Neurogenic bladder: symptoms, causes and treatments

The process of emptying the bladder when urinating requires the coordinated work of nerves and muscles. When there is an alteration in the nerves that control this mechanism it is called neurogenic bladder.

Voluntary urine output from the bladder is called urination. On the one hand, it requires the organ to send signals that it is full. On the other hand, the order to empty comes from the nervous system.

Normal bladder function

The bladder has two main functions:

  • Stores urine until full of its capacity.
  • When it's full initiates the urge to urinate and is completely emptied by the action of your muscle.

While full, the bladder should not leak or leak urine. At the end of the voiding, meanwhile, there should be no residual urine.

In people with a neurogenic bladder the balance between storing and emptying is lost. There are two general ways of altering this control:

  • The bladder can become overactive. This presents as a sudden urge to urinate, involuntary passing of urine, or frequent urination.
  • The bladder becomes hypotonic. In these cases, it fills up more than it should because it lost its ability to empty.

What are the causes of neurogenic bladder?

Urine storage and output control mechanisms are delicately balanced with each other. Therefore, muscle or nerve disorders involved can produce a neurogenic bladder.

There are many diseases involved, among which we count the following:

  • Spinal cord injuries.
  • Stroke.
  • Parkinson's disease.
  • Multiple sclerosis.
  • Tumors of the central nervous system.
  • Advanced cases of type 2 diabetes mellitus.

Brain injuries and neurodegenerative pathologies are related to the neurogenic bladder symptom.

Neurogenic bladder symptoms

The most common symptom of this disorder is the inability to control urine output. It can also be presented in the following ways:

  • Difficulty urinating: it involves pushing or straining to start urination.
  • Urinate more frequently: some people go to urinate eight or more times a day, with little volume each time.
  • Weak urine flow: or dripping when finished.
  • Feel urgency: it is the urge to urinate immediately.

Read on: What is polyuria?

How is it diagnosed?

The comprehensive evaluation for a urination problem includes several steps. The first one is a 3-day record. As its name indicates, the schedules and accompanying data of each of the urinations are noted. Then the professional will prescribe complementary methods.

Urodynamic studies

Once the frequency and characteristics of the urine have been observed, urodynamic studies are performed. With them the function of the bladder is evaluated.

As they are more invasive, they are used only if there is accurate suspicion data for neurogenic bladder. Ultrasound provides very valuable information. It measures the capacity, pressure and emptying after urination.

Cystoscopy

If the doctor considers it convenient, he can request a cystoscopy. This test consists of look inside the bladder and urethra. This is in order to see if there is any obstruction to the passage of urine.

Neurological evaluation

Studies of the central nervous system, especially the spinal cord, are also necessary. It seeks to determine if the cause of urinary dysfunction is found there. This is done with a neurologist.

Neurogenic bladder complications

Complications of this disease are related to the inability to control urine. First is the impact of urinary symptoms on quality of life. The urge to urinate and the increase in frequency cause stress and anxiety.

When urine collects and the bladder does not empty completely, urinary infections can occur. Having them repeated favors kidney damage.

Find out more: Foods that can cause kidney stones

What are the treatment options?

The treatment of this alteration should be chosen depending on the cause or the type of neurogenic bladder that is suffered. The main objectives are two:

  • Reduce the pressure of the urinary tract by accumulation of urine.
  • Improve the quality of life of people who suffer from it.

Typically, the treatments for this urine disorder are combinations of the following:

  • Physical therapy: the recommendation is to have a schedule to urinate. This requires keeping track of the hours when fluids were drunk to know when it will be convenient to have a toilet nearby.
  • Medicines: There are no specific drugs for neurogenic bladder, but some can improve muscle contractions.
  • Intermittent catheterization: A tube or catheter that is inserted through the urethra is used to empty the bladder at regular intervals. Strict hygiene measures must be followed to avoid associated urinary infections.
  • Electrical-stimulatory therapy: consists of placing small electrodes on the bladder. When stimulated by the amount of urine they send signals to the brain indicating that it needs to be emptied.
  • Surgery: An artificial sphincter can be placed that closes the urethra and prevents urinary leakage. This sphincter is released manually. There are other reconstruction techniques that help as well.

Repeated urinary infections add a problem to the kidney system, with the possibility of leaving permanent damage.

Neurogenic bladder and differential diagnoses

This disease can produce very diverse symptoms. If you are a woman and you have any of these signs, your doctor should rule out gynecological problems. In fact, many times it is just a urinary tract infection.

In men, the evaluation should include a complete kidney, ureter, and prostate exam. The latter, when it grows, can cause increased frequency or difficulty in urinating. Only the professional and the diagnostic tests will lead us to know the origin of the symptoms.

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