Neurogenic Bladder, commonly known as “Neurogenic Lower Tract Dysfunction”. It collectively defines the number of urinary dysfunctions due to an injury to the spinal cord, brain, and nerves. The urinary bladder is responsible to store and expel urine in a coordinated method provided by the CNS (Central Nervous System) and PNS (Peripheral Nervous System). Nerves present in the body control the urine system from its store to expel from the body. The respective nerves and muscles of the urinary system work together to regulate the normal urinary function of holding and releasing urine when required. Nerves are responsible to carry messages between the brain, spinal cord, and bladder. These messages from nerves inform the muscles to either tighten or release.
In the case of a Neurogenic Bladder, nerves don’t work properly. In the neurogenic bladder, an affected person lacks bladder control.
- Approximately 1.5 million people In the US are affected by neurogenic bladder. (Source: National Institute of Diabetes and Digestive and Kidney Diseases)
- Studies showed a male-female ratio of 3:1 in the population affected by neurogenic bladder. It is more common in men than in women. (Source: National Institute of Diabetes and Digestive and Kidney Diseases)
Causes of Neurogenic Bladder:
Several muscles and nerves work in combination to regulate the usual urinary function. If there is any damage to the nerve, muscles will not be able to perform their task (contract or relax) without the command at the right time.
Complications of Nerve damage:
- Overactive Bladder
- Underactive Bladder
Overactive Bladder:
In this condition, muscles may become overactive resulting in squeezing more often than usual even before the bladder is full. It often leads to urinary incontinence in which urine is often passed before you’re ready.
Underactive Bladder:
In this condition, muscles may become underactive resulting in less or no squeezing when the bladder is full. It often leaves the bladder filled with urine as it won’t fully empty at all.
- In this way, the Sphincter muscles, present around the urethra also do not function properly.
- Some people experience both conditions, overactive or underactive bladder.
Neurogenic Bladder can be congenital (present at birth) or non-congenital:
Congenital- Neurogenic Bladder can be caused by:
- Cerebral palsy: CP is generally known as a Chronic disorder resulting in the overall weakening of the muscles that results in the inability to control body movements and postures. It resulted from the injury to the motor areas of the brain.
- Sacral agenesis: A condition in which some parts of the lower spine are missing.
- Spina bifida (myelomeningocele): In this condition, the spine is not developed completely During the first trimester of pregnancy. This results in weakness or paralysis that affects the function of the bladder.
Non-Congenital medical conditions that can cause Neurogenic Bladder:
- Stroke
- CNS Tumors
- Multiple Sclerosis
- Parkinson’s disease
Other Conditions include:
- Erectile Dysfunction
- Spinal cord injuries
- Spine Surgeries
- Trauma
- Diabetes
- Infection
- Heavy Metal Poisoning
- Accidents causing injuries to the brain and Spinal Cord
Injuries to nerves that supply the bladder can cause the following conditions.
- Neuropathy
- Nerve damage due to high consumption of Alcohol
- Diabetes induced Nerve damage
- Syphilis-induced nerve damage
- Nerve damage due to pelvic surgery/ herniated disc/ spinal canal stenosis
- vitamin B12 deficiency-induced nerve damage
Symptoms Of Neurogenic Bladder:
Symptoms vary from person to person. It also depends on the type of nerve damage. It may include the following.
- UTI (Urinary Tract Infection)
- Leakage of Urine
- Increased frequency of Urine
- Urine dribbles
- Kidney Stones
- Urinary Incontinence (inability to control urine)
- Less Urine Volume
- Urinary Urgency
Diagnosis Of Neurogenic Bladder:
Neurogenic bladder involves the CNS/PNS and the bladder. Therefore to determine the cause of neurogenic bladder, the following steps can be taken.
- Medical History
- Bladder Diary
- Physical Exam
- Pad Test
Other Tests
The other tests include:
- Urine cultures: To test urine for infection or blood.
- Bladder scans: Ultrasound that shows the volume of urine that remains in the bladder after you pass the urine.
- Cystoscopy: A tiny narrow tube is inserted into the bladder through the urethra.
- Urodynamic testing: It shows the performance of the lower urinary tract, and how well it performs its function.
Imaging tests:
Treatment Of Neurogenic Bladder:
Neurogenic Bladder is considered a serious condition. If the proper diagnosis and treatment are done, it can help achieve great achievements in the patient’s condition and quality of life.
Specific treatment for the specific condition of the patient is designed by the healthcare provider based on:
- Age of the patient, overall health, and medical history
- Cause of the nerve injury
- Type of symptoms
- Severity?Complexity of symptoms
- Tolerance for certain drugs, procedures, or therapies
The treatment for neurogenic bladder depends on the cause or symptoms. It also focuses on the prevention of kidney damage. Treatment includes
- Medicines (oxybutynin, tolterodine, mirabegron, solifenacin succinate, and others.)
- Use of catheter to the empty bladder at regular times
- Use of Preventive antibiotics to treat/reduce infection
- Surgical approach to remove stones/ blockages in the passage
- Use of Botox injections into the bladder muscle
- Electrical device approach to stimulate/ slow down the activity of the bladder.
- Changes in lifestyle
- Clean intermittent catheterization (CIC)
- Continuous catheterization
- Bladder augmentation (augmentation cystoplasty)
- Ileal conduit; In this, the urine stoma is made by the part of the small bowel. This stoma helps in draining the urine into a bag that is attached to the outside of the body.
How to prevent wetness and odors in the Neurogenic Bladder?
Following is the list of things that can be used to avoid or prevent wetness and odors. As well as, protect the skin and clothing.
- Pads
- Absorbent undergarments
- Panty shields
- Panty liners
- Adult diapers
- For the protection of sheets and mattresses, Bed pads can be used.