The bladder is a hollow organ in your lower abdomen that stores urine. Many conditions can affect your bladder. Some common ones are

• Cystitis - inflammation of the bladder, often from an infection
• Urinary incontinence - loss of bladder control
• Overactive bladder - a condition in which the bladder squeezes urine out at the wrong time
• Interstitial cystitis - a chronic problem that causes bladder pain and frequent, urgent urination
• Bladder cancer

Doctors diagnose bladder diseases using different tests. These include urine tests, x-rays, and an examination of the bladder wall with a scope called a cystoscope. Treatment depends on the cause of the problem. It may include medicines and, in severe cases, surgery.

Key points

• To lower the risk of bladder cancer, don’t smoke and be especially careful around certain kinds of chemicals.
• Blood in the urine is the most common symptom.

Overview

Cancer is a disease in which cells in the body grow out of control. When cancer starts in the bladder, it is called bladder cancer.

The bladder (sometimes called the urinary bladder) is a balloon-shaped organ in your lower abdomen, near the pelvis. It stores urine from the kidneys until it is passed out of the body.

Symptoms

• Blood in the urine. This is the most common symptom.
• Having to urinate often.
• Pain while urinating.
• Back pain.
• Pelvic pain.

These symptoms can also come from other conditions. If you have any of these symptoms, talk to your doctor, which is the only way to find out what may be causing them.

Risk factors

Smoking is the most important risk factor for bladder cancer. Other risk factors include:

• Having a family history of bladder cancer.
• Having certain gene mutations (unusual changes made when your body's cells are dividing).
• Being exposed to too much of certain workplace chemicals used in processing paint, dye, metal, and petroleum products.
• Taking some kinds of chemotherapy drugs.
• Drinking well water contaminated with arsenic.
• Taking the Chinese herb Aristolochia fangchi.
• Having chronic urinary tract infections (including those caused by Schistosoma haematobium).

Reducing risk

To lower the risk of bladder cancer, don’t smoke (and if you do, quit) and be especially careful around certain kinds of chemicals.

Cystitis is most often caused by a bacterial infection of the bladder, but it can also occur as a reaction to certain treatments or irritants such as radiation treatment, hygiene sprays, or spermicides. Common symptoms of cystitis include dysuria (urination accompanied by burning, discomfort, or pain), pyuria (pus in the urine), hematuria (blood in the urine), and bladder pain.

In women, bladder infections are more common because the urethra is short and located in close proximity to the anus, which can result in infections of the urinary tract by fecal bacteria. Bladder infections are also more common in the elderly because the bladder may not empty fully, causing urine to pool; the elderly may also have weaker immune systems that make them more vulnerable to infection. Conditions such as prostatitis in men or kidney stones in both men and women can impact proper drainage of urine and increase risk of bladder infections. Catheterization can also increase the risk of bladder infection.

Gram-negative bacteria such as Escherichia coli (most commonly), Proteus vulgaris, Pseudomonas aeruginosa, and Klebsiella pneumoniae cause most bladder infections. Gram-positive pathogens associated with cystitis include the coagulase-negative Staphylococcus saprophyticus, Enterococcus faecalis, and Streptococcus agalactiae. Routine manual urinalysis using a urine dipstick or test strip can be used for rapid screening of infection. These test strips are either held in a urine stream or dipped in a sample of urine to test for the presence of nitrites, leukocyte esterase, protein, or blood that can indicate an active bacterial infection. The presence of nitrite may indicate the presence of E. coli or K. pneumonia; these bacteria produce nitrate reductase, which converts nitrate to nitrite. The leukocyte esterase (LE) test detects the presence of neutrophils as an indication of active infection.

Low specificity, sensitivity, or both, associated with these rapid screening tests require that care be taken in interpretation of results and in their use in diagnosis of urinary tract infections. Therefore, positive LE or nitrite results are followed by a urine culture to confirm a bladder infection. Urine culture is generally accomplished using blood agar and MacConkey agar, and it is important to culture a clean catch of urine to minimize contamination with normal microbiota of the penis and vagina. A clean catch of urine is accomplished by first washing the labia and urethral opening of female patients or the penis of male patients. The patient then releases a small amount of urine into the toilet bowl before stopping the flow of urine. Finally, the patient resumes urination, this time filling the container used to collect the specimen.

Bacterial cystitis is commonly treated with fluoroquinolones , nitrofurantoin , cephalosporins , or a combination of trimethoprim and sulfamethoxazole . Pain medications may provide relief for patients with dysuria. Treatment is more difficult in elderly patients, who experience a higher rate of complications such as sepsis and kidney infections.

Eosinophilic cystitis (EC) is a rare inflammatory bladder condition caused by the build up of eosinophils in the bladder. The exact cause of this condition is not known. However, EC has been found in those with allergies and asthma, and in those with a history of bladder trauma or infection, open bladder surgery, or surgery for a bladder tumor. EC has also been found in those who take certain medications.

Interstitial cystitis (IC) is a chronic condition that causes painful urinary symptoms. Symptoms and severity can vary. Some people may have only mild discomfort, or feel tenderness or pressure in the bladder or pelvis. Others may experience intense bladder pain, urgent or frequent needs to urinate, or pain during sexual intercourse. Symptoms may be constant, or they may come and go. Some people with IC have Hunner's ulcers (areas of inflammation on the bladder wall, identified by cytoscopy).

The exact cause of IC is not known. While the symptoms are similar to those of a bladder infection, IC is not an infection. It occurs more commonly in women, and in people with other chronic pain disorders such as irritable bowel syndrome or fibromyalgia.

There is no cure for IC, but there are treatment options to help relieve the symptoms. No single treatment works for all people with IC. Often, people try different treatments or combinations of treatments before finding something that works. Treatment options may include lifestyle changes, oral or topical medications, bladder instillations, neuromodulation therapy, Botox injections in the bladder muscles, and surgery (in rare cases). Without treatment, IC can affect a person's sleep, daily activities, and social life.

Nerves that work poorly can lead to three different kinds of bladder control problems.

Overactive bladder. Damaged nerves may send signals to the bladder at the wrong time, causing its muscles to squeeze without warning. The symptoms of overactive bladder include

• urinary frequency—defined as urination eight or more times a day or two or more times at night
• urinary urgency—the sudden, strong need to urinate immediately
• urge incontinence—leakage of urine that follows a sudden, strong urge to urinate

Poor control of sphincter muscles. Sphincter muscles surround the urethra and keep it closed to hold urine in the bladder. If the nerves to the sphincter muscles are damaged, the muscles may become loose and allow leakage or stay tight when you are trying to release urine.

Urine retention. For some people, nerve damage means their bladder muscles do not get the message that it is time to release urine or are too weak to completely empty the bladder. If the bladder becomes too full, urine may back up and the increasing pressure may damage the kidneys. Or urine that stays too long may lead to an infection in the kidneys or bladder. Urine retention may also lead to overflow incontinence.

Overactive bladder is a condition in which the bladder squeezes urine out at the wrong time. You may have overactive bladder if you have two or more of these symptoms:

• You urinate eight or more times a day or two or more times at night
• You have the sudden, strong need to urinate immediately
• You leak urine after a sudden, strong urge to urinate

You also may have incontinence, a loss of bladder control. Nerve problems, too much fluid, or too much caffeine can cause it. Often the cause is unknown.

Your doctor may prescribe a medicine that can calm muscles and nerves. The medicine may come as a pill, a liquid, or a patch. The medicines can cause your eyes to become dry. They can also cause dry mouth and constipation. To deal with these effects, use eye drops to keep your eyes moist, chew sugarless gum or suck on sugarless hard candy if dry mouth bothers you, and take small sips of water throughout the day.

UI is the loss of bladder control, or being unable to control urination.

UI can affect men, women, and children, but women are twice as likely as men to experience UI. This is due to the structure of the female urinary tract as well as the effects of pregnancy, childbirth, and menopause. UI is also more common among older women, although it is not a normal part of the aging process.

Adults may experience one of several types of UI

• Stress incontinence is usually related to a structural issue, such as when the bladder is out of its normal position. Urine leaks can occur during physical movement such as laughing, coughing, exercising, or lifting, or when no movement is occurring.
• Urge incontinence or overactive bladder is usually related to the muscles around the bladder. It occurs when urine leaks at unexpected times, including during sleep. Urge incontinence is most common in older people and may or may not be a sign of a UTI. It is also associated with certain neurological conditions, such as multiple sclerosis.
• Overflow incontinence happens when an overfilled bladder causes uncontrollable leaking of urine. A person with overflow incontinence may feel unable to completely empty the bladder. Causes include tumors, kidney stones, diabetes, and medications. Overflow incontinence is most common in men.
• Functional incontinence is the inability to get to the bathroom in time because of a physical or other type of disability.
• Mixed incontinence occurs when a person experiences more than one type of incontinence. Generally, mixed incontinence refers to a combination of stress and urge incontinence.
• Transient incontinence occurs when urine leakage is caused by a temporary situation such as an infection or new medication. Once the cause is removed, the incontinence goes away.

Stress urinary incontinence (SUI) is a leakage of urine during moments of physical activity that increases abdominal pressure, such as coughing, sneezing, laughing, or exercise. SUI is the most common type of urinary incontinence in women.

SUI can happen when pelvic tissues and muscles, which support the bladder and urethra, become weak and allow the bladder "neck" (where the bladder and urethra intersect) to descend during bursts of physical activity. This descent can prevent the urethra from working properly to control the flow of urine. SUI can also occur when the sphincter muscle that controls the urethra weakens. The weakened sphincter muscle is not able to stop the flow of urine under normal circumstances and when there is an increase in abdominal pressure. Weakness may occur from pregnancy, childbirth, aging, or prior pelvic surgery. Other risk factors for SUI include chronic coughing or straining, obesity and smoking.

It is important for you to consult with your health care provider for proper diagnosis of SUI.

UTIs are common infections, usually caused by bacteria, in the bladder or urethra.

There are several kinds of UTI. The type of a UTI depends on where the infection occurs. For example:

• Urethritis is an infection in the urethra.
• A bladder infection is called cystitis.

If left untreated, a UTI could travel up one or both ureters to the kidney(s), causing pyelonephritis or a kidney infection. Kidney infections can become serious and may require hospitalization as part of treatment. UTIs are not the only cause of kidney infections.

UTIs are more common among women than among men. They also can affect children.

People rarely talk about bladder health, but everyone is affected by it. Located in the lower abdomen, the bladder is a hollow organ, much like a balloon, that stores urine. Urine contains waste and extra fluid left over after the body takes what it needs from what we eat and drink. Each day, adults pass about a quart and a half of urine through the bladder and out of the body.

As people get older, the bladder changes. The elastic bladder tissue may toughen and become less stretchy. A less flexible bladder cannot hold as much urine as before and might make you go to the bathroom more often. The bladder wall and pelvic floor muscles may weaken, making it harder to empty the bladder fully and causing urine to leak.

While you can’t control everything that affects your bladder, here are 15 steps you can take to keep it as healthy as possible:

1. Use the bathroom often and when needed. Try to urinate at least once every 3 to 4 hours. Holding urine in your bladder for too long can weaken your bladder muscles and make a bladder infection more likely.
2. Be in a relaxed position while urinating. Relaxing the muscles around the bladder will make it easier to empty the bladder. For women, hovering over the toilet seat may make it hard to relax, so it is best to sit on the toilet seat.
3. Take enough time to fully empty the bladder when urinating. Rushing when you urinate may not allow you to fully empty the bladder. If urine stays in the bladder too long, it can make a bladder infection more likely.
4. Wipe from front to back after using the toilet. Women should wipe from front to back to keep gut bacteria from getting into the urethra. This step is most important after a bowel movement.
5. Urinate after sex. Sexual activity can move bacteria from the bowel or vaginal cavity to the urethral opening. Both women and men should urinate shortly after sex to lower the risk of infection.
6. Do pelvic floor muscle exercises. Pelvic floor exercises, also known as Kegel exercises, help hold urine in the bladder. Daily exercises can strengthen these muscles, which can help keep urine from leaking when you sneeze, cough, lift, laugh, or have a sudden urge to urinate. These exercises also may help avoid infections by strengthening the muscles that help empty the bladder.
7. Wear cotton underwear and loose-fitting clothes. Wearing loose, cotton clothing will help keep the area around the urethra dry. Tight-fitting pants and nylon underwear can trap moisture and help bacteria grow.
8. Exercise regularly. Physical activity can help prevent bladder problems as well as constipation. It can also help maintain a healthy weight.
9. Keep a healthy weight. People who are overweight may be at higher risk for leaking urine. Making healthy food choices and being physically active can help keep a healthy weight.
10. Watch what you eat. Some people with bladder problems find that some foods and drinks, such as sodas, artificial sweeteners, spicy foods, citrus fruits and juices, and tomato-based foods, make bladder problems worse. Changing your diet may help you feel better.
11. Drink enough fluids, especially water. More than half of the human body is made up of water, so it is important that you are drinking enough. How much water you need can vary based on your size, activity level, and where you live. In general, drink enough fluids so that you need to urinate every few hours. Some people need to drink less water because of certain conditions, such as kidney failure or heart disease. Ask your health care provider how much fluid is healthy for you.
12. Limit alcohol and caffeine. For many people, drinking alcohol can make bladder problems worse. Caffeinated drinks (like coffee, tea, and most sodas) can bother the bladder and increase symptoms such as frequent or urgent need to urinate. Cutting down may help.
13. Avoid constipation. Too much stool built up in the colon, called constipation, can put pressure on the bladder and keep it from expanding the way it should. Eating plenty of high-fiber foods like whole grains, vegetables, and fruits), drinking enough water, and being physically active can help prevent this from happening.
14. Quit smoking. Bladder problems are more common among people who smoke. Smoking can also increase the risk for bladder cancer. If you smoke, take steps to quit.
15. Know your medications. Some medications may make it more likely for your bladder to leak urine. Medications that calm your nerves so you can sleep or relax may dull the nerves in the bladder, and you may not feel the urge to go to the bathroom.