Editing Bladder (section)

==Clinical significance==
{{See also|Urinary bladder disease}}

===Inflammation and infection===
[[File:Schistosomiaisis Bladder Calcifications.png|thumb|right|260px|Calcifications on bladder wall caused by urinary [[schistosomiasis]]]]
[[Cystitis]] refers to infection or inflammation of the bladder. It commonly occurs as part of a [[urinary tract infection]].{{sfn|Davidson's|2018|pp=426-429}} In adults, it is more common in women than men, owing to a shorter [[urethra]]. It is common in males during childhood, and in older men where [[benign prostatic hypertrophy|an enlarged prostate]] may cause urinary retention.{{sfn|Davidson's|2018|pp=426-429}} Other risk factors include other causes of blockage or narrowing, such as [[prostate cancer]] or the presence of [[vesico-ureteric reflux]]; the presence of outside structures in the urinary tract, such as [[urinary catheter]]s; and neurologic problems that make passing urine difficult.{{sfn|Davidson's|2018|pp=426-429}} Infections that involve the bladder can cause pain in the lower abdomen (above the [[pubic symphysis]], so called "suprapubic" pain), particularly before and after passing urine, and a desire to [[urinary frequency|pass urine frequently]] and with little warning ([[urinary urgency]]).{{sfn|Davidson's|2018|pp=426-429}} Infections are usually due to [[bacteria]], of which the most common is [[E coli]].{{sfn|Davidson's|2018|pp=426-429}}

When a urinary tract infection or cystitis is suspected, a [[medical practitioner]] may request a [[urine sample]]. A [[urine dipstick|dipstick placed in the urine]] may be used to see if the urine has [[leukocytes|white blood cells]], or the presence of [[nitrates]] which may indicate an infection. The urine specimen may be also sent for [[microbial culture and sensitivity]] to assess if a particular bacteria grows in the urine, and identify its [[antibiotic sensitivities]].{{sfn|Davidson's|2018|pp=426-429}} Sometimes, additional investigations may be requested. These might include testing the function of the kidneys by assessing [[electrolytes]] and [[creatinine]]; investigating for blockages or narrowing of the renal tract with an [[renal tract ultrasound|ultrasound]], and testing for an enlarged prostate with a [[digital rectal examination]].{{sfn|Davidson's|2018|pp=426-429}}

Urinary tract infections or cystitis are treated with [[antibiotic]]s, many of which are [[per oral|consumed by mouth]]. Serious infections may require treatment with [[intravenous]] antibiotics.{{sfn|Davidson's|2018|pp=426-429}}

[[Interstitial cystitis]] refers to a condition in which the bladder is infected due to a cause that is not bacteria.<ref>{{cite web | title = Interstitial cystitis | publisher = Mayo Clinic | date = 14 September 2019 | url = https://www.mayoclinic.org/diseases-conditions/interstitial-cystitis/symptoms-causes/syc-20354357 | access-date = 10 May 2020}}</ref><ref>{{cite book |last1=Glass |first1=Cheryl A. |last2=Gunter |first2=Debbie |editor1-last=Glass |editor1-first=Cheryl A. |editor2-last=Cash |editor2-first=Jill C. |title=Family Practice Guidelines |date=2017 |publisher=pringer Publishing Company, LLC |location=New York |isbn=978-0826177117 |pages=352–353 |edition=4}}</ref>

===Incontinence and retention===
[[File:UltrasoundBPH.jpg|thumb|Urinary bladder (black butterfly-like shape) and hyperplastic [[prostate]] (BPH) visualized by [[medical ultrasound]]]]Frequent urination can be due to excessive urine production, small bladder capacity, irritability or incomplete emptying. Males with an [[enlarged prostate]] urinate more frequently. One definition of an [[overactive bladder]] is when a person urinates more than eight times per day.<ref>{{cite web|url=https://www.cornellurology.com/clinical-conditions/female-urology-urogynecology/overactive-bladder|title=Overactive Bladder|publisher=Cornell Medical College|access-date=2013-08-21|archive-date=2 June 2016|archive-url=https://web.archive.org/web/20160602223527/https://www.cornellurology.com/clinical-conditions/female-urology-urogynecology/overactive-bladder/|url-status=dead}}</ref> An overactive bladder can often cause [[urinary incontinence]]. Though both urinary frequency and volumes have been shown to have a circadian rhythm, meaning day and night cycles,<ref>{{cite journal|last=Negoro|first=Hiromitsu|title=Involvement of urinary bladder Connexin43 and the circadian clock in coordination of diurnal micturition rhythm|year=2012|doi=10.1038/ncomms1812|pmid=22549838|pmc=3541943|volume=3|journal=Nature Communications|page=809|bibcode=2012NatCo...3..809N}}</ref> it is not entirely clear how these are disturbed in the overactive bladder. [[Urodynamic testing]] can help to explain the symptoms. An [[underactive bladder]] is the condition where there is a difficulty in passing urine and is the main symptom of a [[neurogenic bladder]]. Frequent urination at night may indicate the presence of [[bladder stone]]s.

Disorders of or related to the bladder include:
* [[bladder exstrophy]]
* [[bladder sphincter dyssynergia]], a condition in which the sufferer cannot coordinate relaxation of the urethra sphincter with the contraction of the bladder muscles
* [[paruresis]]
* [[trigonitis]]
* [[underactive bladder]], a condition with its main symptom being [[urinary retention]].<ref>{{Cite journal|last1=C|first1=Moro|last2=C|first2=Phelps|last3=V|first3=Veer|last4=J|first4=Clark|last5=P|first5=Glasziou|last6=Kao|first6=Tikkinen|last7=Am|first7=Scott|date=2021-11-24|title=The effectiveness of parasympathomimetics for treating underactive bladder: A systematic review and meta-analysis|url=https://pubmed.ncbi.nlm.nih.gov/34816481/|journal=Neurourology and Urodynamics|volume=41 |issue=1 |pages=127–139 |language=en|doi=10.1002/nau.24839|issn=1520-6777|pmid=34816481|s2cid=244530010 }}</ref>

Disorders of bladder function may be dealt with surgically, by redirecting the flow of urine or by replacement with an [[artificial urinary bladder]]. The volume of the bladder may be increased by [[bladder augmentation]]. [[Urinary bladder neck obstruction|An obstruction of the bladder neck]] may be severe enough to warrant surgery. [[Ultrasound]] can be used to estimate bladder volumes.<ref>{{Cite journal |last1=Bih |first1=L. I. |last2=Ho |first2=C. C. |last3=Tsai |first3=S. J. |last4=Lai |first4=Y. C. |last5=Chow |first5=W. |date=December 1998 |title=Bladder shape impact on the accuracy of ultrasonic estimation of bladder volume |url=https://pubmed.ncbi.nlm.nih.gov/9862299/ |journal=Archives of Physical Medicine and Rehabilitation |volume=79 |issue=12 |pages=1553–1556 |doi=10.1016/s0003-9993(98)90419-1 |issn=0003-9993 |pmid=9862299}}</ref><ref>{{Cite web |title=Bladder Volume Calculator |url=https://radathand.com/radiology-calculators/body-imaging/bladder-volume-calculator/ |access-date=2024-07-11 |website=Rad At Hand |date=10 July 2024 |language=en-US}}</ref>

===Cancer===
{{main|Bladder cancer}}

[[File:Bladder Cancer.jpg|thumb|231x231px|Cross-section of the male [[genitourinary system]] showing a cancer within the bladder. When a cancer occurs it is most likely to be a [[transitional cell carcinoma]].]]
[[Cancer]] of the bladder is known as [[bladder cancer]]. It is usually due to cancer of the [[urothelium]], the cells that line the surface of the bladder. Bladder cancer is more common after the age of 40, and more common in men than women;<ref name="Davidsons2018cancer">{{cite book|title=Davidson's principles and practice of medicine|editor1-last=Ralston |editor1-first=Stuart H. |editor2-last=Penman |editor2-first=Ian D. |editor3-last=Strachan |editor3-first=Mark W. |editor4-last=Hobson |editor4-first=Richard P. |date=2018 |publisher=Elsevier |isbn=978-0-7020-7028-0 |edition=23rd|pages=435–6|section=Urothelial tumours}}</ref> other risk factors include [[smoking]] and exposure to [[dye]]s such as [[aromatic amine]]s and [[aldehydes]].<ref name="Davidsons2018cancer" /> When cancer is present, the most common symptom in an affected person is [[haematuria|blood in the urine]]; a physical [[medical examination]] may be otherwise normal, except in late disease.<ref name="Davidsons2018cancer" /> Bladder cancer is most often due to cancer of the cells lining the ureter, called [[transitional cell carcinoma]], although it can more rarely occur as a [[squamous cell carcinoma]] if the type of cells lining the urethra have changed due to chronic inflammation, such as due to stones or [[schistosomiasis]].<ref name="Davidsons2018cancer" />

Investigations performed usually include collecting a sample of urine for an inspection for malignant cells under a microscope, called [[cytology]], as well as [[medical imaging]] by a [[CT urogram]] or [[ultrasound]].<ref name="Davidsons2018cancer" /> If a concerning lesion is seen, a flexible camera may be inserted into the bladder, called [[cystoscopy]], in order to view the lesion and take a [[biopsy]], and a [[CT scan]] will be performed of other body parts (a [[Full-body CT scan|CT scan of the chest, abdomen and pelvis]]) to look for additional {{wt|en|metastatic}} lesions.<ref name="Davidsons2018cancer" />

Treatment depends on the cancer's [[tumour staging|stage]]. Cancer present only in the bladder may be removed surgically via [[cystoscopy]]; an injection of the [[chemotherapy|chemotherapeutic]] [[mitomycin C]] may be performed at the same time.<ref name="Davidsons2018cancer" /> Cancers that are [[tumour grade|high grade]] may be treated with an injection of the [[BCG vaccine]] into the bladder wall, and may require surgical removal if it does not resolve.<ref name="Davidsons2018cancer" /> Cancer that is invading through the bladder wall may be managed by complete surgical removal of the bladder ([[radical cystectomy]]), with the ureters diverted into a segment of part of [[ileum]] connected to a [[stoma bag]] on the skin.<ref name="Davidsons2018cancer" /> Prognosis can vary markedly depending on the cancer's stage and grade, with a better prognosis associated with tumours found only in the bladder, that are low grade, that do not invade through the bladder wall, and that is {{wt|en|papillary}} in visual appearance.<ref name="Davidsons2018cancer" />

===Investigation===
[[File:Bladderdiverticulum.png|thumb|A [[diverticulum]] of the bladder]]A number of investigations are used to examine the bladder. The investigations that are ordered will depend on the taking of a [[medical history]] and an examination. The examination may involve a [[medical practitioner]] feeling in the suprapubic area for tenderness or fullness that might indicate an inflamed or full bladder.{{citation needed|date=July 2020}} Blood tests may be ordered that may indicate inflammation; for example a [[full blood count]] may demonstrate elevated [[white blood cell]]s, or a [[C-reactive protein]] may be elevated in an infection.{{citation needed|date=July 2020}}

Some forms of [[medical imaging]] exist to visualise the bladder. A [[bladder ultrasound]] may be conducted to view how much urine is within the bladder, indicating [[urinary retention]]. A [[urinary tract ultrasound]], conducted by a more trained operator, may be conducted to view whether there are stones, tumours or sites of obstruction within the bladder and urinary tract. A [[Computed tomography of the abdomen and pelvis|CT scan]] may also be ordered.

A flexible internal camera, called a [[cystoscope]], can be inserted to view the internal appearance of the bladder and take a [[biopsy]] if required.

[[Urodynamic testing]] can help to explain the symptoms.