Neurogenic Bladder
What is it?
Neurogenic bladder is a condition in which the
nerves of the urinary system don’t work properly
when the bladder is full. It can lead to different
kinds of problems, including urine leakage if the
muscles holding urine do not get the right
message. For some, the muscles don’t get the
message the bladder is full and its time to let
go. If the bladder becomes too full, urine may
back up into the kidneys, and the extra pressure
causes damage to the tiny blood vessels in the
kidney. Urine that stays too long may also cause
an infection of the bladder or ureters, which are
the tubes that carry urine from the kidney to the
bladder.
Who gets it?
Those at risk for developing neurogenic bladder
problems include being involved in an accident
that causes trauma to the brain or spinal cord,
exposure to heavy metal poisoning, diabetes, and
acute infections. Some patients are born with
nerve problems, which can keep a baby's bladder
from releasing urine, leading to urinary
infections or kidney damage.
What causes it?
Hypotonic (flaccid) neurogenic bladder is
generally caused by damage to the spinal cord due
to congenital causes such as lesions to the spinal
cord. Spastic (contracted) neurogenic bladder is
usually caused by brain or spinal cord damage that
results in paraplegia or quadriplegia. Several
diseases, including syphilis, as well as diabetes
mellitus, brain or spinal cord tumors, stroke, ruptured
intervertebral disk, and degenerating diseases such as
multiple sclerosis and amyotrophic lateral sclerosis
can also cause hypotonic and spastic neurogenic
bladder. What are the symptoms?
Patients with hypotonic neurogenic bladders
have flaccid and distended bladders and constantly
leaking small amounts of urine (overflow
dribbling). In patients with chronic hypotonic
neurogenic bladder, urinary tract infections are
common.
Patients with spastic neurogenic bladders from
upper spinal cord lesions usually suffer from
incontinence. How is it diagnosed?
To diagnose neurogenic bladder, a doctor may
test both the nervous system (including the brain)
and the bladder itself. The doctor may take x-rays
of the skull and spine and do an EEG, a test where
wires are taped to the forehead to sense any
dysfunction in the brain.
The doctor will also test the nerves and
muscles of the bladder, including x-rays of the
bladder and ureters. Other tests may involve
filling the bladder to see how much it can hold
and checking to see if the bladder empties
completely.
What is the treatment?
Treatment for neurogenic bladder depends on the
cause of the nerve damage and the type of voiding
dysfunction that results. If the problem is
urinary retention (the bladder does not know when
to let go), it may be necessary to use a catheter
to empty the bladder at regular times. A catheter
is a thin tube that can be slid through the
urethra up to the bladder.
In the case of incontinence, the doctor will
choose from a range of treatments depending on the
cause of leakage. Certain drugs may help the
bladder stay relaxed and store urine longer, or an
artificial sphincter may be necessary to stop the
flow of urine. Permanent urinary diversion is
rarely needed but may be considered if kidney function
is deteriorating or if social circumstances or
quadriplegia prevent the use of a catheter.
Self-care tips
Patients diagnosed neurogenic bladder usually
don’t totally recover. However, appropriate
treatment may produce excellent results.
Distinguishing between the hypotonic and the
spastic neurogenic bladder is important because
these conditions are treated differently. A
patient diagnosed with neurogenic bladder will
need continued monitoring for urinary tract
infections and kidney function.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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