What is an atonic bladder?

An atonic bladder, sometimes called a flaccid or acontractile bladder, refers to a bladder whose muscles don’t fully contract. This makes it hard to urinate.

Usually, when your bladder fills with urine and stretches out, it sends two signals to your spinal cord:

  • a sensory signal that gives you the urge to urinate
  • a motor signal that makes your bladder muscles contract

Someone with an atonic bladder might sense that they need to urinate, but they’re unable to because their bladder muscles won’t contract. As a result, your bladder can overflow with urine, causing leakage and discomfort.

Read on to learn more about atonic bladders and how they’re treated.

The main symptom of an atonic bladder is urine spilling out of your bladder. This is known as overflow incontinence. When this happens, you frequently leak urine, but your bladder never fully empties.

Having a constantly full bladder may also cause discomfort. However, depending on the underlying cause, some people with an atonic bladder don’t have much sensation in their bladder wall.

Several things can cause an atonic bladder, including neurological conditions, injuries, or obstruction.

Neurological conditions

Any condition that damages the local sensory nerves from your bladder to your spinal cord can cause an atonic bladder. This usually involves a disease that destroys the lower part of your spinal cord or the nerves coming from it.

Some conditions that can cause an atonic bladder include:


Injuries to your bladder wall or spinal cord can also result in an atonic bladder. These can be the result of many things, including:

  • traumatic injuries, such as a hard fall or collision
  • long or difficult vaginal childbirth
  • pelvic surgery


Any kind of blockage or obstruction in your bladder can also make it hard for your bladder to contract. When this happens, urine can’t leave your bladder, even when your bladder contracts.

When this happens repeatedly for a long period of time, it can stretch out your bladder muscles, making it harder for your bladder to sense when it’s full.

Some common causes of bladder obstruction include:

If you think you might have an atonic bladder, make an appointment with your doctor. There are several tests they can do to diagnose an atonic bladder, including:

  • Cystometrogram. This test shows the size of your bladder, how much pressure its muscular wall can produce, and how well it empties. Atonic bladders are larger and don’t produce much pressure.
  • Electromyogram. This tests your bladder’s muscle tone and ability to contract. An atonic bladder will have little to no tone or ability to contract.
  • Ultrasound. This imaging test will show how much urine is left in your bladder after you try to urinate. An atonic bladder will still have a large amount of urine in it.
  • Pelvic MRI scan. This imaging test can help your doctor check for any damage to your spinal cord or nearby nerves.

In most cases, there’s no cure for an atonic bladder. Instead, treatment focuses on removing urine from your bladder in other ways to avoid complications.

Nonsurgical treatment

Your doctor might suggest inserting a catheter. This is a flexible tube that goes into your bladder to release urine. You’ll need to use a catheter four to eight times a day. Your doctor can show you how to do it on your own at home.

In addition, certain lifestyle changes can help to reduce the amount of urine you produce. For example, avoiding carbonated beverages and coffee can reduce the number of times you need to insert a catheter throughout the day.

You can also try wearing absorbent undergarments to help manage overflow incontinence.

Surgical treatment

If other treatments don’t work or you can’t use a catheter, your doctor might recommend surgical treatment, including:

  • Suprapubic catheter. This is a permanent catheter that goes through your skin and into your bladder. It’s attached to a bag that has to be emptied regularly.
  • Urinary diversion. This procedure creates a new path for your urine to leave your body. It’s rerouted so it exits through a hole in your abdomen into a pouch that you’ll need to empty as needed.
  • Cystoplasty. This procedure uses surrounding tissue to enlarge your bladder. This lets your bladder hold more urine, meaning you won’t have to insert a catheter as often. It can also help to reduce overflow incontinence.

Left untreated, an atonic bladder can cause several complications. These are all due to a buildup of stagnant urine, which can harbor lots of bacteria over time.

Possible complications from an untreated atonic bladder include:

Having an atonic bladder can be uncomfortable, especially because there’s no cure. However, your doctor can help you manage the condition and empty your bladder. While it can take some time to get used to, many people find that self-catheterization becomes much easier over time. If you’re unable to keep using a catheter, talk with your doctor about surgical treatment options.