Large bladders that are dilated but not emptying properly are known as atonic bladders. Often called a flaccid bladder, the ailment arises when an underlying medical disease hinders the bladder’s nerves from sending the right signals to the brain. As a result, urine accumulates in the bladder due to nerves’ inability to notify the brain. The end effect is a significantly uncomfortable dilated bladder. Understanding the atonic bladder symptoms and treatment is crucial for managing this condition effectively.

Atonic Bladder Definition

Atonic bladder can occasionally result from the thinning of the detrusor muscle, which permits the bladder to expand and contract and makes up the majority of the bladder wall. The detrusor muscle cannot contract sufficiently to cause this procedure to occur in an atonic bladder. 

An atonic bladder is one of the many bladder problems that can arise from diseases, traumas, or injuries to this muscle. 

Symptoms of an Atonic Bladder

Symptoms of an Atonic Bladder

Weak Urine Stream

A weakened urine stream is a common symptom of an atonic bladder. This can make it challenging to initiate or sustain urination. If the urine stream stops entirely it results in a condition called urinary retention.

Chronic Urinary Retention

Individuals with atonic bladder will suffer from prolonged difficulty in emptying the bladder. Additional issues, like renal damage or infections, may result from this.

Frequent Urinary Tract Infections (UTIs)

Incomplete emptying of the bladder can increase the risk of urinary tract infections. Symptoms may include pain during urination, cloudy or foul-smelling urine, and fever.

Urinary Incontinence

This is the state in which a person’s bladder is full and expanded to its maximum capacity but they are still unable to urinate. In the end, urinary incontinence might result in an uncontrollable leakage of pee.

Bladder Distention

When the bladder can’t empty the urine, it stretches to hold more urine and becomes enlarged, or distended. An overfull bladder might result in localized pain or discomfort. 

What Drug Is Used for Atonic Bladder?

Drugs used for atonic bladder

For a very long time, oybuxtynin has been used to treat Atonic Bladder. It is a frequently used medication in children with atonic bladder and has been demonstrated to be safe and efficacious in this population. 

The FDA has approved bethanechol for the treatment of postoperative urine retention, postpartum urinary retention, and overflow incontinence brought on by atonic bladder. It is helpful for problems associated with nonobstructive urinary retention, as well as its indications, mode of action, and contraindications. 

As an antimuscarinic, tolterodine enhances catheterization volumes and reduces incontinence. and cystometric bladder capacity with less dry mouth.

Trospium chloride has significantly less dry mouth, but it has a similar rise in maximum cystometric capacity (MCC), bladder compliance, and bladder storage pressures.

Difference between Atonic and Spastic Bladder

Atonic (Flaccid) Bladder

Spastic (Hyperreflexive) Bladder

Bladder with weak or absent muscle tone, poor bladder emptying, and retention of urine Bladder with increased muscle tone and involuntary contractions leading to urgency and involuntary leakage of urine
Urinary retention, dribbling urine, frequent urinary tract infections (UTIs), and overflow incontinence are the common symptoms Urinary urgency, frequency, urinary incontinence, and sometimes difficulty initiating urination are its symptoms
It can result from spinal cord injury, nerve damage from diabetes, or neurological conditions like multiple sclerosis (MS) It is often associated with spinal cord injury, multiple sclerosis, stroke, or conditions like Parkinson’s disease

What Causes an Atonic Bladder?

Neurological damage has been linked to atonic bladder, hence it is also known as neurogenic bladder. The body’s nerves regulate how the bladder holds and releases pee. Issues concerning these nerves can lead to a variety of bladder problems such as overactive bladder (OAB), underactive bladder (UAB), and even obstructive bladder. 

Some people’s causes of atonic bladder can be linked to birth abnormalities. 

Spina bifida occurs when the fetus’s spine is not fully developed in the first trimester of pregnancy. This illness frequently results in paralysis that affects bladder function. 

Sacral agenesis, a portion of the lower spine is absent in this disease. It can also be the reason for atonic bladder.

Cerebral palsy is another birth condition that may cause an atonic or neurogenic bladder. 

Damage to the brain’s motor region is the major cause of atonic bladder.

How Do You Test for Atonic Bladder?

physical examination

Testing for atonic bladder involves several diagnostic procedures, which may include:

Medical History and Physical Examination

A thorough medical history is taken, including symptoms, medical conditions, medications, and any previous surgeries. A physical examination may also be conducted to assess neurological function and bladder distension.


A urinalysis may be performed to check for signs of infection, such as the presence of white blood cells or bacteria, and to assess kidney function.

Urodynamic Testing

Urodynamic testing is a series of tests that evaluate bladder function. It may include, Cystometry, Uroflowmetry, Electromyography (EMG), Pressure-Flow Study, Post-Void Residual (PVR) Measurement, Imaging Studies, Cystoscopy, and Neurological Evaluation.

Once a diagnosis of atonic bladder is confirmed, treatment options can be discussed, which may include lifestyle modifications, medication, catheterization, or surgery, depending on the underlying cause and severity of symptoms.

Can an Atonic Bladder Be Cured?

Atonic bladder cannot be cured. Nonetheless, a lot of the time, people can learn how to successfully manage their illness and help avoid complications.

How Is Atonic Bladder Treated?

Atonic bladder is not only usually incurable and frequently progresses, but there are also very few effective treatment options. Treatment options for an atonic bladder may include;


Certain medications, such as cholinergic drugs, can help stimulate bladder contractions and improve muscle tone, thereby aiding in bladder emptying.


Intermittent catheterization or the use of a permanent catheter may be necessary to empty the bladder regularly if the muscles are unable to do so effectively on their own.

Bladder Training

This involves techniques to retrain the bladder to empty more effectively, such as scheduled voiding or techniques to improve muscle control.

Pelvic Floor Exercises

Kegel exercises, which target the pelvic floor muscles, have been shown to enhance bladder control and emptying.

Pelvic Floor Exercises

Electrical stimulation

In some cases, electrical stimulation of the bladder nerves or muscles may be used to improve bladder function.


In severe cases or when other treatments are ineffective, surgical procedures such as bladder augmentation or implantation of a device to stimulate the bladder muscles may be considered.

The appropriate treatment approach depends on the underlying cause of the atonic bladder, the severity of symptoms, and the individual’s overall health. It’s important to consult with a healthcare professional for proper diagnosis and management of this condition.

What’s the Outlook?

Better quality of life

Atonic bladder can significantly impact an individual’s quality of life, affecting their ability to urinate normally and increasing the risk of complications such as urinary tract infections. Early recognition of symptoms and appropriate treatment are essential for effectively managing this condition. 

By working closely with healthcare professionals and implementing a comprehensive treatment plan, individuals with atonic bladder can minimize symptoms and improve bladder function, leading to a better overall quality of life.