Bladder Symptoms: Causes and What They Mean

Types of bladder symptoms

Storage (filling) symptoms

• Frequency: passing urine more than about 8 times during the day.
• Urgency: a sudden, strong need to go that is hard to put off.
• Nocturia: waking more than once a night to urinate.
• Urge incontinence: leaking with or after a sudden urge.
• Stress incontinence: leaking with coughing, sneezing, laughing or lifting.

Emptying (voiding) symptoms

• Hesitancy: delay before the stream starts.
• Weak or interrupted stream.
• Straining to pass urine.
• Incomplete emptying: feeling the bladder is still full afterward.
• Post-void dribbling: leaking a little just after finishing.

Pain and other symptoms

• Dysuria: burning or stinging during urination.
• Bladder pain: suprapubic pain that worsens as the bladder fills.
• Blood in the urine (hematuria).
• Cloudy or strong-smelling urine.

What bladder symptoms can mean

Bladder atony: when the bladder cannot empty

Bladder atony means the bladder muscle (the detrusor) has lost its tone and cannot squeeze properly. Urine builds up, the bladder stretches, and the excess dribbles out as overflow incontinence. People often notice a weak stream, straining, frequent small voids, recurrent infections and sometimes little feeling of fullness. Causes include diabetes, nerve damage from the spine or pelvic surgery, and long-term overstretching from a blockage. It is diagnosed with a bladder scan after you pass urine and treated mainly with self-catheterization. See atonic bladder for full details, and neurogenic bladder for nerve-related bladder problems in general.

Bladder symptoms in women

• UTIs are far more common in women because of the shorter urethra.
• Stress incontinence is common after childbirth and menopause.
• Low estrogen after menopause thins the urinary tissues, causing urgency, frequency and recurrent infections (genitourinary syndrome of menopause).
• Pelvic organ prolapse can cause a slow stream and incomplete emptying.

Bladder symptoms in men

• An enlarged prostate is the most common cause of emptying symptoms after 50.
• Prostatitis causes pain in the perineum, frequency and burning.
• UTIs in men are less common and always need medical review.
• Prostate cancer usually causes no early urinary symptoms, but men with symptoms should discuss PSA testing with their doctor.

Other causes of bladder symptoms

• Caffeine, alcohol and fizzy drinks irritate the bladder.
• Medicines: diuretics increase urine; antihistamines, opioids and some antidepressants can cause retention.
• Constipation presses on the bladder.
• Neurological conditions: multiple sclerosis, Parkinson's disease, stroke, spinal cord injury.
• Diabetes: increases urine volume and can damage bladder nerves.
• Pregnancy: pressure from the womb causes frequency.
• Bladder stones.

How bladder symptoms are diagnosed

1. Urine test: dipstick and culture for infection and blood.
2. Bladder diary: record what you drink, when you urinate, how much, and any leaks for 3 days.
3. Examination: abdomen, pelvic exam in women, prostate exam in men, and neurological checks.
4. Post-void residual scan: an ultrasound after urinating to measure leftover urine.
5. Blood tests: kidney function, blood sugar, PSA in men when appropriate.
6. Urodynamic tests: measure bladder pressures during filling and emptying.
7. Cystoscopy: a camera inside the bladder, especially for blood in the urine.

Treatment and self-help

Self-help

• Drink about 1.5 to 2 liters (6 to 8 cups) of fluid a day unless advised otherwise; too little concentrates urine and irritates the bladder.
• Cut down on caffeine, alcohol and fizzy drinks.
• Stop drinking 2 hours before bed if you get up at night.
• Pelvic floor exercises (Kegels): squeeze and hold for up to 10 seconds, 10 times, 3 times a day, for at least 3 months.
• Bladder training: gradually stretch the time between visits to the toilet.
• Double voiding: pass urine, wait a minute, then try again, for incomplete emptying.
• Treat constipation and keep to a healthy weight.

Medical treatments

• Antibiotics for UTIs.
• Overactive bladder: antimuscarinic medicines or beta-3 agonists such as mirabegron; bladder Botox injections or nerve stimulation if needed.
• Enlarged prostate: alpha-blockers, 5-alpha-reductase inhibitors, or surgery.
• Stress incontinence: pelvic floor physiotherapy, devices, or surgery.
• Atonic bladder and retention: intermittent self-catheterization.
• Vaginal estrogen for postmenopausal urinary symptoms.

Frequently asked questions

What are the most common bladder symptoms?

The most common are needing to urinate often, sudden urgency, waking at night to urinate, leaking, burning on urination, and a weak or interrupted stream. Pain and burning usually suggest infection, while weak flow and dribbling suggest a blockage or weak bladder muscle.

What is bladder atony?

Bladder atony means the bladder muscle has lost its tone and cannot contract to empty properly. Urine is retained and overflows in dribbles. Causes include diabetes, nerve damage and long-term overstretching. It is treated mainly with intermittent self-catheterization.

How do I know if I have a bladder infection?

Typical signs are burning or stinging when you urinate, needing to go often and urgently, passing small amounts, cloudy or strong-smelling urine and lower belly discomfort. Fever, back pain or vomiting suggest a kidney infection, which needs urgent treatment.

When should I worry about bladder symptoms?

See a doctor urgently for blood in the urine, being unable to pass urine, fever or back pain with urinary symptoms, or new numbness in the saddle area. Book a routine appointment for persistent frequency, leaking, weak stream or recurrent infections.

Can bladder problems be cured?

Many can. UTIs clear with antibiotics, and pelvic floor exercises cure or greatly improve stress incontinence in many women. Overactive bladder and prostate symptoms are usually well controlled with lifestyle changes, medicines or procedures.