BPH

Bladder Outlet Obstruction: Causes In Men?

The bladder is a critical part of the urinary system. This system allows toxins to be expelled from the body.

A failure in the urinary and renal system can lead to unpleasant complications.

In some cases, these events may even become life-threatening. This can happen when the bladder or urinary problems lead to an obstruction or a severe infection. 

Bladder outlet obstruction is one of these conditions. It can sometimes completely block the flow of urine. This can lead to urine backing up into a man’s system. Serious complications can happen in these scenarios.

There are several reasons why men may experience bladder outlet obstruction.

We look at what this condition is, and the symptoms men should look out for. The post will also look at possible causes behind the condition. We consider the best treatment options that are currently available too.  

What is Bladder Neck Obstruction?

The bladder is responsible for storing urine. Urine is pushed to the bladder from the kidneys. Here, toxins and fluids are removed from the body.

The bladder will store urine until a man goes to the bathroom to urinate. This ensures the toxins collected by the kidneys can be removed from the body. It also ensures that excess fluids are expelled. 

There are some cases where an obstruction occurs with the bladder. In the case of bladder outlet obstruction, there is a problem with the bladder’s neck. The neck of the bladder contains a muscle that responds to signals from the brain.

The muscles relax when a man has to urinate. This allows urine to flow from the bladder through the urethra. Once urination stops, a contraction of these muscles helps to keep urine inside the bladder. It also ensures the man does not experience dribbling. This can be quite an unpleasant and even embarrassing situation. 

There are a few conditions that have been associated with bladder neck obstruction. The issue is also considered relatively common among the male population. 

Some cases of bladder neck obstruction require urgent medical attention. This is not always the case, however. A doctor first needs to consider the severity of the condition. If it is an emergency, then the bladder may be drained immediately. Sometimes, treatment may be less invasive. This is generally the case when there is not a complete obstruction. 

Several tests can be used in the diagnosis of bladder neck construction. A doctor will need to perform these tests to determine why the male patient experienced the complication. This also helps the doctor assess the urgency of the situation. 

An appropriate treatment plan is provided once a diagnosis is made. The treatment will address the underlying cause of bladder obstruction. Medication is often used to help with the condition. In some cases, a doctor may refer the patient to a surgeon. This is the case when a surgical procedure is needed to rectify the issue. 

What are the symptoms of Bladder Neck Obstruction?

Earlier treatment of bladder neck obstruction is important. This may help to reduce the risk of complications. For early treatment to be provided, men need to understand the symptoms that may indicate the development of the condition. 

Various symptoms may be a sign of bladder obstruction. When men notice these symptoms, it is generally best to see a doctor. In some patients, the symptoms will develop gradually. At first, they will be barely noticeable.

The symptoms then start to get worse over time. There is sometimes also a more rapid onset of the symptoms. These are usually cases that require urgent medical care. 

Symptoms that men are advised to take notice of include1:

  • Pain may be experienced while the man urinates. 

  • Some men find it difficult to start urination. 

  • There may be a pain in the abdomen when the urine starts to push back upward. 

  • If the man can urinate, the urine stream may be weak and slow. 

  • The man may feel like their bladder is full all the time.

  • Incomplete bladder emptying is also common. 

  • Frequent nighttime urination is also considered a common symptom. 

  • Void can happen with small amounts of urine. 

Even in a non-serious way, it is generally better for the man to consult a doctor when these symptoms are present. 

The presence of these symptoms does not guarantee a patient has bladder outlet obstruction. Many of these symptoms may also be signs of other conditions. These conditions are generally easier to treat when they are identified at an early stage. Thus, the sooner a man sees a doctor, the easier the treatment will usually be. 

What causes it?

Understanding the potential causes behind bladder outlet obstruction is just as important. This can help men determine why they develop the condition. Men can often also realize their own risk when looking at possible causes. Men with a higher risk need to be warier about symptoms. 

There are a few reasons why men may develop bladder outlet obstruction. These can sometimes be easy to treat. When treated, the condition itself may improve. At the same time, there are also a few causes that may be more difficult to treat. Men can better understand what to expect when they know why they experience the condition. 

Some of the causes that have been linked to a risk of bladder outlet obstruction include:

Benign Prostatic Hyperplasia

This condition is also sometimes referred to as an enlarged prostate. It is considered the most common reason for men to develop urinary problems. Lower urinary tract symptoms are common in men with prostate enlargement.

The prostate pushes against the bladder and urethra. When the enlargement becomes more severe, it can lead to an obstruction. 

The risk of benign prostatic hyperplasia increases with age. About 90% of men aged 90 and above have signs of this condition. Younger men can be affected too. In one study, it was found that about 8% of men have benign prostatic hyperplasia before they reach the age of 402. 

Benign prostatic hyperplasia is not a cancerous condition. It is also generally not considered a fatal disease. At the same time, patients do need to note that the condition can cause adverse effects. Some complications can happen when the man does not receive adequate treatment. 

A bladder neck contracture and urethral stricture are both possible with benign prostatic hyperplasia. Men may also experience bladder neck stricture. Among men with BPH, urinary incontinence also seems to be a common issue. 

Prostate Cancer

There is another prostate condition that can lead to bladder outlet obstruction. This would be prostate cancer. It is one of the most common kinds of cancers diagnosed in men. Prostate cancer is, in most cases, localized. This means cancer only affects the prostate gland. It may be slow-growing and not cause any serious concerns. This is not the case with all patients, however. 

Prostate cancer that becomes metastatic can spread to other parts of the man’s body. When not caught early on, treatment becomes extremely difficult. The chances of survival may be reduced too. 

Prostate cancer can cause swelling in the area where the gland is located. Cancer can also spread to tissue in close perimeter to the prostate. This includes the urethra, the ureteral orifices, and the area surrounding the detrusor muscle. 

In these cases, some patients may experience damage to parts of their urinary system. The result may be an obstruction in the bladder’s neck.

Urethra Scarring

There are a few cases where scarring in the urethra may also lead to an obstruction in the urinary system. Scarring that affects the bladder’s neck may lead to similar effects. 

Scarring can happen for only a few reasons in these regions. In the majority of cases, scarring may be a result of surgery. A surgical procedure done on the bladder or urethra may lead to scarring. When this happens, excess tissue growth may occur in the areas that suffered from the scarring. 

The excess tissue can make the urethra narrower than it should be. This eventually causes the urine stream to become weaker. In serious cases, the narrowing may even cause complete obstruction. 

Catheterization is one factor that can also damage the urethra. The use of a foreign object in the urethra sometimes leads to scarring. This particular risk is more common in men who require long-term catheterization. The continued scarring caused by changes in the tube may lead to excessive tissue growth in the urethra.

Medication

Another possible reason for bladder neck obstruction is the use of certain medications. There are a couple of drugs that have been shown to increase the risk of this condition. 

Antihistamines are commonly associated with a risk of bladder obstruction. Men should also be careful when using decongestants. When using these drugs, it is a good idea to discuss them with a doctor first. The doctor will be able to provide the man with further details on the safety of these drugs. The doctor can also help the man determine if the specific drug may increase the risk. 

Drugs that are used to treat an overactive bladder may be another contributing factor. These drugs sometimes lead to problems with the muscle at the bladder neck. In turn, it may lead to obstruction as a side-effect. 

How is it diagnosed?

Prompt diagnosis of bladder outlet obstruction is critical. This becomes even more serious in cases of acute bladder outlet obstruction. A doctor will need to consider several factors. The doctor should consider what type of condition the patient has. This may include primary bladder neck obstruction, for example. 

Some symptoms associated with bladder neck obstruction may rather be linked to another condition. For this reason, the doctor needs to consider all possibilities. Treatment for stress urinary incontinence differs from a case where BPH causes bladder obstruction. 

There are several tests that a doctor may request if they suspect a patient has bladder outlet obstruction. 

The doctor will start by asking the patient a few questions. The healthcare provider asks the patient about the symptoms they experience. This will allow the doctor to get a better idea of what may be the issue. It can also help the doctor confirm if the cause behind their symptoms may be bladder outlet obstruction. 

A physical examination is needed during the initial diagnosis process. The doctor will feel the abdomen area of the patient. This will help them identify an abnormal growth in the abdomen. The doctor will also be able to feel if the bladder is larger than it should be. These may be signs that urine is pushing back into the urinary system

Once this process is done, the doctor will ask the patient to undergo additional tests. These tests will assist in confirming what the issue is. 

Some tests that may be performed:

  • The doctor may request blood tests to be conducted. This can help the doctor determine if the patient had suffered kidney damage

  • A urine culture test may be done too. This helps the doctor determine if the patient may have an infection. An infection can happen as a complication of obstruction. It can also be the reason behind a reduced urine flow. 

  • A urine sample may sometimes be tested for blood. The doctor will look at whether blood is present in the patient’s urine. This may also signal certain problems. 

  • An x-ray test is often requested. The x-ray will focus on the urethra specifically. It helps the doctor see how much narrowing the urethra had suffered. It can also help the doctor identify scarring and other issues with the urethra. 

  • Ultrasound is another useful test. This test provides a visual overview of the bladder and kidneys. The ultrasound test provides the doctor with details on where the obstruction originates from. 

Complications

There are a few complications that can occur if bladder outlet obstruction is not treated. Patients should realize what complications can happen. When the condition is diagnosed and treated early, the risk of these complications can be reduced. 

Consistent nighttime urination is a common problem. Nocturia can interfere with the patient’s ability to sleep at night. This can lead to sleep deficiency. Sleep is an important part of maintaining a healthy body; the deficiency in sleep can become problematic. 

Bladder obstruction can also cause toxins in urine to be pushed into the patient’s system. The condition can also lead to an excessive accumulation of fluids. In turn, the patient may experience the development of edema

Apart from these, there is a risk of infection that should be noted too. When urine is unable to exit from the bladder, the patient may develop a bacterial infection. The infection may affect the lower urinary tract. A bladder infection can happen too. 

How is it treated?

Treatment for bladder outlet obstruction largely depends on why the patient developed the condition. There may be an initial treatment provided to the patient immediately. This is the case when the patient has an emergency situation on their hands. 

In such a case, the bladder may be drained. An incision may be made to push a catheter into the patient’s bladder. If there is a stricture at the bladder’s neck, then bladder neck incision is rarely considered too. This allows urine to flow out of the bladder. It provides immediate relief of certain symptoms. 

Draining the bladder is only an initial step to treat the condition. Following this process, the doctor needs to understand why the event happened. 

The doctor will be able to provide details on an appropriate treatment plan following a series of tests. 

Problems like bladder exstrophy may need correction through surgery. When the prostate is giving problems, there are a few treatments that can help address these prostate gland conditions. The doctor may advise on a procedure like laparoscopic radical prostatectomy or radical retropubic prostatectomy. 

If medication is the cause behind the bladder outlet obstruction, the doctor may change the patient’s prescription. This helps to reduce the use of medicines that may contribute to an obstruction in the urinary system. 

How to prevent it

Prevention is the best way to help a man avoid having to experience an emergency situation with bladder outlet obstruction. There are a few potential preventative measures that men can take. At the same time, some causes are also unpreventable. 

Understanding the risks is important. Men also need to ensure they learn about the symptoms that may indicate an obstruction at their bladder neck. When the man notices these symptoms, seeking a consultation with a doctor is a good idea. This can help to prevent serious complications. 

Men should also take care of their prostate health. An enlarged prostate can cause bladder outlet obstruction. There are treatments available for benign prostatic hyperplasia.

Getting the condition diagnosed is the first step. Obtaining appropriate treatment can then help to minimize the growth of the prostate gland. This, in turn, may help to lower the risk of a bladder outlet obstruction.  

Conclusion

Bladder outlet obstruction can be uncomfortable and lead to severe problems in a man’s body. It is often caused by prostate problems. Certain types of drugs can also cause urinary issues. These may lead to an obstruction of the bladder’s outlet.

Men should realize what symptoms signal the issue. They should also understand what may increase their risk of bladder outlet obstruction. This ensures the man can take action before serious complications develop. 

Sources

  1. Cleveland Clinic. Bladder Outlet Obstruction. [online] Available at: https://my.clevelandclinic.org/health/diseases/15181-bladder-outlet-obstruction-
  2. 2 AJMC. (2006) BPH: Epidemiology and Comorbidities. [online] Available at: https://www.ajmc.com/journals/supplement/2006/2006-04-vol12-n5suppl/apr06-2288ps122-s128#:~:text=Prevalence%20and%20Impact.,chronic%20disease%20that%20spans%20decades.
  3. 3 Mayo Clinic. Bladder outlet obstruction: Causes in men? [online] Available at: https://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/expert-answers/bladder-outlet-obstruction/faq-20058537

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