Bladder exstrophy is a congenital condition that affects a baby’s urinary system. It occurs when the bladder develops outside of the belly. Most babies with bladder exstrophy need surgery within the first few days of life. Children who receive treatment usually develop as expected and don’t have any activity restrictions.
Bladder exstrophy (ex-strUH-fee) is a congenital urinary abnormality in which a fetus’s urinary bladder develops outside the body. “Congenital” means the condition occurs during fetal development. The bladder can’t hold pee or function as expected, which causes urinary incontinence.
In newborns with bladder exstrophy, the skin and pelvis don’t join as expected. As a result:
Bladder exstrophy affects a baby’s urinary system. Typically, when your bladder fills with pee, nerve signals tell your brain that your bladder is full. Your bladder muscles contract (squeeze) and force pee through a tube from your bladder to the outside of your body (urethra).
With bladder exstrophy, the cloaca (clo-AY-ka) doesn’t develop as it should. The cloaca is the area where the reproductive, digestive and urinary organs come together. Babies with bladder exstrophy empty pee through an opening in their abdomens instead of through their urethras.
Babies who have bladder exstrophy have a typical life expectancy.
Bladder exstrophy is one condition in a group of congenital conditions (birth defects) that healthcare providers call bladder exstrophy-epispadias complex (BEEC). Some babies have one type of BEEC at birth. Others have multiple BEEC conditions.
Other types of BEEC include:
Yes, bladder exstrophy is rare. It affects around 1 out of every 50,000 newborns.
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The main symptom of bladder exstrophy is that the bladder sticks out (protrudes) through an opening in your child’s belly. But bladder exstrophy can also lead to other symptoms, including:
In some cases, babies may also have an inguinal hernia or umbilical hernia. Hernias occur when part of the intestines bulge out of the abdominal wall. Hernias usually require surgery to put the organs back in the correct place.
Healthcare providers and medical researchers aren’t exactly sure what causes bladder exstrophy. But there’s some evidence that genetics and environmental factors may play a role.
Risk factors for bladder exstrophy include:
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If you don’t treat bladder exstrophy, your child will leak pee. With treatment, some children have ongoing challenges with their bladders or kidneys, including:
They’re also at an increased risk of developing the following conditions later in life:
People AFAB who had bladder exstrophy are also more likely to have high-risk pregnancies. You’ll likely need to deliver your baby through C-section.
People AMAB often need assisted reproductive technology (such as IVF) to have biological children.
Yes, people AMAB who had bladder exstrophy can have biological children.
In a baby born with bladder exstrophy, the bladder typically sticks through the abdominal wall at birth. Healthcare providers may use imaging tests such as an MRI (magnetic resonance imaging) or X-ray to confirm bladder exstrophy and check for other problems.
Providers may spot bladder exstrophy during an ultrasound or fetal MRI before birth. Signs that your baby may have bladder exstrophy include:
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Babies who have bladder exstrophy at birth need surgery.
Sometimes, babies have one surgery to close the abdomen and repair the urethra. This happens in the first few months of life.
Other times, they may have a three-step surgery process:
Surgery is the only way to treat bladder exstrophy. The type and number of surgeries your baby needs will depend on the severity of their symptoms. Your baby’s surgeon will explain the best approach for your baby’s needs. As your child grows, they may need additional surgeries so they can hold their pee until it’s time to use the bathroom.
No, biological parents can’t prevent bladder exstrophy because there’s no apparent cause. If you have known risk factors, be sure to speak with a healthcare provider about potential testing and treatment plans.
Most babies have good long-term outcomes if they have surgery to treat bladder exstrophy. Most children who receive treatment can run, play or do any other typical activities without problems.
Some children may need additional surgeries as they grow. If your child develops kidney infections or kidney stones, their provider will treat them as necessary.
Bladder exstrophy isn’t life-threatening. Children with bladder exstrophy have an average life span.
You may want to ask your provider:
Epispadias commonly associates with bladder exstrophy.
If your child has a penis, epispadias will cause it to be shorter, wider and curve up (congenital penile curvature, or chordee). The urethral opening (meatus) also forms at the top of their penis instead of the tip.
If your child has a vagina, epispadias will cause the urethra to form between their clitoris. In addition, the clitoris can’t connect in the middle because their pubic bones are separate, and the folds of skin outside of their vagina (labial folds) don’t form as expected.
A note from Cleveland Clinic
One of the biggest fears for most parents is learning that their child has a congenital condition. You may cycle through many different emotions, including fear, anxiety and self-blame. These are normal feelings. But it’s important to remember that you didn’t do anything wrong — bladder exstrophy happens sometimes, and healthcare providers aren’t sure why. Give yourself time to understand and accept the condition. Treatment has a good success rate, and bladder exstrophy shouldn’t prevent your child from enjoying typical childhood experiences. Healthcare providers understand your feelings. They’re available to support you and offer advice every step of the way.
Last reviewed on 08/21/2024.
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Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy