Q1. What is neurogenic bladder?
|
Q2. What are the signs and symptoms of neurogenic bladder?
|
Q3. How is neurogenic bladder diagnosed?
|
Q4. How is neurogenic bladder managed and/or treated?
|
| ............................................................................................................................................................................................... |
| |
|
| Q1. |
What is neurogenic bladder? |
| A1. |
Neurogenic bladder is a term used for a dysfunctional lower urinary tract, resulting due to causes other than primary urinary tract pathology.
Except in infants and small children, who have automatic and involuntary passing of urine, the act of passing urine is completely voluntary. Urination is initiated when a person wants to pass urine, and can be controlled if the situation is not conducive. The passing of urine should be free, without the need to strain, and should empty the urinary bladder each time urination takes place.
When the bladder keeps filling, the sphincters tighten and prevent the leakage of urine. When the bladder contracts to empty, the sphincters open to let urine out. These work in an extremely coordinated manner. Any condition other than this – such as any involuntary leakage of urine or difficulty to urinate – is abnormal and needs evaluation. Difficulty to pass urine or leakage of urine can be a major social handicap or a problem for others.
The passing of urine, or the control of urination, is regulated by the central nervous system. Messages from the brain are sent through the spinal cord, and the lumbar and sacral nerves, to the bladder and the sphincters.
This control is lost if the spinal cord or its nerves are damaged, or the normal functioning of the brain itself is affected. The bladder may then lose sensation, and fail to empty. Or it may overwork – the sphincter may or may not open appropriately.
Diseases such as Parkinson's, Alzheimer's, large cerebral haemorrhage, dementia, spinal cord injury / tumours / transverse myelitis, diabetes mellitus or injury to the nerves by surgery, etc., may all cause a neurogenic bladder. |
| |
..................................................................................................................................................................................... |
| Q2. |
What are the signs and symptoms of neurogenic bladder? top |
| A2. |
Retention of urine, inability to control urination (frequency and urgency), urinary incontinence, loss of bladder sensation, etc. – one or more of these signs and symptoms are shown by patients with neurogenic bladder. Disturbance of bowel control is also very common. These signs and symptoms are in addition to the general symptoms of neurological injury such as coma / paralysis, etc.
While the physical disabilities may seem very frightening, they are usually not life-threatening. But bladder dysfunction, while not very overt, is usually the cause of severe morbidity, renal failure and even mortality. It is often neglected due to a lack of awareness of its ill-effects. |
| |
.................................................................................................................................................................................... |
| Q3. |
How is neurogenic bladder diagnosed? |
| A3. |
The clinical diagnosis of a neurogenic bladder is made on the basis of certain simple and preliminary tests such as urine analysis, an ultrasound evaluation, and tests that document the degree of change in the urinary tract. |
| |
..................................................................................................................................................................................... |
| Q4. |
How is neurogenic bladder managed and/or treated? |
| A4. |
The focus in managing a neurogenic bladder is to prevent renal damage. Renal damage occurs due to greatly increased pressures in the bladder, causing pressure being exerted backwards on to the kidneys, resulting in their slow damage without symptoms in the early stages. They also develop urinary tract infection, stones, etc.
All treatment will therefore be aimed to reduce these bladder pressures. A normal urination may or may not be achieved, but this is not important. If, in the process of treatment, this is achieved, it is a bonus.
The treatment options will be decided after performing a test called a urodynamic study. This is similar to the ECG study of the heart function. It is performed by passing various small catheters of different sizes into the urinary passage and the rectum. This test also measures the activities of the sphincters. All of these are studies performed on a computer.
The treatments for neurogenic bladder are: top
-
Clean Intermittent Self-Catherisation (CISC) for Men and Women: is the simplest of treatment that teaches patients to pass a catheter themselves, every 4-6 hours, depending upon the urine volumes, to keep the bladder empty and also to prevent incontinence.
-
Pacemaker: A new form of treatment, which involves the placement of a pacemaker at the level of a spinal cord, is now being tried out in India. Selected patients do extremely well with this form of treatment.
-
Medical Treatment: Medicines are also used to reduce the pressures in the bladder. Usually, the tablets will have to be taken for a lifetime, until alternative therapies can be instituted.
-
Bowel Management: Management of neurogenic bladder must also include bowel management as an integral part of the treatment. This may include change in the dietary fibre, enemas, digital evacuation of stools, etc.
-
Surgery: is performed either to reduce the pressures in a bladder by adding other body tissues resulting in an increase in capacity, or by inserting an artificial sphincter to prevent a constant leak of urine. Surgery is resorted to only if all other measures have failed. |
| |
top
| |
