Bladder diverticulum is a condition that someone can be born with or it can be acquired later on in life. While the congenital form rarely requires any specific treatment, those who acquire bladder diverticulum later often need some kind of medical care.
The condition presents as a pouch on the bladder wall. In the case of congenital bladder diverticulum, some of the bladder lining pokes through a weak section of the bladder wall. In children, there is usually just one pouch. However, with acquired diverticulum, there is often more than one pouch, so it is called bladder diverticula.
What causes bladder diverticulum?
Many medical experts refer to this condition as urinary bladder diverticulum because it can have a significant impact on the urinary tract. There are several different causes of bladder diverticulum. The following list outlines many of them:
Hutch diverticula: These are congenital bladder diverticula that occur due to weakness in a muscle near the opening of the ureter in the bladder. Hutch diverticula occur almost exclusively in boys. Symptoms often include urinary tract infections, incontinence, or urinary retention.
Bladder neck obstruction: In this case, an obstruction impacts muscles that run from the bladder to the urethra. These muscles usually hold urine in and release it when the time is right; however, when obstruction occurs, urine flow can be disrupted. It can leak and it may not expel. This happens more often in men over the age of 50, although it can also occur in women.
Neurogenic bladder: This is best described as diverticulum from urinary conditions due to brain, spinal, or nerve problems. Sometimes, nerve damage can be the result of diseases like multiple sclerosis, diabetes, or Parkinson’s disease. Neurogenic bladder can also be the result of an infection in the brain or spinal cord, heavy metal poisoning, stroke, spinal cord injury, or even pelvic surgery. Those born with Spina Bifida can also have neurogenic bladder. With neurogenic bladder, people can either have difficulty urinating or they can leak urine.
Posterior urethral valves: Only seen in boys, this is also called congenital obstruction posterior urethral membranes or COPUM. It is an obstruction in the urethra. Depending on how severe the obstruction is, the unborn fetus can appear small for gestational age on an ultrasound. In other cases, the problem is not noticed until early infancy. Urinary tract infections are a common symptom in these cases.
Enlarged prostate: This is a condition in men that means the prostate gland is larger than it should be. When it is referred to as benign prostatic hyperplasia (BPH), it means that it is not cancerous. As a prostate enlarges, the gland can press against the urethra and the bladder wall becomes thicker. In many cases, the bladder wall eventually weakens and loses its ability to empty completely.
Ureterocele: While we’re all supposed to have two ureters coming from each kidney to drain urine from the bladder, some people are born with two ureters draining a kidney, and this is called duplex anomaly. This can lead to ureterocele, which impacts girls more than boys. It leads to swelling at the end of the ureter and urine refluxing backward to the kidney.
Urethral stricture: This is something that occurs when the urethra narrows and thus restricts urinary flow. It mostly affects men and is often associated with inflammation or scar tissue.
Diamond-Blackfan anemia: A disorder of the bone marrow, Diamond-Blackfan anemia is basically a malfunctioning of the bone marrow. It fails to make enough red blood cells, which are meant to carry oxygen to the body’s tissues. Normally, the symptoms appear within the first year of life. At least half of the people who suffer from this disorder have a number of different physical abnormalities, including kidney and urethra issues.
Ehlers-Danlos syndrome: This is a group of disorders that can impact the connective tissues that support skin, bones, and many other organs and tissues. The symptoms can range from mild to severe. Some forms of this syndrome can cause life-threatening complications.
Menkes syndrome: This is a disorder that impacts copper levels in the human body. It can cause weak muscle tone, deterioration of the nervous system, and affect a person’s ability to gain weight and grow. Children with Menkes syndrome develop symptoms during infancy and often die before the age of four.
Prune belly syndrome: Also called Eagle-Barrett syndrome, this is a rare disorder that involves partial or complete absence of abdominal muscles and malformation of the urinary tract. The urinary malformations can include abnormal widening of the ureters, accumulation of urine in the ureters, and backflow of urine from the bladder into the ureters.
Williams syndrome: This is a developmental condition that impacts several different parts of the body. It is characterized by both physical and intellectual challenges.
Symptoms and diagnosis of bladder diverticulum
In many cases, bladder diverticulum doesn’t really present any direct signs. Often times, the problem is found while a doctor is looking for the cause of other urinary problems. Below are a few of the bladder diverticulum symptoms that you could call typical. Keep in mind that these can also be signs of other health conditions.
- Urinary tract infection
- Difficulty urinating
- Feelings of abdominal fullness
- Trouble urinating
- Blood in urine
- Urine flowing backward into the kidneys
- Bladder stones
- Bladder tumors
Bladder diverticulum may be suspected if a patient has the symptoms listed above, but in the majority of cases, problems are discovered during tests. For instance, a special X-ray of the bladder can detect bladder diverticula. A scope of the bladder can also find diverticula. A bladder pressure test is often what ends up leading to the discovery of an obstruction of the bladder, while ultrasounds can detect obstruction of the kidneys. Bladder diverticulum ultrasound is also performed in some cases to get a clearer view of the bladder.
Bladder diverticulum treatment
Bladder diverticula don’t always cause uncomfortable symptoms. so treatment may not be necessary. In cases where treatment is required, the approach will depend on the underlying cause. For example, diverticula caused by a block in the bladder are often treated with bladder diverticulum surgery. Some of the surgeries need to be conducted in an open fashion, while others are done through small tubes fed inside the bladder. A robot may or may not be used to assist with the surgery.
Bladder diverticulum treatment can be very effective. In some situations, after the cause of the diverticulum is addressed, the patient won’t need any further treatment. Occasionally, a doctor should check the diverticulum with a cystoscope through the urethra. In the case of tumors found in the diverticulum, samples will be taken and tested for cancer.
If someone undergoes bladder diverticulum surgery, there is a chance that he or she will need a catheter to drain the bladder for a week or two. This can be uncomfortable, but necessary. There can also be risks with diverticulum surgery, such as damage to the intestines or ureters, infection, or urine leakage.
A diagnosis of bladder diverticulum can seem frightening, and while the long-term outcome largely depends on the underlying cause, many urologists agree that early detection and treatment can go a long way in helping patients lead a comfortable life.
Related: Gallbladder pain: Causes, symptoms, diagnosis, and treatment