Bladder distention refers to the abnormal enlargement of the urinary bladder due to urine retention. This condition arises when the bladder is unable to excrete urine, leading to accumulation. Causes include mechanical or anatomic obstruction, neuromuscular disorders, or the use of certain medications.

Epidemiology

Bladder distention is relatively common across all ages and sexes but is most prevalent among older men with prostate-related disorders that cause urinary retention.

Clinical features

Onset

• Gradual Distention: Typically asymptomatic until significant stretching causes discomfort.

• Acute Distention: Characterized by suprapubic fullness, pressure, and pain.

Symptoms

• Suprapubic pain and fullness

• Difficulty urinating

• Urgency or inability to void

• A weak, intermittent urine stream

• Sensation of incomplete bladder emptying

• In severe cases, bladder wall thinning and impaired renal function

Aggravating factors

• Caffeine

• Alcohol

• Large fluid intake

• Diuretics

Emergency interventions

In cases of severe bladder distention:

• Insert an indwelling urinary catheter to relieve discomfort and prevent bladder rupture.

• If more than 700 mL of urine is drained, the patient may feel faint due to rapid decompression of compressed blood vessels.

• Clamp the catheter for 30–60 minutes post-drainage to allow for vascular compensation.

History and physical examination

History

• Time and volume of last urination

• Fluid intake

• Difficulty initiating or controlling urination

• Use of Valsalva’s or Credé’s maneuver

• Painful or urgent urination

• Urinary stream characteristics

• History of UTIs, STIs, surgeries (pelvic, intestinal, neurologic), trauma

• Drug history (including over-the-counter medications)

Physical Examination

• Vital signs

• Bladder palpation and percussion

• Inspection of urethral meatus and any discharge

• Perineal sensation and anal sphincter tone

• Digital rectal exam for prostate evaluation in males

Table: Additional Urogenital Symptoms vs. Common Causes

✅ Legend:

• BPH – Benign Prostatic Hyperplasia

• MS – Multiple Sclerosis

Medical causes of bladder distention

1. Benign Prostatic Hyperplasia (BPH)

• Gradual or acute onset

• Symptoms: urinary hesitancy, straining, reduced stream force, nocturia, post-void dribbling

• Advanced signs: prostate enlargement, suprapubic fullness, constipation, hematuria

2. Bladder calculi

• Referred pain (tip of penis, vulva, heel, lower back)

• Pain worsens with movement, relieved by lying down

• Symptoms: terminal hematuria, frequency, urgency, dysuria

• Pain peaks at end of micturition

3. Bladder cancer

• May obstruct urethral orifice

• Common sign: hematuria

• Others: frequency, urgency, nocturia, dysuria, pyuria, pelvic/back/flank pain, vomiting, diarrhea, sleeplessness

• Palpable mass on bimanual exam

4. Multiple sclerosis

• Neuromuscular cause due to loss of upper motor neuron control

• Symptoms: optic neuritis, paresthesia, diplopia, nystagmus, dysarthria, weakness, Lhermitte’s sign, Babinski’s sign, ataxia

5. Prostate cancer

• Causes bladder distention in ~25% of patients

• Symptoms: dysuria, urgency, frequency, nocturia, perineal pain, weight loss, fatigue, rigid/irregular prostate

6. Prostatitis

• Acute: rapid onset with perineal pain, tender/enlarged prostate, dysuria, fever, malaise, nausea

• Chronic: rare bladder distention, may cause discomfort, tenderness, persistent discharge, ejaculatory pain

7. Spinal neoplasms

• Disrupt upper motor neuron control

• Symptoms: pelvic fullness, overflow incontinence, back pain (sciatica-like), sensory loss, muscle atrophy, signs of UTI

8. Urethral calculi

• Obstruction with interrupted stream

• Pain radiating to penis or vulva

• May have palpable stone or urethral discharge

9. Urethral stricture

• Common signs: chronic discharge, frequency, dysuria, decreased stream force

• Possible complications: urinoma, urosepsis

Other causes

Catheterization

• Improperly placed or blocked catheters may lead to retention

• Removal may cause edema or detrusor muscle spasm

Drugs

• Medications like anticholinergics, parasympatholytics, sedatives, anesthetics, and opioids can induce urinary retention

Special considerations

• Monitor vital signs and bladder distention

• Encourage position changes for comfort

• Administer analgesics as needed

• Prepare for diagnostic procedures (e.g., imaging, cystoscopy)

• Surgical intervention may be necessary if obstruction cannot be relieved via catheterization

Patient counseling

• Teach Valsalva’s or Credé’s maneuver to aid voiding

• Educate on bladder stimulation techniques

Pediatric pointers

• Monitor infants for signs of retention:

  • First 48 hrs: ~60 mL urine/day

  • By 1 week: ~300 mL/day

• In males, potential causes include:

  • Posterior urethral valves

  • Meatal stenosis

  • Phimosis

  • Spinal cord anomalies

  • Congenital bladder anomalies

References

1. James, N., Hussain, S., Hall, E., et al. (2010). Results of a 2 × 2 phase III randomized trial of synchronous chemoradiotherapy compared to radiotherapy alone and standard vs. reduced high volume RT in muscle invasive bladder cancer (BC2001 CRUK/01/004). Int J Radiat Oncol Biol Phys, 78(3), S2–S3.

2. James, N. D., Hussain, S. A., Hall, E., et al. (2012). Radiotherapy with or without chemotherapy in muscle-invasive bladder cancer. New England Journal of Medicine, 366(16), 1477–1488.