Atonic bladder is a condition where the bladder muscles cannot contract fully. This can cause difficulty urinating or completely emptying the bladder. Left untreated, it can lead to complications such as infection.

Doctors may also refer to this condition as an underactive or flaccid bladder. Trauma to, or disorders of, the nerves involved in the reflex arc (the brain, spinal cord, bladder innervation) can lead to atonic bladder.

In some cases, thinning of the detrusor muscle, which is responsible for contracting the bladder, will lead to atonic bladder. The nervous system may also play a role when signals are blocked and do not reach the detrusor muscle.

While there is no cure for atonic bladder, certain behavioral modifications can help someone manage symptoms. In more complex cases, surgery may be beneficial.

This article discusses atonic bladder, including symptoms, causes, diagnosis, treatment, and possible complications. It also answers some frequently asked questions surrounding similar conditions that affect the bladder.

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The detrusor muscle is responsible for contracting the bladder. It makes up most of the bladder wall and allows the bladder to both stretch and contract. When this muscle is affected by disease, injury, or trauma, it can cause various bladder issues, one of which is an atonic bladder.

When a typical bladder needs to empty, the brain signals the detrusor muscle to contract and the urethral sphincter to relax, allowing the person to urinate. When a person has an atonic bladder, the detrusor muscle cannot contract enough to make this process happen.

Symptoms of an atonic bladder may include:

  • Chronic urinary retention: This refers to an inability to completely empty the bladder that lasts for a long time. This can lead to further complications, such as damage to the kidneys or infections.
  • Frequent urinary tract infections (UTIs): Urinary retention can leave stagnant urine in the bladder, leading to bacteria growth and infection. Someone may be at risk of developing frequent UTIs.
  • Overflow incontinence: This occurs when the bladder is full and stretched as far as it can, but the person is still unable to urinate. Ultimately, overflow incontinence can cause urine to leak out in a way the individual cannot control.
  • Bladder discomfort: An overfilled bladder can cause pain or discomfort in the area. However, some causes of an atonic bladder also reduce sensation in this area, which could potentially lead to people who have increasing urinary retention being unaware of any symptoms.

There are several possible causes for atonic bladder, including:

Neurological conditions

Neurological conditions can affect nerve signaling between the bladder and the spinal cord. Conditions may include the following:

Injury and trauma

Nerve injury can lead to an atonic bladder. Possible causes can include the following:

A doctor may use several different urodynamic tests to diagnose atonic bladder. These tests check various bladder functions, assess for damage or injury, and examine urinary retention.

Tests to help diagnose atonic bladder include:

  • Cystometrogram: This test assesses bladder functions, including capacity, pressure, and fullness.
  • Uroflowmetry: This test assesses the amount of urine released from the body and how long it takes to expel urine from the bladder. It can also determine the strength of the detrusor muscle.
  • Ultrasound: This can help doctors visualize how much urine remains in the bladder after urinating. A large amount of urine remaining in the bladder can indicate an atonic bladder.
  • Electromyography: This test uses sensors to measure the electrical activity produced by the detrusor muscle and the nerves around the bladder and urethral sphincters. It can determine whether the nerves and muscles are coordinating correctly.

There is no cure for atonic bladder, but some treatments can help reduce symptoms and the risk of complications.

Behavioral treatments and catheterization

Clean intermittent self-catheterization is a common treatment for bladder conditions that cause urinary retention. It involves inserting a small tube (catheter) through the urethra into the bladder to regularly drain urine throughout the day. This procedure helps reduce the risk of damage caused by stagnant urine remaining in the bladder.

In some situations, self-catheterization may not be suitable. For example, if the individual cannot perform the catheterization. In this case, a doctor may suggest a long-term suprapubic catheter.

Certain routines, habits, and prompts can help manage incontinence and urinary retention symptoms. This might include bladder training.


In some complex cases, a doctor may suggest surgical intervention. Surgery either aims to address the aftereffects of atonic bladder or some of its causes but does nothing for the condition itself.

A 2017 study found that an intervention called sacral neuromodulation may be useful in treating underactive bladder.

Atonic bladder can lead to further complications if left untreated, mismanaged, or due to intermittent catheterization.

Possible complications include:

While there is no cure for atonic bladder, in many cases, individuals can manage their condition through self-catheterization, allowing them to live independently.

In some cases, quality of life can be greatly reduced when the individual cannot manage the condition independently and instead requires a permanent catheter. This is more common among older adults and those otherwise unable to perform self-catheterization.

Below are some commonly asked questions and their answers on the topic.

What is the difference between an atonic bladder and a neurogenic bladder?

Neurogenic bladder is an umbrella term for various bladder conditions related to a brain, spinal cord, or nerve condition. Atonic bladder may fit under this umbrella depending on the cause.

What is the difference between a spastic bladder and an atonic bladder?

“Spastic bladder” is a term that describes an overactive bladder. This condition causes a frequent and sudden need to urinate. It may lead to incontinence, in which the individual cannot manage their bladder. On the other hand, with atonic bladder, the bladder muscles cannot contract enough to expel urine from the bladder.

Can a doctor cure atonic bladder?

There is no cure for atonic bladder. However, in many cases, people can learn to manage their condition effectively and help prevent complications.

Atonic bladder refers to a condition where the detrusor muscle in the bladder loses its ability to contract, making emptying the bladder difficult. It can lead to overflow incontinence, discomfort, and complications such as UTIs.

Various neurological conditions or trauma can cause this condition. Damage to the spinal cord or nervous system can leave the detrusor muscles in the bladder unable to contract and expel urine completely.

Intermittent self-catheterization is the preferred treatment for this condition. However, in cases where this is not possible, doctors may recommend a long-term catheter or surgical intervention.