wandering bladder definition

Commentary:A Clone of My Own

Topics of discussion.

• The episode aired on John's mom's birthday. John says she likes to call herself "Futuramamomma".
• This is one of two episodes Patric wrote that rhyme with his last name, the other being " A Leela of Her Own ".
• The drawing of the Professor on the screen is in the style of a certain artist but they can't remember who.
• This is the first episode to show Zoidberg 's interest in stand-up comedy.
• The set where the Professor's 150th birthday party is hosted is based on The Dean Martin Celebrity Roast .
• Patric explains that "Musky" and "Pike" are both types of fish.
• John was approached by a fan who told him that he was really good at doing different voices when playing Dungeons & Dragons with his friends and that he wanted to be a voice actor.
• The time machine is based on the one from the 1960 film adaptation of the H. G. Wells story The Time Machine .
• When all the characters speak at the same time, it is known as an "omni" in directing terms. This episode is the first one to have a character end the omni with a "topper", e.g. they speak last and can be heard above all the other characters. In this case, it is Zoidberg saying "a successor to the professor?"
• Cubert was conceived before the show even began to enter production.
• Cubert was meant to point out scientific inconsistencies throughout the show, anticipating how fanatics of the show would probably do the same thing.
• It is later explained this is because the Professor was originally going to explain how the engines of the ship work to Cubert from inside his laboratory in the top of the Planet Express building's tower.
• David says it isn't a good tradition and that Matt may be thinking of Wesley Crusher from Star Trek: The Next Generation .
• The characters in the show wouldn't put up with Cubert any more than the audience would.
• Matt says there are a lot of things in science fiction that you have to side-step in order to make the show adventurous, fun and fast-moving, such as faster-than-light travel, aliens speaking English, levitation and time travel.
• Matt says Bart Simpson 's early designs looked like Pugsley, too.
• The third act is "jam-packed" with 3D animation.
• David says Matt likes assembly lines and "people having stuff done to them by machines".
• Patric says all the old people jokes are revenge for him having to live in Southwest Florida for 13 years.
• The huge room with the tombstone-looking towers was inspired by a cemetery near the offices where the show is made.
• Rich thinks Futurama is the only primetime animated show that has effects animatiors working on staff.
• John thinks there is a quota to include the words "bastard" and "ass" in the show.
• The "wandering bladder" joke was pitched at every stage of the episode's re-write. Patric says they had everything from "rectal gout" to "cancerous hangnails".
• Cubert was originally meant to appear in 1ACV08, " A Big Piece of Garbage ".

Highlights / Quotes

Patric Verrone : [Reading the title caption] Coming soon to an illegal DVD, now this is not an illegal DVD that you're watching this on, unless, of course, it is. John DiMaggio : [Laughs]

[The Professor is shown wearing a pale yellow "Dungeon Master" shirt] David X. Cohen : I never had a shirt like that...and it was also a different colour.

Matt Groening : Well, the original idea for this character was that he was gonna be the character who was standing on the sidelines of every episode, pointing out all the logical flaws, and that he would comment on--anticipating the criticisms of the fanatics who are following the show. And uh... Patric Verrone : But then the show had no flaws and so there was no... David X. Cohen : [Laughs] John DiMaggio : Awh yeah! Matt Groening : Exactly.

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• Commentaries with David X. Cohen
• Commentaries with Rich Moore
• Commentaries with Patric M. Verrone
• Commentaries with Scott Vanzo
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Overactive Bladder

The bladder is a hollow organ in the abdomen that holds urine. When the bladder is full, it contracts, and urine is expelled from the body through the urethra. Overactive bladder starts with a muscle contraction in the bladder wall. The result is a need to urinate (urinary urgency), which is also called urge incontinence or irritable bladder.

While overactive bladder is most common in older adults, the condition is not a normal result of aging. While one in 11 people in the United States suffer from overactive bladder, it mainly affects people 65 and older, although women can be affected earlier, often in their mid-forties.

There are two kinds of overactive bladder. One without urge incontinence, which is called overactive bladder, dry, and affects two thirds of sufferers; and overactive bladder, wet, which includes the symptoms with urge incontinence (leaking or involuntary bladder voiding).

• Frequent urination
• Urgency (need to urinate)
• Leaking or involuntary, and/or complete bladder voiding (urge incontinence)
• Need to urinate frequently (eight or more times in 24 hours)
• Nocturia or waking up two or more times at night to urinate

Overactive bladder is caused by a malfunction of the detrusor muscle, which in turn can be cased by:

• Nerve damage caused by abdominal trauma, pelvic trauma or surgery
• Bladder stones
• Drug side effects
• Neurological diseases, such as multiple sclerosis , Parkinson's disease , stroke or spinal cord lesions
• Bladder cancer
• Prostate cancer
• Urinary tract infection
• Normal pressure hydrocephalus

A preliminary assessment for suspected overactive bladder can include a screening questionnaire, a request that the patient maintain a voiding diary for a prescribed number of days, a detailed medical history, and a comprehensive physical examination. Often a urinalysis, which detects the presence of bacteria in urine and indicates infection, will be ordered to determine if the condition is caused by an infection. A urinalysis also can determine if there is blood or too much protein in the urine, which may indicate kidney or cardiac disease, and can also detect the presence of puss in urine, which is also a sign of infection.

The physical examination for overactive bladder includes checking the neurological status of a patient for any sensory issues, as well as a cough stress test to measure urine loss, whether as an immediate or a delayed reaction. The exam will usually include a check of the abdomen, rectum, genitals and pelvis.

Specialized diagnostics for overactive bladder are called urodynamic tests. They assess bladder function, measure the amount of urine after voiding, the degree of incontinence (how completely the bladder empties), and bladder irritability. Measurements are performed by inserting a thin tube through the urethra into the bladder or by performing an ultrasound to acquire an image of the bladder.

Other specialized tests include:

• Uroflowmetry is a diagnostic test that uses a device that measures the volume and speed of urination.
• Cystometry uses a device called a cystometer to measure the pressure of the bladder and its capacity. It also evaluates the function of the detrusor muscle to determine the degree of muscle contraction, the pressure of any leakage, and the pressure required to fully empty the bladder.
• Electromyography is used to assess the coordination of nerve impulses in the bladder muscles and in the urinary sphincter. Sensors are placed on the abdominal region or catheters are inserted into the urethra or rectum to measure the nerve impulses.
• Video Urodynamics uses imaging and ultrasound to create images of the bladder, both filled and after voiding.
• Cystoscopy is a test in which a thin tube with a camera at one end is used to see the interior of the urethra and the bladder.

In addition to medication, behavioral interventions for an overactive bladder may help reduce episodes and strengthen bladder muscles. Bladder training, which includes the delay of voiding from 10 minutes to two hours, can be done to strengthen bladder muscles. Pelvic floor muscle exercises, also called Kegel exercises, can improve function of the pelvic floor muscles and urinary sphincter to hold urine and suppress involuntary movement of the bladder. Vaginal weight training is a process by which small weights are held within the vagina through the tightening of the vaginal muscles. These exercises are recommended twice daily for approximately 15 minutes for four to six weeks. Biofeedback in combination with Kegel exercises can also help the patient build build awareness and control of pelvic muscles.

Other possible treatments include adjusting fluid intakes and reducing irritants, such as limiting caffeine and alcohol. Patients can also try increasing fiber intake or taking supplements for constipation, which can reduce the symptoms of overactive bladder.

In some cases, absorbent pads can be worn to protect undergarments and prevent embarrassment.

The use of antisasmodics, also called anticholinergics can reduce bladder urge episodes. These include:

• Tolterodine (Detrol)
• Oxybutynin (Ditropan)
• Oxybutynin skin patch (Oxytrol)
• Trospium (Sanctura)
• Solifenacin (Vesicare)

For severe cases of overactive bladder, a sacral nerve stimulator may be recommended. This is a pacemaker-type device placed under the skin of the abdomen and connected to a wire near the sacral nerves (near the tailbone). The sacral nerves are the primary link between the spinal cord and bladder tissue. Modulating these nerve impulses has been shown to be an effective treatment for overactive bladder.

In some cases, augmentation cystoplasty may be recommended. This is a reconstructive procedure that uses parts of the bowel to replace parts of the bladder. It can improve bladder capacity, although the use of a catheter for voiding may still be necessary.

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What the Bladder Does and Where It's Located

The bladder sites in your lower abdomen and stores urine

• Anatomy and Location
• Associated Conditions

The bladder is a hollow organ located in the lower abdomen whose main function is to store urine until it is passed out of the body when you pee (urinate).

As urine is produced, it moves from each of your two kidneys into your bladder via a set of tubes called ureters . The bladder’s flexible walls stretch to hold urine and, when full, contract to expel urine through another tube known as the urethra .

This article explains everything you need to know about the location, structure, and function of the bladder. It also describes conditions that can adversely affect the bladder and things you can do to keep your bladder healthy.

Anatomy and Location of the Bladder

The bladder is a triangle-shaped, hollow organ that is part of the urinary system . The organ is made up of the apex (top of the bladder), body (middle of the bladder), fundus (base of the bladder), and neck (a pathway that connects to the urethra).

The bladder is located in the lower abdomen, but its position varies somewhat by your sex:

• In males , the bladder is bordered by the pubic bone at the front of the pelvis and the rectum at the back of the pelvis.
• In females , the bladder is bordered by the pubic bone at the front of the pelvis and the uterus and vagina at the back of the pelvis.

The bladder is supported by connective tissues known as ligaments that help maintain its position in the lower abdomen.

Oxygenated blood is supplied to the apex of the bladder by the superior vesical artery and to the body and base of the bladder by the inferior vesicular artery (in males) or inferior vaginal artery (in females). Deoxygenated blood leaves the bladder via a group of veins called vesicle veins.

Parts of the Bladder

The bladder is a flexible organ made up of smooth (involuntary) muscles. Crisscrossing bands of smooth muscle form the detrusor muscle , the primary muscle of the bladder.

Urine enters the apex of the bladder via two ureters descending from the kidneys. Urine leaves the bladder via the urethra which opens at the tip of the penis in males and the area beneath the clitoris in females.

The release of urine is regulated not only by the detrusor muscle but also by two circular muscles called urethral sphincters situated at the bladder neck:

• The internal urethral sphincter encircles the urethra inside the bladder. It is an involuntary muscle (made up of smooth muscles) that remains shut until it is time to pee.
• The external urethral sphincter  encircles the urethra on the outside of the bladder. It is a voluntary muscle (made up of skeletal muscle ) that opens and closes on demand to control urine flow.

Bladder Location in Children

In children, the bladder is located in the abdomen and does not completely descend into the lower abdomen and pelvis until puberty.

What Does the Bladder Do?

The primary function of the bladder is to serve as the reservoir for urine produced by the kidneys. Urine is a liquid byproduct in which filtered waste and excess fluids are removed from the body to keep the balance of chemicals (such as minerals, proteins, and acids) in the correct proportions.

Once urine enters the bladder via the ureters, it is held in reserve until it needs to be released. As the bladder is full, sensory nerves in the walls of the bladder send signals to the brain, triggering tiny contractions of the detrusor muscle. These contractions serve as "red flags" that it is time to pee.

Thereafter, the relaxation of the (voluntary) external sphincter sends nerve signals to the brain, telling it to simultaneously relax the (involuntary) internal sphincter and compress the detrusor muscle to push urine out of the bladder.

Infants and young children release urine on reflex but learn to control the external sphincter and hold their urine longer during potty training.

How Much Pee Can a Bladder Hold?

When full, the bladder can hold up to 500 milliliters (2 cups) of urine in adult females and up to 700 milliliters (3 cups) of in adult males. Depending on the rate of fluid intake, bladder size, age, and other factors, the bladder needs to be released every two to five hours.

Conditions That Affect the Bladder

The bladder is vulnerable to injury as well as infections, most often arising from a lower urinary tract infection (UTI) . There are also conditions that can affect how the bladder works, as well as neoplasms (abnormal growths) that may be benign (non-cancerous) and malignant (cancerous).

Many of these conditions can cause bladder pain or pressure. These are mainly felt in the lower abdomen but can often extend to the lower back and urethra. In females, the pain or pressure may also be felt in the vulva or vagina.

Some of the conditions commonly affecting the bladder include:

• Cystitis : This is the inflammation in the bladder, mainly due to a UTI that has migrated from the lower urinary tract. Less commonly, cystitis can be triggered by medications or chemicals or may occur frequently for no apparent reason (a condition referred to as interstitial cystitis ).
• Cystocele : This occurs when the ligaments that hold the bladder in place get weak, causing the bladder to fall out of place ( prolapse ). This can cause discomfort and other problems, such as bulging from the vagina in females.
• Neurogenic bladder : Also known as detrusor areflexia , this happens when the bladder cannot contract due to acute or progressive nerve injury. Causes include spinal cord injury, traumatic brain injury, herniated discs, multiple sclerosis, diabetes, and Parkinson's disease.
• Myogenic bladder : Also known as an underactive bladder, this is when the bladder constantly overfills, causing scar tissues that gradually displace muscle tissues. Diabetes can cause this by "muting" signals to the brain. Other causes include an enlarged prostate in males and pelvic organ prolapse in females.
• Urinary incontinence : These include stress incontinence (in which the bladder leaks when laughing or lifting), urge incontinence (in which you have to rush to the bathroom urgently), functional incontinence (in which an impairment prevents you from getting to the bathroom on time), or overflow incontinence (in which the bladder doesn't fully empty, causing dribbling).
• Overactive bladder (OAB) : This is a condition where the frequent need to pee undermines your quality of life. It affects as many as one in four adult females and one in six adult males in the United States. It occurs when nerve signals between the brain and bladder are not coordinated.
• Pelvic surgery injury : Pelvic surgery can sometimes cause damage to the bladder or the nerves and vessels that service it, leading to neurogenic bladder, myogenic bladder, and other bladder problems.
• Bladder cancer : This is the most common cancer of the urinary system and the sixth most common cancer overall in the United States. It mainly arises from epithelial tissues that line the bladder, causing symptoms like blood in the urine, pain with urination, and lower back pain.

Diagnosing Bladder Problems

There are a number of tests that can give you and your healthcare provider insights into your bladder health. The most common tests and procedures include:

• Urinalysis : This is one of the most common tests to diagnose bladder problems. A urine sample is collected and sent to a lab to detect abnormalities like excessive white blood cells, red blood cells, bacteria, or protein indicative of an infection or disease.
• Urine culture : A urine culture is commonly used to diagnose a bladder infection. By submitting a urine sample to the right environmental conditions, the lab can "grow" microorganisms in the lab and determine whether the cause is bacterial, fungal, or viral.
• Bladder ultrasound : This non-invasive imaging test uses reflected sound waves to image the bladder. It can help spot abnormal growth, blockages, or other abnormalities.
• Cystoscopy : This involves the insertion of a catheter equipped with a lighted camera into your urethra to view inside your bladder. Tools can also be threaded through the catheter neck to obtain a tissue biopsy .
• Imaging studies : In addition to ultrasound, your healthcare provider may order an X-ray, computed tomography (CT) scan, or magnetic resonance imaging (MRI) to obtain detailed images of the bladder and adjacent structures.

Preventing Bladder Disorders

You can't avoid every bladder problem, but there are things you can do to keep your bladder healthy whether you've been diagnosed with a bladder condition or not.

Here are five healthy bladder tips that can help:

• Use the bathroom when needed : Try to urinate at least once every three to four hours. Holding it in can weaken the bladder muscles, promoting incontinence and increasing the risk of a UTI. Also, be sure to empty the bladder fully—don't rush—to further reduce the risk of infection.
• Drink plenty of fluids : Aim to drink six to eight 8-ounce glasses per day, ideally water. This can flush bacteria from the urinary tract that might otherwise cause a UTI. It also helps prevent constipation which can limit how fully the bladder can expand.
• Do pelvic floor exercises : Also known as  Kegel exercises , these exercises help reduce the risk of urge and stress incontinence. By consciously contracting and relaxing the perineal muscles between your anus and genitals, you may better avoid bladder leakage.
• Improve your diet : Some people with bladder problems are affected by foods such as tomatoes, heavy spices, caffeine, alcohol, citrus, sodas, and artificial sweeteners. Cutting back on these may reduce bladder irritation which contributes to urinary incontinence and interstitial cystitis.
• Quit smoking : Aside from increasing the risk of bladder cancer, smoking tobacco can irritate the bladder and aggravate symptoms of overactive bladder, interstitial cystitis, urge incontinence, and stress incontinence.

The bladder is a hollow organ in the lower abdomen that receives urine from the kidneys and holds it until it is released during urination. The release of urine is controlled by voluntary and involuntary muscles (including urethral sphincters and the bladder's main detrusor muscle) and nerve signals sent back and forth from the bladder and brain.

Many conditions can adversely affect the bladder, including cystitis, overactive bladder, neurogenic bladder, urinary incontinence, and bladder cancer.

You can maintain good bladder health by drinking plenty of fluids, avoiding foods that irritate the bladder, doing Kegel exercises, and going to the bathroom frequently rather than holding it in.

Hickling DR, Sun TT, Wu XR. Anatomy and physiology of the urinary tract: relation to host defense and microbial infection . Microbiol Spectr. 2015 Aug;3(4):10.1128/microbiolspec.UTI-0016-2012. doi:10.1128/microbiolspec.UTI-0016-2012

Oregon State Universithy. 25.8 Urine transport and elimination .

Johns Hopkins Medicine. Anatomy of the urinary system .

John Hopkins Health. Diagnosis and screening of urologic conditions .

MedlinePlus. Cystitis .

National Institute of Diabetes and Digestive and Kidney Diseases.  Cystocele .

Jung J, Kim A, Yang SH. The innovative approach in functional bladder disorders: the communication between bladder and brain-gut axis , Int Neurourol J. 2023 Mar;27(1):15–22. doi:10.5213/inj.2346036.018

Reynolds WS, Fowkes J, Dmochowsi R.  The burden of overactive bladder on US public health .  Curr Bladder Dysfunct Rep . 2016 Mar;11(1):8–13. doi:10.1007/s11884-016-0344-9

National Cancer Institute.  What is bladder cancer?

National Institute on Aging. 15 tips to keep your bladder healthy .

By Rachael Zimlich, BSN, RN Zimlich is a critical care nurse who has been writing about health care and clinical developments for over 10 years.

Marla Carlson, P.A.

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Listen to your bladder: 10 symptoms that demand attention

• Urinary Incontinence
• Pelvic Health

Every day, you get direct feedback from a vital organ: your bladder. Most people urinate six to eight times a day, and this regular act can reveal much about your bladder's health.

Some messages are easier to explain. If you down a lot of water, it's likely that you'll need to urinate soon. Some medications, like diuretics or decongestants, can increase your need to urinate.

Some messages, however, are a sign of more serious issues like urinary tract infections, bladder stones, trauma, ureteral obstruction, an enlarged prostate or even bladder cancer. When you pay close attention to your bladder health, you're more likely to identify signs and symptoms earlier and help your healthcare team determine the cause.

Here are 10 bladder symptoms that you should discuss with your healthcare team:

1. frequent urination.

On average, most people urinate six to eight times in 24 hours. This varies based on the amount of liquid you drink, along with whether you are pregnant or taking medications that increase urination. A sudden increase in urination that can't be explained, especially at night, can be a sign of a bladder problem or diabetes. Dietary bladder irritants can also increase urinary frequency and urgency.

Most of the time, adults can hold their urine until they reach a restroom. A sudden, strong urge to urinate that's difficult to control can indicate a urinary tract infection, urge incontinence or other bladder conditions.

3. Incontinence

Involuntary leakage of urine is a common bladder condition. There are two types of incontinence. Stress incontinence occurs when a person coughs, laughs or sneezes. It can also happen during physical activities. Urge incontinence happens after a sudden and intense urge to urinate, quickly followed by the involuntary loss of urine. You can have both types of incontinence.

4. Painful urination

Urinating shouldn't be painful. A burning or stinging sensation while urinating can be a sign of bladder issues like a urinary tract infection or bladder stones.

5. Hematuria

It can be scary to see blood in your urine, also called hematuria. Blood in the urine can be a sign of a serious illness such as kidney or bladder stones, an infection, or bladder or kidney cancer. Sometimes blood can be seen and appears pink, red or brown. In other cases, it can only be detected by a microscope when a lab tests the urine. Either way, it's important to figure out the reason for the bleeding.

6. Difficulty emptying the bladder

Most people feel relief when the bladder is emptied. But if you can't completely empty your bladder after urinating, it can be a sign of bladder dysfunction.

7. Weak urine stream

Changes in urine stream strength often develop over time, especially with age. A weak or interrupted urine stream could be a symptom of an enlarged prostate in men.

8. Pain or pressure

Pelvic pain can feel like a dull ache, built-up pressure or a sharp, localized pain. In addition to the pelvic area, the pain can be in your lower abdomen or back. While there are many possible causes of pelvic pain or pressure, it can be related to bladder issues.

9. Recurrent urinary tract infections

Frequent infections can be a sign of an underlying bladder problem. You may have chronic or recurrent bladder infections if you have two or more bladder infections in six months or three or more infections in a year.

10. Nocturia

Waking up more than once each night to pass urine is called nocturia. This can disrupt your sleep pattern and can be a sign of many different bladder issues or underlying health issues like obstructive sleep apnea or glucosuria, which is glucose in the urine.

It's important to understand that symptoms vary based on the type and severity of any bladder condition, your lifestyle and whether you have other chronic health conditions.

Talk with your healthcare team if you're experiencing any of these symptoms. After a thorough exam and tests, they can determine the cause of your symptoms and recommend appropriate treatment options.

Marla Carlson is a physician assistant in Urology in Red Wing , Minnesota.

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Understanding The Under Distended Bladder: Common Causes And Symptoms

• Last updated Nov 27, 2023
• Difficulty Advanced

• Category Breast Cancer

The human body is an intricate system of interconnected organs and functions, each relying on the other to maintain a state of equilibrium and wellness. One such organ, often overlooked but crucial for bodily waste disposal, is the bladder. The bladder, a muscular sac located in the lower abdomen, is responsible for storing and excreting urine. However, when this important organ becomes under distended, it can lead to a host of uncomfortable symptoms and health issues. Understanding the root causes of an under distended bladder is not only fascinating from a physiological standpoint but also crucial for proper diagnosis and treatment.

What You'll Learn

What are the common causes of an under distended bladder, how does a bladder become under distended, what role does urinary retention play in causing an under distended bladder, are there any medical conditions or medications that can lead to an under distended bladder, what are the potential complications of an under distended bladder if left untreated.

An under distended bladder, also known as urinary bladder distension, occurs when the bladder does not empty completely, leading to an accumulation of urine. This condition can be caused by various factors and may result in discomfort, urinary tract infections, and other complications. Understanding the common causes of under distended bladder can help individuals seek appropriate treatment and prevent further complications.

One of the most common causes of under distended bladder is urinary retention. Urinary retention occurs when the bladder muscles are unable to contract effectively, preventing the complete emptying of urine. This can be caused by a variety of factors, including nerve damage, prostate enlargement in men, and urethral strictures.

Nerve damage, often caused by conditions such as diabetes, multiple sclerosis, or spinal cord injuries, can disrupt the signals between the bladder and the brain, resulting in under distended bladder. Similarly, prostate enlargement, a condition known as benign prostatic hyperplasia (BPH), can exert pressure on the bladder, inhibiting proper emptying. Urethral strictures, which are narrowings of the urethra, can also obstruct the flow of urine and contribute to urinary retention.

Another common cause of under distended bladder is incomplete bladder emptying. This can occur when the muscles of the bladder do not contract with enough force, leaving behind residual urine. Incomplete bladder emptying can be caused by conditions such as bladder outlet obstruction, pelvic organ prolapse, or weakened bladder muscles.

Bladder outlet obstruction refers to any condition that obstructs the flow of urine from the bladder. This can be due to an enlarged prostate, tumors, or bladder stones. Pelvic organ prolapse, which commonly affects women, occurs when the pelvic organs, including the bladder, uterus, or rectum, descend into the vaginal area. This can put pressure on the bladder, preventing complete emptying. Weakened bladder muscles, which can be caused by aging, childbirth, or certain medications, can also contribute to incomplete bladder emptying.

In some cases, under distended bladder may be a result of bladder infections or inflammation. Infections and inflammation can cause temporary changes in bladder function, leading to urinary retention. These conditions can be caused by bacteria, viruses, or other irritants, and may be accompanied by symptoms such as frequent urination, burning sensation, or cloudy urine.

Treating under distended bladder often involves addressing the underlying cause. For individuals with urinary retention, medications to relax the bladder muscles or surgery to remove obstructions may be recommended. In cases of incomplete bladder emptying, bladder training exercises, pelvic floor muscle exercises, or surgery to repair weakened muscles may be suggested.

It is important to seek medical attention if experiencing symptoms of under distended bladder. A healthcare professional can perform a physical examination, conduct diagnostic tests, and recommend appropriate treatment options. By addressing the underlying causes of under distended bladder, individuals can reduce discomfort, prevent complications, and improve overall bladder function.

Understanding the Function of the Muscularis Propria: A Guide

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The bladder is a muscular organ located in the lower abdomen that stores urine until it is ready to be excreted from the body. When the bladder becomes under distended, it means that it is not filling up to its normal capacity or is not emptying completely. This can happen for a variety of reasons and can lead to discomfort and urinary problems.

One common cause of under distended bladder is a condition called urinary retention. This occurs when the muscles of the bladder are unable to contract properly, preventing the bladder from emptying completely. Urinary retention can be caused by a number of factors, including nerve damage, bladder outlet obstruction, and medication side effects.

Nerve damage can occur as a result of certain medical conditions, such as diabetes or multiple sclerosis, that affect the nerves controlling the bladder. When these nerves are damaged, they may not send the appropriate signals to the bladder muscles, leading to under distension. Bladder outlet obstruction can occur when there is a blockage in the urinary tract, such as an enlarged prostate or a bladder stone, that prevents urine from flowing out of the bladder properly.

Medications, such as certain antidepressants and antihistamines, can also interfere with bladder function and lead to under distension. These medications can relax the muscles of the bladder, making it difficult for the bladder to empty completely.

In addition to these physiological factors, lifestyle choices can also contribute to an under distended bladder. Not drinking enough fluids throughout the day can result in concentrated urine, which can irritate the bladder and lead to incomplete emptying. Holding urine for too long can also put strain on the bladder muscles and affect their ability to contract fully.

Symptoms of an under distended bladder may include a frequent urge to urinate, difficulty starting or stopping the flow of urine, weak urine stream, and a feeling of incomplete emptying. If left untreated, under distended bladder can lead to urinary tract infections, kidney damage, and bladder stones.

Treatment for an under distended bladder will depend on the underlying cause. In some cases, lifestyle changes, such as increasing fluid intake and emptying the bladder regularly, may be enough to alleviate symptoms. Medications can also be prescribed to help relax the muscles of the bladder or treat underlying conditions, such as an enlarged prostate.

In more severe cases, a procedure called catheterization may be necessary to empty the bladder completely. This involves inserting a tube into the bladder to drain the urine. In some cases, surgery may be needed to correct any structural abnormalities or remove obstructions in the urinary tract.

In conclusion, a bladder can become under distended due to a variety of reasons, including nerve damage, bladder outlet obstruction, medication side effects, and lifestyle factors. It is important to seek medical attention if you are experiencing symptoms of an under distended bladder, as it can lead to complications if left untreated. Treatment options will depend on the underlying cause and may include lifestyle changes, medications, catheterization, or surgery.

The Link Between Talcum Powder and Bladder Cancer: What You Need to Know

Urinary retention is a condition characterized by the inability to completely empty the bladder. It can be caused by numerous factors including an obstructed urinary flow, neurological disorders, and medications. One of the consequences of urinary retention is an under distended bladder, which poses various risks and complications if not addressed promptly.

An under distended bladder refers to a state in which the bladder is not fully stretched or expanded due to inadequate urine accumulation. This can occur when the bladder muscles are weak and cannot contract effectively, or when there is an obstruction preventing the bladder from filling properly. Urinary retention is a frequent cause of an under distended bladder, as the inability to urinate results in a lack of urine accumulation.

When the bladder is under distended, several problems can arise. Firstly, it can lead to urinary tract infections (UTIs). The residual urine left in the bladder provides an ideal environment for bacterial growth, which can ascend to the urinary tract, causing infections. UTIs can further exacerbate urinary retention, creating a cycle of worsening symptoms and complications.

Additionally, an under distended bladder can lead to bladder stones. The stagnant urine in the bladder can crystallize and form stones, which can cause pain, irritation, and potential blockage of the urinary tract. These stones may require surgical intervention to remove, adding further complexity to the management of urinary retention.

Furthermore, an under distended bladder can negatively impact kidney function. The accumulation of urine in the bladder exerts pressure on the kidneys, impairing their ability to effectively filter waste products and regulate fluid and electrolyte balance. Over time, this can lead to kidney damage and dysfunction, requiring medical intervention to restore proper kidney function.

The treatment of an under distended bladder involves addressing the underlying cause of the urinary retention. In cases where the obstruction is the primary cause, such as in men with an enlarged prostate gland, surgical intervention may be necessary to remove the obstruction and restore normal urinary flow. In other cases, medication adjustments, physical therapy, or behavioral interventions may be employed to improve bladder function.

Preventing urinary retention and an under distended bladder involves addressing risk factors such as maintaining a healthy lifestyle, managing chronic conditions, and regularly emptying the bladder. Pelvic floor exercises, known as Kegel exercises, can strengthen the muscles associated with bladder control and reduce the risk of urinary retention. Additionally, avoiding medications that may contribute to urinary retention and promptly treating any urinary symptoms can help prevent the development of an under distended bladder.

In conclusion, urinary retention can lead to an under distended bladder, which poses various risks and complications. Prompt identification and treatment of urinary retention is crucial to prevent urinary tract infections, bladder stones, and kidney damage. A comprehensive approach, including lifestyle modifications, medication adjustments, and surgical interventions when necessary, can help manage urinary retention and prevent an under distended bladder.

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Bladder distention, or the expansion of the bladder to the point where it is filled with urine, is an important process that allows us to urinate comfortably and efficiently. However, certain medical conditions or medications can lead to an under distended bladder, where the bladder does not reach its full capacity when filling with urine. This can result in a range of symptoms and potential complications that can impact a person's quality of life.

There are several medical conditions that can contribute to an under distended bladder. One common condition is urinary retention, which occurs when the bladder does not fully empty during urination. This can be caused by a blockage in the urinary tract, such as an enlarged prostate in men, or a weakened bladder muscle that is unable to contract effectively. Other conditions such as nerve damage, spinal cord injuries, and certain neurological disorders can also lead to urinary retention and an under distended bladder.

Certain medications can also affect bladder distention. For example, anticholinergic medications, which are often prescribed for overactive bladder or urinary incontinence, can relax the bladder muscle and decrease its ability to fully expand. This can result in decreased bladder distention and a reduced bladder capacity. Additionally, some medications used for pain management or muscle relaxation, such as opioids or muscle relaxants, can also impact bladder function and lead to an under distended bladder.

The symptoms of an under distended bladder can vary depending on the underlying cause and the severity of the condition. Some common symptoms include frequent urination, a constant feeling of needing to urinate (even after just voiding), difficulty initiating the urinary stream, weak urine flow, and a sense of incomplete bladder emptying. In severe cases, an under distended bladder can lead to urinary tract infections, bladder stones, kidney damage, and urinary incontinence.

Treatment for an under distended bladder will depend on the underlying cause of the condition. In cases where urinary retention is causing the problem, a doctor may need to insert a catheter to empty the bladder and relieve symptoms. If medications are contributing to the under distended bladder, alternative treatments or adjustments to medication dosages may be necessary. For some individuals, physical therapy exercises that focus on strengthening the pelvic floor muscles may be helpful in improving bladder distention and function.

In conclusion, an under distended bladder can be caused by a range of medical conditions and medications. Recognizing the symptoms and seeking appropriate medical treatment is essential to prevent complications and improve quality of life. If you are experiencing symptoms of an under distended bladder, it is important to consult with a healthcare professional who can diagnose the underlying cause and recommend appropriate treatment options.

Understanding the Eligibility of Bladder Cancer for Disability Benefits

The bladder is an important organ in the human body that stores urine before it is excreted. Under normal circumstances, the bladder should be distended or stretched when it is full, and then it contracts to expel the urine. However, if the bladder is not adequately distended, it can lead to various complications if left untreated.

One potential complication of an under distended bladder is urinary retention. This occurs when the bladder is unable to empty completely, resulting in a build-up of urine. Urinary retention can be acute or chronic. Acute urinary retention is a medical emergency and requires immediate treatment, as it can cause severe discomfort and pain. Chronic urinary retention, on the other hand, can lead to long-term complications such as recurrent urinary tract infections, damage to the bladder and kidneys, and urinary incontinence.

Another potential complication of an under distended bladder is a urinary tract infection (UTI). When the bladder does not empty fully, bacteria can multiply and cause an infection. UTIs can cause symptoms such as frequent urination, a strong urge to urinate, burning sensation during urination, and cloudy or bloody urine. If left untreated, the infection can spread to the kidneys and lead to a more serious condition called pyelonephritis. Pyelonephritis can cause high fever, back pain, and kidney damage if not promptly treated with antibiotics.

In addition to urinary retention and UTIs, an under distended bladder can also lead to bladder stones. These are hard deposits that form in the bladder when urine is not properly expelled. Bladder stones can cause symptoms such as lower abdominal pain, blood in the urine, frequent urination, and difficulty urinating. If left untreated, bladder stones can lead to complications such as urinary tract obstruction and damage to the bladder wall.

To prevent these potential complications, it is important to treat an under distended bladder promptly. Treatment options may include medications to help the bladder contract and empty properly, bladder training exercises to improve bladder function, and surgical intervention in severe cases. Additionally, lifestyle changes such as drinking an adequate amount of fluids, maintaining a healthy weight, and avoiding excessive caffeine and alcohol consumption can help prevent an under distended bladder.

In conclusion, an under distended bladder can lead to various complications if left untreated. These complications can include urinary retention, urinary tract infections, and bladder stones. Prompt treatment is essential to avoid long-term complications such as kidney damage and urinary incontinence. If you are experiencing symptoms of an under distended bladder, it is important to seek medical attention to determine the underlying cause and receive appropriate treatment.

The Role of the Urethra in Carrying Urine from the Bladder

Frequently asked questions.

An under distended bladder can occur due to various reasons. One common cause is obstruction in the urinary tract, such as an enlarged prostate in men or bladder stones. These obstructions can prevent the bladder from fully emptying and lead to chronic under distension. Other causes can include nerve damage or dysfunction, which can interfere with the normal signaling between the bladder and the brain. In some cases, certain medications or medical conditions, such as diabetes or multiple sclerosis, can also contribute to an under distended bladder.

Nerve damage or dysfunction can disrupt the normal communication between the bladder and the brain. This can affect the bladder's ability to contract and relax at the appropriate times, leading to urine retention and under distension. Nerve damage may result from conditions such as spinal cord injury, stroke, or certain neurological disorders.

Yes, certain medications can contribute to an under distended bladder. Some medications, such as anticholinergic drugs, can interfere with the normal muscle contractions of the bladder, leading to ineffective emptying and under distension. Other medications, such as alpha-blockers used for high blood pressure or prostate enlargement, can relax the bladder muscles and hinder the complete emptying of urine.

While lifestyle factors are not a direct cause of under distended bladder, certain habits or behaviors can contribute to the development of this condition. For example, holding in urine for extended periods of time and not emptying the bladder fully can lead to bladder distension and weaken the muscle tone over time. Additionally, inadequate fluid intake or consuming diuretic substances, such as caffeine or alcohol, can affect bladder function and contribute to under distension.

Treatment for an under distended bladder depends on the underlying cause. In cases of obstruction, such as an enlarged prostate or bladder stones, surgical intervention may be necessary to remove the blockage. Nerve damage-related under distension may require medical management, such as medications or interventions to improve nerve function. Lifestyle modifications, such as bladder training techniques and ensuring adequate fluid intake, can also help improve bladder emptying. It is important to consult a healthcare professional to determine the appropriate treatment plan for an under distended bladder.

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• v.2013; 2013

The Case of the Wandering Kidney

David w. sobel.

1 School of Medicine, Tufts University, Boston, MA 02111, USA

Brian M. Jumper

2 Pediatric Urology, Maine Medical Center, Tufts University, Portland, ME 04102, USA

Nephroptosis is a controversial phenomenon well described in the literature. In this case report, we present a patient whose right kidney had “wandered” from its normal anatomic position in the retroperitoneum anteriorly and was in a fixed position anterior to the liver secondary to hydronephrosis. As opposed to the suspected mechanism of nephroptosis, we offer a hydraulic theory as to the origin of the energy required to cause this translocation. The work required to move the patient's kidney was generated by her cardiac output.

1. Introduction

Nephroptosis, or “floating kidney,” is a well-known and controversial phenomenon where the kidneys descend bilaterally by a significant distance (traditionally >5 cm or two vertebral bodies on IVU) upon moving from supine to erect [ 1 ]. Historically, symptomatic nephroptosis has been treated with a multitude of surgical and nonsurgical modalities, including capsulectomy, fixation with sutures, and abdominal binding with restrictive clothing [ 2 ]. More recently, in the twentieth century, nephropexy has been suggested as the definitive therapy for symptomatic nephroptosis. The efficacy of this has been questioned too [ 3 ]. In this case report, we describe a patient whose right kidney had “wandered” from its normal anatomic position in the retroperitoneum anteriorly and was in a fixed position anterior to the liver secondary to hydronephrosis. As opposed to the suspected mechanism of nephroptosis, we offer a hydraulic theory as to the origin of the energy required to cause this translocation.

2. Case Presentation

The patient was an 87-year-old female who initially presented to her primary care provider in May 2010 complaining of increasing abdominal pain and tightness in the central abdomen for two days with associated nausea, vomiting, and anorexia. Her physician sent her to the emergency department for further evaluation. The patient's surgical history included an open appendectomy in 1960 and her past medical history was significant for hypertension, atrial fibrillation, polycythemia rubra vera, and epilepsy. Her urological history was unremarkable. According to the patient, she had similar episodes in the past few years where she felt occasional bloating and the feeling that something was protruding into her scar, but that pain usually passed within a day.

Upon evaluation in the emergency department, the emergency medicine resident noted a “soft, midline mass, which is tender and is incompletely reducible with moderate increase in discomfort.” A healed 5 cm scar was present in the right abdomen. Bowel sounds were increased, and the mass was initially attributed to a ventral hernia causing the patient's symptoms. An acute abdominal series showed no clear signs of obstruction. A CT scan (Figures ​ (Figures1 1 and ​ and2) 2 ) of the abdomen was obtained due to her age and severity of pain and the report from the on-call radiologist noted the following.

Previous CT scan from 2006 (a) and CT scan from 2010; (b) patient presentation in the emergency department depicting new anterior position of right kidney.

Previous CT scan from 2006 (a) and CT scan from 2010; (b) patient presentation in the emergency department depicting crossing vessel (indicated by arrow).

“The right kidney is no longer within the renal fossa as seen in 2006, but has changed position and is now anterior to the liver. There is resultant severe hydronephrosis involving the renal pelvis and proximal ureter. This abruptly changes caliber on axial image 38 and the ureter is not well seen inferior to this level. There is symmetric renal perfusion. High attenuation material is seen dependently within the dilated renal pelvis, this could reflect blood products or stone material.” Additionally, there was no diaphragmatic hernia noted.

The urologist on call was then called at approximately two thirty in the morning to assess the patient, and noted in the documentation the following. “A patient with what appears to be UPJ obstruction on the right side that has developed since 2006 when she had a CT scan demonstrating what looks to be a lower pole crossing the arterial vessel. She has since had progressive obstruction that has pushed her renal pelvis posteriorly and her kidney anteriorly up in front of her liver and has displaced her colon. I am concerned that a full surgical repair would require open surgery in this delicate 88 year old and would suggest that she undergo a cystoscopy and right double-J stent placement to assess how she tolerates that.” Approximately 6 weeks following the emergency department visit, a cystoscopy, bilateral retrograde pyelograms, and right double-J stent placement were performed. This ameliorated her symptoms and the stents were removed in a timely fashion.

The patient was seen recently in followup in June 2013 and she stated that she had an additional episode of abdominal pain similar to her presentation to the emergency department and that manual pressure on her right upper quadrant was successful in reducing the mass and relieving the pain. In followup, the right kidney was palpable but nontender. The patient was scheduled for a routine six-month followup to track her progress. Since then, she endorsed self-treating with manual manipulation of the kidney when it has been painful.

In November 2013, however, the patient again presented to the emergency department with the same abdominal pain. A noncontrast CT scan was performed and the patient's right kidney had now translocated across the midline to a position anterior to her left kidney with extreme hydronephrosis present ( Figure 3 ). The following day, a retrograde pyelogram ( Figure 4 ) was performed showing that the right kidney had moved back to the right lower quadrant. A double-J stent was placed to reduce the hydronephrosis and subsequently her symptoms resolved. She is expected to follow up for repeated imaging and stent removal.

CT scan from November 2013 performed in the emergency department depicting right kidney (indicated by arrow) anterior to left kidney with extreme hydronephrosis.

Right retrograde pyelogram conducted the following day indicating translocated right kidney now in the right lower quadrant with double-J stent in place.

3. Discussion

During the sixth through the ninth week of embryologic development, the kidneys ascend to a lumbar site, just below the adrenal glands. The exact mechanisms responsible for renal ascent are not known, but a combination of embryonic differential growth, vascular supply changes, and regression of transient embryonic structures may all contribute to this phenomenon [ 4 ]. This ascent does not imply that the kidney defies gravity to attain its ultimate position in the body.

Nephroptosis is a common finding caused by muscular contraction of the diaphragm during respirations or by assuming an upright posture, allowing gravitational force to lower the kidney from its usual position. Over the time period from 2006 to 2010, our patient experienced progressive scoliosis and a shortening of her stature. A previous nonobstructing lower pole vessel to her right kidney then caused the compression of her proximal ureter, leading to a hydronephrotic change in her collecting system. This hydraulic lift pushed her kidney to its ultimate position in the right upper quadrant, anterior to her liver as seen on her sequential CT scans. To our knowledge, this “wandering kidney” phenomenon has not been previously described in the literature.

In our patient's condition, the result of her right kidney's journey anterior to her liver was caused by a series of events, which were powered by energy from her heart in the form of cardiac output. For urine production to occur, the glomerular filtration is a product of the series of forces favoring and opposing the process. The main driving force is the hydrostatic pressure in the glomerular capillaries, and the filtration is opposed by the hydrostatic pressure in the glomerular capsule and the osmotic pressure attributable to the plasma proteins [ 5 ]. Thus, without glomerular filtration, urine production, and eventual hydronephrosis, this patient's kidney could not have traveled to this unique location. The work required to accomplish this movement was generated by her cardiac muscles.

Conflict of Interests

The authors declare that there is no conflict of interest regarding the publication of this paper.

• Patient Care & Health Information
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• Overactive bladder

Overactive bladder, also called OAB, causes sudden urges to urinate that may be hard to control. There might be a need to pass urine many times during the day and night. There also might be loss of urine that isn't intended, called urgency incontinence.

People with an overactive bladder might feel self-conscious. That can cause them to keep away from others or limit their work and social life. The good news is that it can be treated.

Simple behavior changes might manage symptoms of an overactive bladder. These might include changes in diet, urinating on a certain schedule and using pelvic floor muscles to control the bladder. There also are other treatments to try.

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If you have an overactive bladder, you may:

• Feel a sudden urge to urinate that's hard to control.
• Lose urine without meaning to after an urgent need to urinate, called urgency incontinence.
• Urinate often. This can mean eight or more times in 24 hours.
• Wake up more than twice a night to urinate, called nocturia.

Even if you can get to the toilet in time when you feel an urge to urinate, having to urinate often during day and night can disrupt your life.

When to see a doctor

Although common among older adults, overactive bladder isn't a typical part of aging. It might not be easy to talk about your symptoms. But if the symptoms distress you or disrupt your life, talk to your healthcare professional. There are treatments that might help.

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How a healthy bladder works

Female urinary system

Your urinary system includes the kidneys, ureters, bladder and urethra. The urinary system removes waste from the body through urine. The kidneys are located toward the back of the upper abdomen. They filter waste and fluid from the blood and produce urine. Urine moves from the kidneys through narrow tubes to the bladder. These tubes are called the ureters. The bladder stores urine until it's time to urinate. Urine leaves the body through another small tube called the urethra.

Male urinary system

The kidneys make urine, which drains into the bladder. When urinating, urine passes from the bladder through a tube called the urethra (u-REE-thruh). A muscle in the urethra called the sphincter opens to release urine out of the body.

In people assigned female at birth, the urethral opening is just above the vaginal opening. In people assigned male at birth, the urethral opening is at the tip of the penis.

As the bladder fills, nerve signals sent to the brain trigger the need to urinate. When urinating, these nerve signals cause the pelvic floor muscles and the muscles of the urethra, called the urinary sphincter muscles, to relax. The muscles of the bladder tighten, also called contract, pushing the urine out.

Involuntary bladder contractions

Overactive bladder happens when the muscles of the bladder start to tighten on their own even when the amount of urine in the bladder is low. These are called involuntary contractions. They cause an urgent need to urinate.

Several conditions may be a part of overactive bladder, including:

• Conditions that affect the bladder, such as tumors or bladder stones.
• Conditions that affect the brain and spinal cord, such as stroke and multiple sclerosis.
• Factors that get in the way of urine leaving the bladder, such as an enlarged prostate, constipation or having had surgery to treat lack of control over urinating, called incontinence.
• Hormonal changes during menopause.
• Urinary tract infections, which can cause symptoms like those of an overactive bladder.

Overactive bladder symptoms also may be linked to:

• Cognitive decline due to aging. This can make it harder for the bladder to use the signals it gets from the brain.
• Drinking too much caffeine or alcohol.
• Medicines that cause the body to make a lot of urine or that need to be taken with a lot of fluids.
• Not being able to get to the bathroom quickly.
• Not emptying the bladder all the way. This leads to not enough space in the bladder for more urine.

Sometimes the cause of overactive bladder isn't known.

Risk factors

Aging increases the risk of overactive bladder. So does being female. Conditions such as enlarged prostate and diabetes also can increase the risk.

Many people with declines in thinking ability, such as those who have had a stroke or have Alzheimer's disease, get an overactive bladder. That's because they're less able to notice the symptoms of needing to urinate. Drinking fluids on a schedule, timing and prompting urination, absorbent garments, and bowel programs can help manage the condition.

Some people with an overactive bladder also have trouble with bowel control. Tell your healthcare professional if you're having trouble controlling your bowels.

Complications

Any type of incontinence can affect quality of life. If your overactive bladder symptoms disrupt your life, you might also have:

• Emotional distress or depression.
• Sexual problems.
• Sleep disturbances and interrupted sleep cycles.

People assigned female at birth who have an overactive bladder also may have a condition called mixed incontinence. This has both urgency and stress incontinence.

Stress incontinence is the sudden loss of urine from physical movement or activity that puts pressure on the bladder. Examples are coughing, sneezing, laughing or exercising.

These healthy lifestyle choices may reduce your risk of overactive bladder:

• Do exercises to make the pelvic floor muscles stronger. These are called Kegel exercises.
• Get regular, daily physical activity and exercise.
• Limit caffeine and alcohol.
• Maintain a healthy weight.
• Manage ongoing, called chronic, conditions, such as diabetes, that might add to overactive bladder symptoms.
• Quit smoking.

Overactive bladder care at Mayo Clinic

• Urinary incontinence. Office on Women's Health. https://www.womenshealth.gov/a-z-topics/urinary-incontinence. Accessed Oct. 6, 2023.
• Bladder control problems. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-control-problems/all-content. Accessed Oct. 6, 2023.
• Ferri FF. Urinary incontinence. In: Ferri's Clinical Advisor 2024. Elsevier; 2024. https://www.clinicalkey.com. Accessed Oct. 6, 2023.
• Lukacz ES. Urgency urinary incontinence/overactive bladder (OAB) in females: Treatment. https://www.uptodate.com/contents/search. Accessed Oct. 6, 2023.
• AskMayoExpert. Male urinary incontinence (adult). Mayo Clinic; 2022.
• AskMayoExpert. Female urinary incontinence and voiding dysfunction (adult). Mayo Clinic; 2023.
• Diagnosis and treatment of non-neurogenic overactive bladder (OAB) in adults: An AUA/SUFU guideline (2019). American Urological Association. https://www.auanet.org/guidelines/overactive-bladder-(oab)-guideline. Accessed Oct. 6, 2023.
• Urodynamic testing. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/diagnostic-tests/urodynamic-testing. Accessed Oct. 6, 2023.
• Hargreaves E, et al. Acupuncture for treating overactive bladder in adults. Cochrane Database of Systematic Reviews. 2022; doi:10.1002/14651858.CD013519.pub2.
• Peyronnet B, et al. A comprehensive review of overactive bladder pathophysiology: On the way to tailored treatment. European Association of Urology. 2019; doi:10.1016/j.eururo.2019.02.038.
• Ami TR. Allscripts EPSi. Mayo Clinic. Oct. 6, 2023.

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Wandering Spleen

Last updated: February 11, 2008 Years published: 1994, 2003, 2008

Congenital wandering spleen is a very rare, randomly distributed birth defect characterized by the absence or weakness of one or more of the ligaments that hold the spleen in its normal position in the upper left abdomen. The disorder is not genetic in origin. Instead of ligaments, the spleen is attached by a stalk-like tissue supplied with blood vessels (vascular pedicle). If the pedicle is twisted in the course of the movement of the spleen, the blood supply may be interrupted or blocked (ischemia) to the point of severe damage to the blood vessels (infarction). Because there is little or nothing to hold it in place the spleen “wanders” in the lower abdomen or pelvis where it may be mistaken for an unidentified abdominal mass.

The spleen is a small organ located in the upper left portion of the abdomen. The spleen removes or filters out unnecessary or foreign material, breaks down and eliminates worn out blood cells, and produces white blood cells, which aid the body in fighting infection. Symptoms of wandering spleen are typically those associated with an abnormally large size of the spleen (splenomegaly) or the unusual position of the spleen in the abdomen. Enlargement is most often the result of twisting (torsion) of the splenic arteries and veins or, in some cases, the formation of a blood clot (infarct) in the spleen.

“Acquired” wandering spleen may occur during adulthood due to injuries or other underlying conditions that may weaken the ligaments that hold the spleen in its normal position (e.g., connective tissue disease or pregnancy).

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• Displaced Spleen
• Drifting Spleen
• Floating Spleen
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• Splenic Ptosis
• Splenoptosis
• Systopic Spleen

Some children with wandering spleen may have no symptoms (asymptomatic), while others may experience acute or chronic abdominal pain. In most cases, episodes of pain may be related to the spontaneous twisting and untwisting of the mobile spleen (torsion and detorsion) or of the blood vessels serving the spleen. Infants with wandering spleen may attempt to relieve pain by stretching. Other symptoms may include a bulging abdominal mass, constipation, bloating, nausea, vomiting, frequent difficult urination, and/or menstrual problems in women.

In some cases, the spleen may lack proper blood supply due to the twisting of the splenic arteries. In these cases, symptoms may include abdominal pain, abnormal enlargement of the spleen (splenomegaly), bleeding into the abdomen (infarct), the accumulation of fibrous tissue in the spleen (fibrosis), and/or decay of splenic tissue (necrosis). In severe cases, blood flow into the spleen is diminished and the spleen may become greatly enlarged, as it accumulates (sequesters) blood elements such as platelets and red blood cells. Resulting symptoms may include fatigue, weakness, blood in the stools, anemia, bloody vomit (hematemesis), and/or an abnormally low level of blood platelets (thrombocytopenia).

In adulthood, wandering spleen most often causes abdominal pain or present as an abdominal mass that does not cause symptoms (asymptomatic).

The exact cause of wandering spleen is not known. Researchers suspect that multiple factors play a role in the development of the disorder (multifactorial).

Babies may be born with a wandering spleen that may be the result of a defect in a certain area of the developing embryo (mesogastrium dorsum). This is the area of the embryo that gives rise to the ligaments that normally hold the spleen in the upper left abdomen. Affected children may be missing one or all of these ligaments, or, if present, the ligaments are not positioned properly. Symptoms usually develop due to the abnormal position of the spleen in the lower abdomen or because of the abnormal enlargement of the spleen (splenomegaly).

Wandering spleen may occur during adulthood because of accident or injury, another underlying disorder (e.g., connective tissue disease), or the abnormal relaxation (laxity) of the ligaments caused by pregnancy.

Affected populations

Wandering spleen, whether it is a condition with which a baby is born (congenital form) or is the result of multiple births in women or some sort of accident that may affect men and women (acquired form), is an extremely rare disorder. Fewer than 500 cases of wandering spleen have been reported in the medical literature.

The incidence of wandering spleen is unknown and, because the condition may be underdiagnosed, is difficult to determine. It usually reported between the ages of 20 and 40 years with sex ratios of 7 females to 1 male. Most women are of reproductive age at the time of presentation. Children make up about a third of all cases, with 30 percent under 10 years of age. Among such children, the male-female ratio is 1:1.

As noted, acquired wandering spleen is acquired usually during adulthood, and it affects females many times more frequently than males. This is probably due to the relaxation (laxity) of the splenic ligaments during the childbearing years. Pregnancy is thought to contribute to the laxity, which increases the frequency of acquired wandering spleen among women who have had children.

Symptoms of the following disorders can be similar to those of wandering spleen. Comparisons may be useful for a differential diagnosis:

Peritonitis is a common disease characterized by the inflammation of the membrane that lines the abdominal wall (peritoneum). It may be caused by bacteria or other infectious organisms that enter the abdomen through a wound or hole (perforation) in one of the abdominal organs (e.g., ruptured appendix). Symptoms may include abdominal pain and rigidity, enlargement of the abdomen, vomiting, decreased bowel function, nausea, and/or an abnormally rapid heartbeat (tachycardia). If not treated, late symptoms may include chills, fever, rapid breathing, and/or shock.

Appendicitis is a common disease characterized by the acute inflammation of the appendix. If left untreated, the appendix may burst and cause peritonitis. The most common symptoms of appendicitis include pain in the lower right abdomen, vomiting, fever, and/or abdominal tenderness and rigidity. Treatment involves the prompt surgical removal of the appendix.

Diverticulitis is a common digestive disorder characterized by inflammation of one or more of the sacs (diverticula) that can form due to protrusion of the inner lining of the colon through its intestinal wall. The major symptom of diverticulitis is pain near the groin in the lower part of the abdomen. Other symptoms may include pain when urinating, constipation, diarrhea or other changes in bowel movements, fever, and/or rectal bleeding. (For more information on this disorder, choose “Diverticulitis” as your search term in the Rare Disease Database.)

Intestinal obstruction is a common condition characterized by the blockage of the intestines and a lack of intestinal motility. This results in the failure of waste (feces) to pass through intestines and be eliminated. The most common causes of intestinal obstruction are adhesions from previous surgery, impacted stools, a narrowing of the bowel because of an inflammatory bowel disease, and/or the presence of a tumor. Symptoms may include a swollen abdomen, severe abdominal pain, nausea and vomiting, and/or constipation.

Cholecystitis is a common disease characterized by inflammation of the gall bladder. This disease, which is usually caused by the presence of gallstones, can be acute or chronic. Symptoms may include ongoing or episodic severe abdominal pain, chills, nausea and vomiting, indigestion, heartburn, gassiness, fever, and/or pain in the chest, shoulder, and back. There may also be some discomfort after eating, an intolerance to fatty foods, and/or a yellowish discoloration of the skin. (For more information on this disorder, choose “Cholecystitis” as your search term in the Rare Disease Database.)

Other common diseases may also have symptoms that are similar to those of wandering spleen. These include pyelonephritis, hiatal hernia, hepatitis, gastric ulcer, gastroenteritis, and/or pancreatitis.

The following disorders may be associated with Wandering Spleen as secondary characteristics. Comparisons are not necessary for a differential diagnosis:

Thrombocytopenia is a condition characterized by abnormally low levels of platelets in the circulating blood. When the spleen becomes enlarged, platelets or other blood elements may be “captured” (sequestered) in the spleen. Symptoms of thrombocytopenia may include excessive bleeding, the tendency to bruise easily, nosebleeds, and/or abnormally heavy menstrual flow in women. If an enlarged spleen (splenomegaly)is not detected in the abdomen, then some people with wandering spleen may be misdiagnosed with other blood disorders that involve low circulating platelets (i.e., autoimmune thrombocytopenia purpura).

Prune belly syndrome is a rare congenital disorder characterized by underdevelopment of the abdominal muscles. The syndrome is associated with a number of intestinal and urogenital abnormalities. Often, the attachments of the muscles to the bones are present, but the muscles are small in size and thickness. Children with prune belly syndrome typically have abnormally large abdomens and the skin may appear loose or lax. The chest may also have a horizontal depression (Harrison groove) or may be very narrow (pigeon breast). Some children with pune belly syndrome may have wandering spleen because of the underdevelopment of the ligaments that normally anchor the spleen in the upper left abdomen. (For more information on this disorder, choose “Prune Belly” as your search term in the Rare Disease Database.)

Other conditions that have been associated with wandering spleen include the absence or abnormal enlargement of a kidney, infectious mononucleosis, malaria, sickle cell anemia, and Hodgkin’s disease. (For more information on these disorders, choose “Malaria,” “Sickle Cell,” and “Hodgkin” as your search terms in the Rare Disease Database or use “splenomegaly” as your search term to find other diseases that include an enlarged spleen.)

The diagnosis of wanderin. spleen is suspected when the pain associated with an abdominal mass can be relieved by moving it toward the upper left quadrant of the abdomen, the normal position of the spleen. Wandering spleen may be confirmed by specialized examinations such as ultrasonography and CT scan that enable the physician to view the structure, size, and placement of the spleen within the abdomen or pelvis. Specialized ultrasound tests (i.e., Doppler studies) may show impaired blood flow in and out of the spleen. Radioisotopic scanning (technetium 99 sulfur colloid scan), another imaging test, allows the physician to determine how well the liver and spleen are functioning. Low spleen function (functional asplenia) may suggest that the organ is damaged as a result of arterial obstruction (infarct).

The treatment of wandering spleen depends on the severity of symptoms and a thorough evaluation to determine the size, location, and functional status of the spleen. Since the spleen helps to maintain the proper function of the blood and immune system, most treatments are aimed at conserving the spleen and maximizing its function. However, since a person can live reasonably well without a spleen, surgical removal is considered.

The most conservative approach to the treatment of wandering spleen includes watchful waiting while observing splenic function and/or enlargement. Prevention of injury by avoiding contact sports or other activities that might threaten the spleen is also a part of the conservative approach.

For children with congenital wandering spleen who are experiencing episodes of torsion and acute pain, the treatment of choice may be surgery that anchors the spleen back in the proper position in the upper left abdomen (splenopexy). In many cases, the spleen can be preserved and the risk of torsion and infarct is reduced. Preservation of the spleen is preferred to removal through surgery because absence of the spleen can make a person vulnerable to certain infections.

If wandering spleen causes chronic abdominal pain, abnormal enlargement of the spleen, and/or deficiencies of one or more necessary blood elements (i.e., thrombocytopenic hypersplenism), the treatment of choice is usually surgery to remove the spleen (splenectomy). Acute abdominal pain associated with wandering spleen is considered a surgical emergency and may require immediate splenectomy.

The potential complications of complete removal of the spleen (splenectomy) may include postsplenectomy infection syndrome, which includes life-threatening bacterial infections (sepsis). People who have had a splenectomy are at higher lifetime risk for serious infections than the general population. Immunizations to boost immunity against haemophilus influenzae B, streptococcus pneumoniae, seisseria meningitis, and other contagious diseases are usually administered before the splenectomy is performed. All people who have had a splenectomy must be observed carefully in case of fever or other symptoms of infection. Antibiotics may be prescribed to help prevent infectious disease (prophylaxis), especially in children under the age of 2 years.

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REVIEW ARTICLES

Benevento A, Boni L, Dionigi G, et al. Emergency laparoscopic splenectomy for wandering pelvic spleen: case report and review of the literature on laparoscopic approach to splenic diseases. Surg Endosc. 2002;16:1364-65.

Satyadas T, Nasir N, Bradpiece HA. Wandering spleen: case report and literature review. J R Coll Surg Edinb. 2002;47:512-14.

Gayer G, Zissin R, Apter S, et al. CT findings in congenital anomalies of the spleen. Br J Radiol. 2001;74:767-72.

Desai DC, Hebra A, Davidoff AM, et al. Wandering spleen: a challenging diagnosis. Douth Med J. 1997;90:439-43.

Horwitz JR, Black CT. Traumatic rupture of a wandering spleen in a child: case report and literature review. J Trauma. 1996;41:348-50.

JOURNAL ARTICLES

Upadhyaya P, St. Peter SD, Holcomb III GW. Laparoscopic splenoplexy and cystectomy for an enlarged wandering spleen and splenic cyst. J Pediatr Surg. 2007;42:E23-E27.

Schaarschmidt K, Lempe M, Kolberg-Schwerdt A, et al. The technique of laparoscopic retroperitoneal splenoplexy for symptomatic wandering spleen in childhood. J Pediatr Surg. 2005;40:575-7.

Brown CVR, Virgilio GR, Vazquez WD. Wandering spleen and its complications in children: a series and review of the literature. J Pediatr Surg. 2003;38:1676-79.

Kim SC, Kim DY, Kim IK. Avulsion of wandering spleen after traumatic torsion. J Pediatr Surg. 2003;38:622-23.

Steinberg R, Karmazyn B, Dlugy E, et al. Clinical presentation of wandering spleen. J Pediatr Surg. 2002;37:E30.

Andley M, Basu S, Chibber P, Internal herniation of wandering spleen/a rare cause of recurrent abdominal pain. Int Surg. 2000;85:322-24.

Peitgen K, Majetschak M, Walz MK. Laparoscopic splenopexy by peritoneal and omental pouch construction for intermittent splenic torsion (wandering spleen). Surg Endosc. 2001;15:413.

Nomura H, Haji S, Kuroda D, et al. Laparoscopic splenopexy for adult wandering spleen: sandwich method with two sheets of absorbable knitted mesh. Surg Laparosc Endosc Percutan Tech. 2000;10:332-34.

Danaci M, Belet U, Yalin T, et al. Power Doppler sonographic diagnosis of torsion in a wandering spleen. J Clin Ultrasound. 2000;28:246-48.

Vural M, Kacar S, Kosar U, et al. Symptomatic wandering accessory spleen in the pelvis: sonographic findings. J Clin Ultrasound. 1999;27:534-36.

Haj M, Bickel A, Weiss M, et al. Laparoscopic splenopexy of a wandering spleen. J Laparoendosc Adv Surg Tech A. 1999;9:357-60.

Kanthan R, Radhi JM. The ‘true’ splenic wanderer. Can J Gastroenterol. 1999;13:169-71.

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The information provided on this page is for informational purposes only. The National Organization for Rare Disorders (NORD) does not endorse the information presented. The content has been gathered in partnership with the MONDO Ontology. Please consult with a healthcare professional for medical advice and treatment.

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