The bladder is a hollow organ like a balloon, whose inner surface is covered with a smooth mucosa (the special tissue that lines its inner surface) and consists of a thin layer of muscle. It is located in the lower abdomen, just behind the pubic bone.
The function of the bladder is to store urine. Kidneys normally produce approximately 1.5-2 liters of urine per day to remove substances and water from the blood. The resulting urine is carried from the kidneys to the bladder through two narrow tubes called ureters. The bladder stretches as it fills and normally stores about 400cc of urine. When half of this volume is approached, the desire to empty the bladder by urinating begins to be felt. It has the ability to store urine by stretching far beyond its capacity, but this causes pain.
Urination is controlled by the muscle called sphincter, which is located circularly at the base of the bladder, which is a structure that normally stops the flow of urine and prevents urine leakage. The sphincter is usually closed, like a ligament at the end of a balloon, thus preventing urinary incontinence. When we relax the sphincter, the bladder outlet opens and at the same time, the muscle in the bladder wall contracts and pushes the urine out. When all the urine is emptied, the sphincter closes again and the muscle contraction in the bladder wall ends and relaxes. The urine in the bladder is thrown out of the body through a small tube called the urethra. (The urethra courses inside the penis in men and opens from the tip of the penis, in women it is shorter and opens just above the vagina.)
What problems can we encounter in the bladder?
1 -Urinary Infections
The inside of a healthy bladder is sterile and does not contain bacteria. However, there are bacteria on the skin, intestines, anus and vaginal areas. These bacteria can sometimes pass into the urinary system from here, move up the urethra and reach the bladder. Normally, the bladder can protect itself from these bacteria and eliminate them by washing them with urine.
However, if these bacteria remain in the bladder and multiply there, they cause infection. The infection causes redness, swelling and pain, called inflammation, in the bladder tissue. Bladder inflammation caused by this type of infection is called CYSTITIS and is seen much more frequently in women than in men. In this type of infections, the bladder feels full before it is full, and there is a frequent urge to urinate along with frequent urination. Small amounts of urination, sometimes not being able to reach the toilet, and leaking are common. There is usually no fever or chills, but there may be fatigue. Fever and chills indicate that the infection has reached the kidneys and is a condition that requires urgent medical attention (ACUTE PYELONEPHRITIS). In such kidney infections, there is severe side-back pain under the lower ribs, high fever and chills, as well as a severe illness and weakness. This type of kidney infection can destroy the kidney and the infection can spread to the blood and become life-threatening.
Only a doctor can decide whether you have a urinary tract infection and, if so, which type it is.
The doctor makes this determination based on the symptoms and complaints. It is determined by examination and urine analysis. Urinary infections are easily treated with medications called antibiotics, which kill bacteria or stop them from multiplying. Those who think they have a urinary infection should immediately see a doctor (preferably a urologist).
Urinary tract infections in men and children may be a sign of an abnormal urinary system or other health problems. Therefore, if such a urinary infection occurs in a child or man, especially if it is recurrent, these people should definitely see a urologist for additional tests and radiological examinations. Although blood is seen in the urine in urinary system infections, if blood is seen in the urine, a urologist should be consulted, because blood in the urine may be due to different urinary system problems (such as urinary system stones and tumors).
2-Interstitial Cystitis (I.S)
It is a painful condition in the bladder area and occurs with cystitis-like findings. However, no bacteria play a role here. In reality, the cause of I.S is unknown. WORK. It is 10 times more common in women than in men. Many people with interstitial cystitis are told that they do not have a physical problem and that the problem is in their head (psychological).
Major Findings Urologists Can Identify in I.S
§ Pain and feeling of pressure in the bladder and urethra, or in the pelvic area, It increases especially when the bladder is full and relieves when it is emptied.
§ Sudden pinching; If the person does not go to the toilet immediately, he feels like he will explode, but when he goes to the toilet, it is seen that there is very little urine in the bladder. �r.
§ Frequent urination: They always want to know the nearest toilet. Some people do not want to travel and the patient even hesitates to go shopping at local markets because they feel the need to urinate very frequently. At the worst moments of their symptoms, they have to urinate every 30 minutes or more frequently, day and night.
I.S. At the beginning of the bladder, the mucosa and its wall covering the bladder become irritated due to inflammation, and serious inflammation causes pain. As inflammation progresses, scar tissue replaces the normal structure of the bladder wall and the bladder gradually shrinks.
How is I.S. Diagnosed?
The person who will make this diagnosis is a urologist. If the person with such complaints does not have any infection or other abnormal conditions, the urologist will want to see the inside of the bladder with a special telescope called a cystoscope. It is ideal for this procedure to be performed under general anesthesia.
In this procedure, the bladder must be filled and stretched sufficiently to see the small bleeding foci in the mucosa lining the bladder. When not performed under anesthesia, these bleeding areas may not be seen, because without anesthesia, the patient may not be able to withstand the stress that will cause these bleedings.
I.S. Can It Be Treated?
Yes I.S. It can be treated but not cured. There is a possibility of treatment with some medications taken orally or given into the bladder.
3-Overactive (Hyperactive) Bladder
Overactive (hyperactive) bladder is a bladder with involuntary contractions, causing urinary incontinence and urgent need to go to the toilet. situations arise. (Urinary incontinence is only common in babies: it is not a normal consequence of aging. If you have a problem with urinary incontinence, you may be embarrassed to ask for help. Don't be ashamed, because many have a solution.)
What are the causes of urinary incontinence?
Urinary incontinence is either due to a hyperactive bladder or weak sphincter muscle (weakness of the muscle mechanism that allows urine retention).
1-Urge Type (Suddenly Compressed) Urinary Incontinence
Hyperactive bladder is against your will. It occurs when it contracts. Suddenly, a strong urge to urinate occurs and the person may not be able to reach the toilet. Sometimes urine leakage occurs without any warning. Bladder infections and nerves that control the bladder In diseases (neurogenic bladder), a hyperactive bladder may occur and the bladder may become very easily stimulated.
2-Stress Incontinence (Stress Type Incontinence)
It may be due to weak sphincter (weakness of the muscle that holds urine) or abnormal urethra. In this case, urine leakage occurs when intra-abdominal pressure increases, such as coughing, sneezing and sometimes walking. It is more common in women over middle age, especially in those with more births.
3-Overflow Incontinence
Incontinence occurs in the form of overflow of urine exceeding the capacity in overfilled bladders with a decreased sensation of not being able to empty normally. It occurs when the bladder is weak or prevents normal emptying of the bladder. An enlarged prostate can cause such an obstruction, and in the later stages of this, the bladder wall weakens and this type of incontinence occurs. Therefore, it is more common in men.
Bladder weakness is a condition that occurs in diabetics, chronic alcoholics, or neurological diseases that impair the function of the nerves that control the bladder, and can be seen in both men and women.
Can patients with urinary incontinence be helped?
/> Yes, these patients should be referred to a urologist. Treatment options include medications, special exercises, bladder training and, as a last resort, surgery.
Bladder Cancer
The word cancer is a word that scares everyone. However, bladder cancer should not be this scary because early diagnosis and treatment usually results in a full recovery. It is generally common between the ages of 50-70 and is 3 times more common in men than women.
What causes Bladder Cancer?
Although the actual cause of many bladder cancers is unknown; Smokers and those exposed to some rare chemicals are at higher risk. Bladder cancer begins as a small tumor growth in the mucosa covering the bladder wall. In this stage, the tumor is superficial and 75-85% of bladder tumors are such superficial tumors at the time of initial diagnosis. Treatment is usually easier at this stage. However, if the cancer is allowed to pass through the mucosa and enter the bladder muscle or extend beyond the wall (bladder wall involvement), treatment becomes more difficult, but treatment and full recovery may be possible at this stage.
What are the symptoms of bladder cancer?
Blood in the urine is the most common symptom. If you see blood in your urine, you should definitely see a urologist, even if this blood disappears completely in a few days. In this case, diagnosis is made through urine analysis, radiological examinations that reveal the urinary system, and cystoscopy (endoscopic examination of the inside of the bladder and, if necessary, removal of pieces).
Is Complete Treatment Possible for Bladder Cancer?
Yes. The first procedure is to remove the tumor using a special tool through the urethra (the tubular structure that connects the bladder to the outside) under anesthesia (Endoscopically = closed surgery). After the tumor is removed, the pathologist makes a definitive diagnosis by examining it with a microscope after special staining, and this examination determines the degree and stage of the tumor (superficial or superficial). It provides valuable information about whether there is muscle involvement or not. In the light of this information given by the pathologist, it is decided whether additional treatment is needed. If it is a superficial tumor, it is followed up without additional treatment and cystoscopic examinations are performed at regular intervals to check whether the tumor has reoccurred. The chance of recurrence is quite high in superficial tumors, especially within the first two years (most of them are in the first year). In some high-grade superficial tumors, treatment by administering medication through a catheter into the bladder can reduce the chance of recurrence by 50-70%. In tumors with muscle involvement, a more aggressive treatment such as complete removal of the bladder is primarily recommended. Alternatively, radiotherapy is less recommended.
What Steps Should You Take to Help Your Bladder Stay Healthy?
To keep your bladder healthy and reduce the risk of bladder cancer :
§ Annual checkup, including urinalysis
§ You should consult a urologist at the first sign of a problem, especially in the case of blood in the urine, but also only in cases of pain when urinating or frequent and sudden urge to urinate.
§ Do not smoke, smokers have at least twice the risk of bladder cancer than non-smokers.
§ When a significant need to urinate occurs, do not wait a long time before emptying your bladder.
§ Do not rush, to ensure that your bladder is completely emptied while urinating. necessary
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