5 Facts about Neurogenic Bladder Treatment

5 Facts about Neurogenic Bladder Treatment

What is a Neurogenic Bladder?

It is a medical condition characterized by lack of bladder control due to some lesion of the brain, spinal cord or nerves. The urinary bladder is present in the lower abdomen and performs two important functions:

  • Storage of urine
  • When it is full of urine, an urge to urinate is felt and it empties without any leakage

If it is unable to empty fully or it empties before a person reaches the proper area, the urination is said to be abnormal. When diseases of the nervous system influence bladder control, it is termed as a neurogenic bladder. This gives rise to two main types of bladder control problems depending upon the nerves involved and the nature of the damage:

Overactive bladder (spastic or hyper-reflexive) - patients having overactive bladder have little or no control of urination. Such patients feel a sudden urge to urinate and they go to bathroom more often than necessary. An overactive bladder can cause urinary incontinence.

Underactive bladder- patients with underactive neurogenic bladder lose the ability to empty their  bladder properly and it fills more than its capacity. When pressure in the bladder increases above its capacity to bear, urine leaks out of it. So underactive bladder is unable to empty completely and hold urine over time1-3,5.

 

Dr. Jose Sotolongo discusses this condition, its causes and treatment options.

Causes

Bladder control is normally achieved by proper working of several muscles and nerves together. Damage to nerves by illness or injury may result in inability of muscles to tighten or relax at the right time. Several disorders of the central nervous system can lead this health problem:

  • Alzheimer’s disease
  • Brain tumors
  • Spinal cord tumors
  • Spinal cord birth defects
  • Cerebral palsy
  • Viral encephalitis
  • Attention deficit hyperactivity disorder
  • Multiple sclerosis
  • Erectile dysfunction
  • Spinal cord surgery
  • Heavy metal poisoning
  • Parkinsonism
  • Spinal cord injury can lead to both a neurogenic bowel and bladder.
  • Stroke recovery

Diseases of nerves supplying the bladder can cause this such as:

  • Diabetic neuropathy
  • Alcoholic neuropathy
  • Pelvic surgery leading to nerve damage
  • Nerve damage from herniation5

Clinical features

Sign and symptoms can depend upon its cause. Clinical features of an overactive bladder include:

  • Urinary frequency- urinate too often in small amounts
  • Inability to the empty all the urine from the bladder
  • Loss of bladder control

Clinical features of underactive bladder include:

  • Excessive fullness of bladder beyond its normal capacity
  • Leakage of urine out of bladder when it is filled beyond its normal capacity
  • Inability to inform when the bladder is full
  • Difficulty in starting urination or emptying all the urine from the bladder
  • Urinary retention

Investigations

The following tests are performed to diagnose this condition:

Bladder function tests- these tests measure bladder capacity, bladder pressure, urinary flow, and bladder emptying.

Cystoscopy- it can be performed to visualize the inside of the bladder.

Brain and spinal cord can be examined with the help of X-Rays, CT-scan and MRI1.

Treatment

The following are the available options for neurogenic bladder treatment 2,3,5:

Physical psychological therapy- patients are advised to keep a voiding diary, i.e., a record of oral intake and urine output, frequency of urination each day and leakage of urine. This recording process makes a pattern that can help the patients to determine the times of the day they should be near a bathroom, and the times when they must attempt to urinate. In this way, periods of time between urination slowly get longer and longer as they gain control over urination.

Electrical stimulatory therapy- in this procedure, electrodes and a small stimulator are kept close to different nerves via minor surgery.  The stimulator sends electrical currents that imitate those that are delivered by normal nerves. This therapy can be used for urinary frequency and urinary retention.

Medications- various drugs can be used to decrease muscle spasms, tremors and to increases the contractions. These are:

  • Antispasmodic agents- used to inhibit excessive bladder contractions. Tolteridine tartrate and oxybutynin chloride relax the smooth muscle of the bladder.
  • Antidepressants- amitryptiline is used to reduce contractions and to relax the smooth muscles found in the bladder walls.
  • Estrogen- used in post-menopausal women for mild to moderate stress incontinence.

Intermittent self catheterization- in this procedure catheters are inserted via the urethra and into the bladder to drain urine.

Surgery– surgical procedures that can be considered for this condition include:

  • Artificial sphincters- for bladder control
  • Urinary diversion- makes an opening through which urine is diverted to a collection pouch.
  • Bladder augmentation- segments of sigmoid colon are removed and attached to the walls of the bladder. This decreases the bladder’s pressure and increases its capacity to store urine.
  • Urethral stents
  • The sphincter can be surgically weakened by sphincter resection4.

Phoenix Children’s Hospital provides a very informative video about neurogenic bowl and bladder surgery

Behavioral changes- several behavioral or life style changes may also help the patients with such abnormality:

  • Control of fluid intake- do not drink a lot of fluids
  • Diet- do not use spicy food, citrus fruits, and caffeinated beverages
  • Exercise- exercises help strengthen the pelvic muscles and may help decrease incontinence4,5

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References:

  1. Flower CJ. Investigation of the neurogenic bladder. J Neurol Neurosurg Psychiatry 1996;60(1):6-13.
  2. Swartz D, Stephenson E. The neurogenic bladder in spinal cord injury. Can Med Assoc J 1957;76(6):462-5.
  3. [internet]. [last updated 2012 May11; cited 2013 Aug 21]. Available from: http://my.clevelandclinic.org/disorders/neurogenic_bladder/hic-neurogenic-bladder.aspx.
  4. Jamil F. Towards a catheter free status in neurogenic bladder dysfunction: a review of bladder management options in spinal cord injury (SCI). Spinal Cord 2001;39(7):355-61.
  5. [internet]. [last updated 2012 May 21; cited 2013 Aug 21]. Available from: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001761/.

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