Bladder Outlet Obstruction: Causes, Symptoms, Treatment and Complications

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Bladder outlet obstruction (BOO), or bladder neck obstruction, is a type of urinary blockage at the base of the bladder neck—a group of muscles connecting the bladder to the urethra.

This kind of lower urinary tract obstruction decreases or stops urine flow into the urethra, which is the tube that carries urine from the body.

Bladder neck obstruction can occur in both women and men at any age; however, this bladder blockage is more likely to affect men over age 50 with an enlarged prostate.

Without the proper treatment, the bladder can become permanently weakened, which may lead to kidney damage, urinary tract infections, bladder diverticula, and long-term lack of bladder control—also called an overactive bladder.

This article will explain everything you need to know about urinary bladder outlet obstruction. This will include the causes of bladder outlet obstruction, as well as its symptoms, complications, methods of diagnosis, and how to treat the urinary obstruction with important tips on how to keep your bladder healthy.

Causes of Bladder Outlet Obstruction

What are the causes of urinary bladder outlet obstruction?

An enlarged prostate, or benign prostatic hyperplasia (BPH), is one of the main causes associated with bladder neck obstruction.

The prostate is a male reproductive gland that surrounds the urethra. When the prostate becomes swollen, this restricts urine flow. The urinary obstruction can grow so severe that it leads to urinary retention. In other words, no urine is able to empty from the bladder.

Bladder neck obstruction can also result from radiation treatment for prostate cancer or as a side effect of prostate removal surgery. Urethral stricture (scar tissue) from each procedure can lead to bladder neck blockage.

Although rare in women, bladder neck obstruction can develop when the bladder (cystocele) and urethra (urethral diverticula) descend into the vagina, often due to a weakened vaginal wall. This sometimes results from multiple births, a difficult delivery, menopause, or advanced age.

In some cases, a genetic flaw in bladder structure or its surrounding connective tissues and muscles may even cause this urinary obstruction. Other potential causes of bladder outlet obstruction include bladder stones, bladder tumors (cancer), and pelvic tumors (cervix, prostate, uterus, rectum).

Symptoms of Bladder Outlet Obstruction

Women and men with bladder outlet obstruction have similar symptoms. Lower urinary tract symptoms involve the urinary sphincter, urethra, bladder, and prostate in men. The preferred term for lower urinary tract symptoms in men is prostatism.

Some of these symptoms include:

• Incomplete bladder emptying
• Trouble starting urine stream
• Irregular urine output
• Increased urinary urgency
• Excessive nighttime urination
• Continuous feeling of a full bladder
• Inability to control the urge to urinate
• Pain during urination
• Abdominal pain
• Pelvic pain, especially in men.

The person may even experience urinary tract infections or slow urination.

Complications of Bladder Outlet Obstruction

What are the possible complications related to bladder outlet obstruction?

In addition to lower urinary tract symptoms, those with bladder outlet obstruction may experience other complications, including:

• Bladder stones
• Bladder wall damage
• Kidney dysfunction
• Urinary tract infections
• Blood in the urine
• Involuntary loss of bladder control (urinary incontinence)
• Acute and chronic urinary retention
• Erectile dysfunction in men

Acute and chronic kidney failures are also common complications of urinary obstruction.

Diagnosis of Bladder Outlet Obstruction

How is bladder outlet obstruction diagnosed? Your doctor will first get a full picture of your symptoms since signs of bladder outlet obstruction are often similar to several other conditions, such as neurogenic bladder, urinary tract infections, abdominal growth, enlarged bladder, or an enlarged prostate in men.

To help make the correct diagnosis, your doctor likely will use video urodynamics—a series of tests that help evaluate bladder function. During this process, an ultrasound or X-rays help detail real-time images of the bladder.

A catheter is then inserted into the bladder to empty urine and later fill the bladder with fluid. When the bladder is full, you are asked to cough and urinate. Images then allow the doctor to observe bladder outlet obstruction during the bladder filling and emptying.

A cystoscopy is another diagnostic method that uses a cystoscope device to look inside the bladder and determine whether the urethra has narrowed.

Other diagnostic tests that help determine bladder outlet obstruction include uroflowmetry that determines how fast urine flows from the body, urinalysis to check for blood or infections in the urine, urine cultures that check for infections, and blood chemistries that look for kidney damage signs.

Treatments for Bladder Outlet Obstruction

The treatment for bladder neck obstruction will depend on its cause.

Most of the time, surgery is needed for long-term bladder neck obstruction, and it involves making an incision in the bladder neck. A resectoscope is then inserted through the urethra to view the bladder neck, and an instrument attached to the device will then make a small incision into the bladder neck wall.

Although surgery doesn’t treat the cause of bladder outlet obstruction, it does relieve pressure from the bladder blockage to help with the symptoms.

If the incision doesn’t improve symptoms or the bladder neck obstruction is severe, open surgery may be needed to reconnect the bladder neck to the urethra.

That being said, many of the conditions that cause bladder neck obstruction can be treated with medications or natural remedies before surgery is necessary.

The first step in treating bladder neck obstruction is the use of alpha-blockers like phenoxybenzamine or prazosin, which help the bladder muscles relax.

Other times, self-catheterization will be needed alongside alpha-blockers. Self-catheterization is a painless procedure that helps empty urine from the bladder.

From a natural perspective, herbal supplements that help treat bladder neck obstruction due to BPH include saw palmetto and stinging nettle root.

Research also shows that urinary flow rate gradually improves significantly with pumpkin seed oil in enlarged prostate patients after six months of treatment.

Important Tips to Help Keep Your Bladder Healthy

To help prevent bladder outlet obstruction, there are a number of things you can do to help keep your bladder healthy.

Below are some natural tips to prevent this and other related bladder problems.

Double-void urination: To help with urinary symptoms, double-void at night. This means you urinate twice before bed. Go to the bathroom, brush your teeth and finish your bedtime routine, and urinate once more before going to bed.

Schedule bathroom trips: To help retrain the bladder, keep a daily diary of trips to the bathroom and urinary urges. When you figure out how many times you go to the bathroom daily, you can schedule your trips to help improve bladder control.

Watch water intake: Although it is important to drink enough water, too many liquids before bed will increase the need to urinate at night. Try not to drink liquids after 5:00 p.m. or 6:00 p.m. if you suffer from bladder problems.
Avoid dietary triggers: Foods that contribute to bladder problems include caffeinated beverages, alcohol, artificial sweeteners, milk and dairy products, spicy foods, soda and other carbonated beverages, citrus juices and fruits, and sugar and high-sugar foods.

Quit smoking: Smoking irritates the bladder and increases bladder cancer risk.

Try Kegel exercises: Kegel exercises involve tightening the pelvic muscles as when you hold in your urine. They can be done anywhere, and when performed regularly, they can help an overactive bladder. If you feel an urge to urinate, doing a kegel will help settle the bladder until you get to the bathroom.

Final Thoughts on Bladder Outlet Obstruction

Bladder neck obstruction may be a problem for many years with few symptoms before a diagnosis and treatment are pursued. But, when bladder neck obstruction is treated, the symptoms typically disappear.

The treatment of bladder outlet obstruction will often depend on the cause, and sometimes, surgery may be required to help improve symptoms. Medication or natural remedies can help treat the cause of bladder neck obstruction.

Other ways to improve bladder health include double-void urination, scheduling bladder trips, watching water intake, avoiding dietary triggers, quitting smoking, and trying kegel exercises to help relax the bladder.

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