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What is Bladder Trabeculation?

Medically Reviewed by Dan Brennan, MD on June 09, 2021

Bladder trabeculation happens when the walls of the bladder thicken, making them harder to contract. When that happens, it’s harder for people to completely empty their bladder when they urinate. 

Bladder trabeculation can occur in both men and women. The leading cause is an obstruction to the urethra. 

Causes of Bladder Trabeculation

The bladder is a hollow, triangle-shaped organ in your lower abdomen. Other organs and ligaments attached to the bones in your pelvis hold it in place. Your bladder walls typically expand to store urine, then contract to push urine out through your urethra and expel it from your body.

When something blocks the urethra, like a kidney stone, it can slow down or stop urine from getting out. Your bladder walls must work harder as your bladder tries to force out urine. This causes the bladder walls to thicken. That thickening of the bladder walls is called trabeculation. 

When your bladder walls get too thick, they lose the ability to expand and contract, making it hard for your body to expel urine. 

Bladder trabeculation can be caused by other health conditions, such as blood clots. People who have blood clots may have trouble urinating when the clots harden. This puts pressure on the bladder walls, causing them to thicken.  

Bladder trabeculation in children. Bladder trabeculation in children can be caused by congenital bladder conditions (conditions that they are born with). Certain valves within the urethra can narrow or block the ureter or urethra, causing bladder trabeculation. 

Bladder trabeculation can also be caused by other conditions, including:

  • Polyps (large, benign growths found on body tissues)
  • Tumors (abnormal tissue mass)
  • Muscle or nerve disorders
  • Ureter (the tube carrying urine from the kidneys to the bladder) bulging into the bladder
  • Fecal impaction (large mass of hard stool trapped in the colon)

Bladder trabeculation in men. Benign prostatic hyperplasia (BPH) in men can block the flow of urine. That can eventually cause trabeculation in the bladder. 

The condition typically affects men over 50 years old. Problems urinating are often the first sign men experience when they have trabeculation caused by BPH.

Men can also develop bladder trabeculation after having laser treatment for an enlarged prostate. This procedure can cause blood clots to form within the bladder.   

Bladder trabeculation in women. Women can experience a severe form of pelvic organ prolapse, which can cause lower urinary tract issues. Many women who have this disorder end up developing bladder trabeculation and other problems. This keeps them from experiencing normal urine flow. 

Older women may have a greater risk of developing bladder trabeculation because they more often have severe pelvic organ prolapse.

Women can also develop hydronephrosis, or swelling, of the kidneys during pregnancy when the growing uterus puts pressure on their ureter. Other hormonal changes during that time can also cause hydronephrosis. 

Hydronephrosis lowers the number of muscle contractions that typically help move urine out of the body. 

While these conditions usually clear up after pregnancy, they can both put pressure on the bladder walls and potentially lead to bladder trabeculation.

Diagnosing Bladder Trabeculation

Your doctor will typically diagnose bladder trabeculation by measuring the thickness of your bladder walls. A bladder that measures more than three millimeters when swollen and greater than five millimeters when normal is considered trabeculated.

Treating a trabeculated bladder typically involves treating the cause of the obstruction. For men who have BPH, that starts with getting a diagnosis from a doctor. The doctor typically will do a physical exam that includes: 

  • A digital rectal exam
  • Urine and blood tests
  • A prostate-specific antigen (PSA) blood test

Your doctor may also test your urinary flow and have you track how often you urinate in 24 hours. 

Diagnosing the cause of a urinary tract blockage as soon as possible is important to prevent other complications besides bladder trabeculation. Your doctor may perform a bladder catheterization or other imaging tests to figure out why you have trouble urinating. They will likely ask you about other symptoms you may be having, including:

  • Pain in the lower abdomen
  • Discomfort in the back
  • Blood or pus in the urine
  • Fever
  • Kidney pain

‌Your doctor may also perform an endoscopy to view your urethra, prostate, and bladder. They may also insert a long, flexible endoscope, called a ureteroscope, to examine your kidneys for potential obstructions. 

Treating Bladder Trabeculation

If your doctor diagnoses you with BPH, they may recommend medication to reduce the size of your prostate. If that doesn’t work, they may recommend minimally invasive prostate surgery.

If a cancerous tumor or another blockage is causing your bladder trabeculation, your doctor may recommend other medical procedures to treat your obstruction. 

If your bladder trabeculation is caused by pregnancy, then you may not need treatment after you deliver your baby.

WebMD Medical Reference

Sources

RESOURCES:

Canadian Urological Association Journal: “Case series: Bladder clot evacuation using a prostate morcellation device.”

Johns Hopkins Medicine: “Anatomy of the Urinary System.”

Journal of the Anatomical Society of India: “Histomorphology of trabeculated urinary bladder – A cadaveric report.”

Mayo Clinic: “Benign prostatic hyperplasia (BPH).”

Medscape: “Benign Prostatic Hyperplasia (BPH).”

Menopause: The Journal of the North American Menopause Society: “Significance of bladder trabeculation in postmenopausal women with severe pelvic organ prolapse: clinical and urodynamic assessments.”

Merck Manual Consumer Version: “Urinary Tract Obstruction.”

Radiopaedia: “Bladder wall thickening (differential).”

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