention or incontinence.
• Red Flags:
  • Severe pelvic pain.
  • Difficulty urinating with a full bladder.

6. When to See a Doctor

• Frequent urination disrupting daily life.
• Blood in urine.
• Unexplained pelvic pain.

7. Emergency Signs Requiring Immediate Care

• Sudden inability to urinate (urinary retention).
• High fever with painful urination (UTI with sepsis risk).
• Large blood clots in urine.

8. Diagnostic Process

• Clinical Examination: Abdominal and pelvic assessment.
• Laboratory Tests: Urinalysis, urine culture (for infections).
• Imaging Tests:
  • Ultrasound: Detects stones, tumours.
  • Cystoscopy: Visual inspection of bladder lining.
  • CT Scan: Detailed imaging for complex cases.
• Specialist Procedures: Urodynamic testing (for incontinence).

9. Likely Diagnoses

• UTI
• Overactive Bladder
• Bladder Cancer
• Interstitial Cystitis (Chronic Bladder Pain Syndrome)

10. Treatment Options

A. Medications

• For UTIs:
  • Nitrofurantoin – 100 mg twice daily for 5 days.
  • Ciprofloxacin – 500 mg twice daily for complicated cases.
• For Overactive Bladder:
  • Oxybutynin, Solifenacin – Anticholinergic drugs to relax the bladder.
• For Bladder Pain/Inflammation:
  • Pentosan Polysulfate (Elmiron) – Helps bladder lining repair.
• For Bladder Cancer:
  • BCG Therapy (Intravesical Immunotherapy) – Used for early-stage cancer.
• Approximate Medication Costs (USD):
  • UTI Antibiotics: $10–$50 per course.
  • OAB Medications: $30–$150/month.
  • BCG Therapy: $1,000–$2,000 per session.

B. Surgical/Procedural Interventions

• Cystoscopy ($1,000–$3,000).
• TURBT (Tumour Removal for Bladder Cancer) ($5,000–$15,000).
• Bladder Augmentation (for severe incontinence) ($20,000–$40,000).
• Bladder Removal & Reconstruction (Cystectomy) ($50,000+).

C. Lifestyle Modifications & Home Remedies

• For UTIs: Drink plenty of water, cranberry supplements, avoid irritants.
• For Overactive Bladder: Bladder training, pelvic floor exercises.
• For Incontinence: Weight management, fluid control.

11. Precautions & Prevention

• Maintain hydration to flush bacteria.
• Avoid bladder irritants (caffeine, alcohol).
• Practice good hygiene, especially for women.
• Regular screening for bladder cancer in high-risk individuals.

12. Prognosis & Recovery

• UTIs: Fully treatable with antibiotics.
• Overactive Bladder: Manageable with medication and therapy.
• Bladder Cancer: Early-stage survival rates are high with treatment.
• Surgical recovery: 4–12 weeks, depending on procedure.

13. Cost of Treatment

• Urinalysis: $20–$100.
• Cystoscopy: $1,000–$3,000.
• Bladder Cancer Surgery: $10,000–$50,000+.
• Incontinence Therapy (Medications & Pelvic Therapy): $50–$500/month.

14. Frequently Asked Questions (FAQs)

1. How much urine can the bladder hold?
   • Typically 400–600 mL in adults.
2. What causes frequent urination?
   • Infections, overactive bladder, diabetes, excess fluid intake.
3. How can I prevent UTIs?
   • Stay hydrated, urinate after intercourse, practice hygiene.
4. Are bladder infections serious?
   • Mild ones are treatable, but untreated infections can spread to kidneys.
5. What foods irritate the bladder?
   • Caffeine, alcohol, spicy foods, acidic drinks.
6. Can bladder cancer be cured?
   • Early-stage bladder cancer is treatable; late-stage requires aggressive therapy.
7. Why do women get UTIs more often?
   • Shorter urethra allows easier bacterial entry.
8. Can an overactive bladder be reversed?
   • It can be managed with treatment, but not always cured.
9. How is bladder incontinence treated?
   • Medications, pelvic exercises, surgery if severe.
10. What happens if the bladder is removed?

• A urinary diversion is created (e.g., urostomy or neobladder).