Answering Incontinence Community Questions: How Does Bladder Augmentation Work?

Bladder Augmentation - Reader's Question: If a bladder is augmented, do the bladder muscles stop working completely? Or do they have limited function that won't allow the "new" bladder to empty completely, requiring periodic cathing?

This is an excellent question.  Several weeks ago, I wrote about options for improving bladder capacity and decreasing incontinence.  You raise an important question and one that certainly deserves to be addressed.

To briefly summarize my previous post, there are several different ways to augment a bladder, either to use bowel segments and attach them to the bladder, or to make cuts in the bladder muscle and allow the mucous (inside lining of the bladder) to pucker out.  In general, the purpose of bladder augmentation is to increase the capacity and to allow for more storage of urine, therefore decreasing the frequency a person has to urinate, and hopefully to reduce the number of incontinent episodes.  Another effect of augmenting the bladder is to lower the pressure inside of the bladder to reduce risk of injury to the kidneys due to chronic pressure.

Now, back to the question, will the muscles of the bladder work to empty the bladder normally after a bladder augmentation? 

The answer lies mostly in the status of the bladder's function prior to augmentation.  In general, for those people who qualify for a bladder augmentation, their bladders likely are not working all that well in the first place. 

The new portion of the bladder, which is really a segment of bowel, in usually not effective in contributing to the squeeze of the bladder and the majority of the time a person will have to catheterize themselves after a bladder augmentation.

In general, if you were to have a bladder augmentation, you should expect that you will have to catheterize yourself partially, if not exclusively to empty your bladder.  That being said, bladder reconstruction has been revolutionized in the last decade or so since we have started to create entire bladders out of bowel after removing a bladder for cancer. 

In years past, if a bladder was removed for cancer, a person's urine had to be diverted out through a stoma on the abdomen and then often into a bag, like a colostomy. 

For some time now, we have been using bowel to reconstruct a bladder and place it where the bladder used to be.  Not everyone can urinate on their own, and some people do have to catheterize, however, many people do learn how to use they abdominal muscles better and learn to "push" the urine out.

So, to finally answer your question, can someone urinate normally after their bladder has been augmented?  Possibly, but it is important to understand that self catheterization periodically or exclusively is a realistic outcome.  Most people are just so happy to be continent that they get over the issue of catheterizing themselves.