Neurogenic bladder is a term that is used to refer to a whole complex of various disorders associated with urination. These disorders are united by only one reason, which is a violation of the functioning of the nervous system. In this case, the part of the system that is responsible for the excretion of urine is disrupted. As in cases with other diseases of the nervous system, this pathology can occur in all people, regardless of age. We will talk about the treatment of neurogenic bladder in this article.
General information about the disease
Only two types of this pathology are distinguished: hyporeflex and hyperreflex. Each of these forms is determined by the state of the detrusor. The development of an ailment, the symptoms of which cause a lot of inconvenience to patients, is diagnosed through a list of all kinds of medical studies. Firstly, neurological and urological examinations are prescribed. Therapy of a neurogenic bladder is carried out through medication and non-medication, sometimes doctors resort to catheterization, and in other cases, the intervention of surgeons is required.
Doctors encounter this dysfunction quite often, and it can manifest itself in the absence of the ability to carry out voluntary reflex accumulation with the release of urine. This is primarily provoked by functional, and in addition, organic lesions of the nerves, as well as the centers that are responsible for controlling such processes.
What is accompanied by pathology?
The presence of a neurogenic bladder, the causes of which are far from always clear, is accompanied by various disorders that cause a person to abandon many social activities and life's joys, thus violating his relationship with society.
Often, against the background of the development of neurogenic bladder dysfunction, experts observe signs of venous stasis in the pelvic area. Often with it, various changes in the functioning of the urinary system occur, which are dystrophic or inflammatory in nature. For example, this occurs with pyelonephritis and ureteral reflux, which provokes severe pathologies such as chronic renal failure, arterial hypertension, and nephrosclerosis. Next, we find out what are the main reasons for the development of this pathology.
Causes of the syndrome
The cause of this pathology is often a malfunction that occurs at one of the levels of regulation of the urethra. Among the adult population, this syndrome often occurs against the background of injuries of the spinal cord, and in addition, the brain, which are caused by stroke, surgical interventions, compression or fractures of the spine. Also, a cause of a neurogenic bladder (ICD N 31.2) may be certain diseases of the nervous system, mainly of inflammatory or degenerative nature. It happens that the cause is a tumor, for example tuberculoma, along with polyneuropathy, which has a post-vaccination, diabetic or toxic origin. Cholesteatomas along with disseminated encephalomyelitis, encephalitis, or polyradiculoneuritis are also often causes.
Neurogenic bladder in children is very often detected. Such a pathology can be a consequence of birth trauma or a congenital disorder in the urinary organs. In addition, the cause of this syndrome in children can be congenital problems with the nervous system. After a disease of a neurological nature, and in addition, after cystitis, the elasticity of the bladder may decrease, and at the same time, its capacity will decrease. Similar processes provoke his incontinence.
Symptoms of pathology
The most common symptom of a neurogenic bladder that occurs when there are injuries that are localized above the center, doctors consider constant urination, which occurs more often than in healthy people. Stranguria may also occur, which is rapid and difficult urination, in which pain is observed. Imperative urinary incontinence is not excluded.
In the manifestation of the symptoms of this pathology, there is no established system. This factor in particular affects the social activity of sick people who are constantly forced to feel awkward and afraid when appropriate symptoms occur. It is worth noting that such symptoms always appear at the most inopportune moment.
Such symptoms are a manifestation of the loss or reduction of voluntary control over the process of urination. This also indicates the extinction of the adaptive functions of the detrusor. Against the background of neurogenic dysfunction, the required amount of urine does not accumulate in the bladder, and an independent urinary act is preserved.
Symptoms of the disease in the presence of a lesion over the sacrum
In the event that the center of the lesion falls on the area above the sacrum, detrusor hyperreflection may occur. Often there is imperative urinary incontinence, for example, this is possible with cerebral disorders. A feature of spinal damage lies in the fact that the reticulospinal canals suffer, which play an important role in the process of synergistic integration of the detrusor, and in addition, the urethral sphincter. In this regard, an involuntary process of contraction of the urethral sphincter occurs. Against this background, urination may be delayed and pressure inside the bladder itself increases.
With such pathologies of the spinal cord, frequent urination may occur. In addition, there are mandatory urination. Thus, imperative urinary incontinence is not ruled out, against which stranguria is observed. An equally popular sign of a neurogenic bladder (according to ICD 10 we already mentioned its code) is intermittent urination, which passes at intervals. During a jet interruption, a person experiences pain in the perineum and lower abdomen. In this situation, the bladder may not empty completely. Remaining urine leads to various inflammations that form in the bladder and its pathways. In the presence of such lesions, the striated sphincter may not completely relax, in connection with which it causes paralysis in people. Such paralysis leads to urinary incontinence of a sphincter nature.
Symptoms of the disease in the presence of lesions in the sacrum
In cases where the lesion is formed directly in the sacral region, the reflex contraction fades. In addition, the striated sphincter loses its ability to contract. In such situations, the patient may urge to urinate. In the event that, against the background of a lack of urges, the patient does not carry out forced emptying, then the bubble may overflow and urinary incontinence will occur. It may also be difficult to urinate, which will be expressed as a thin stream, but the bladder will not be able to empty completely. In the case of a sacral lesion, a neurogenic bladder, the therapy of which was not completed on time, can be the cause of various diseases, and in addition, disorders. An example of such disorders is the development of vesicoureteral reflux, chronic kidney failure, and pyelonephritis.
I must say that serious violations are observed with any denervation of the bladder. Bladder neurogenic dysfunction in children and adults can often be combined with cystitis, which causes sclerosis of the bladder, and in addition, its wrinkling. In the event of such a complication, it is often necessary to resort to an increase in the size of the bladder through surgery.
Diagnostics
It is worth noting that in this pathology, the symptoms are very diverse and complex in nature, so it is difficult to diagnose. In this case, for the implementation of proper treatment, it is required not only to make a diagnosis, but also to clarify the pathogenesis of the disease. You also need to find out exactly what changes and in what bodies have occurred.
First of all, doctors carefully analyze the patient's history. This makes it possible to find out about the nature of the urination disorder, to determine whether there are any other signs in the form of general malaise, thirst, visual impairment, and, in addition, intestinal disorders. In addition, it is necessary to clarify the information about what is the dynamics of the urinary disorder. The required diagnosis will be significantly simplified by information about the presence of diseases of the nervous system. In particular, those pathologies that are accompanied by paralysis of the lower region of the trunk are of importance. The presence of head injuries and spinal hernias should also be considered.
Patient examination
At the reception, the doctor examines the patient, evaluating primarily his appearance. For example, sometimes there is uncertainty about the gait, while a person can roll over from side to side. This gait is also called duck. In addition, doctors conduct a study of reflexes with general sensitivity. A visual examination with palpation allows you to identify the presence of fistulas, spinal hernias, and in addition, underdevelopment of the coccyx and other defects. The presence of problems with urination and the process of defecation can give off an odor along with stains on the underwear and hypertrophy of the foreskin. It is equally important to assess the condition of the bladder (its extension) and to check whether there is pain in the kidneys. In addition, the doctor determines the presence of atony of the sphincter.
X-ray examination
In the framework of laboratory studies, a mandatory analysis of a neurogenic bladder (code according to ICD N 31.2) is urinalysis and sampling according to Zimnitsky. A blood test is also prescribed to help detect anemia, along with various biochemical blood tests that make it possible to detect electrolyte metabolism malfunctions that occur in renal failure. In addition, clearance tests are performed.
No less important aspect in the process of diagnosing this syndrome are x-ray studies:
- Conducting a survey radiography, which makes it possible to assess the size of the contour of the kidneys, and in addition, the bladder. This study reveals the splitting of the spinal canal along with the underdevelopment of the tailbone. It can also confirm the presence of spinal hernias and other deformities.
- Conducting urethrocystography with a neurogenic bladder in women makes it possible to determine the displacement of the bladder along with the narrowing or expansion of the urethra, false diverticula, and so on.
- Excretory urography allows you to notice a change in the size of the pelvic system, while assessing the activity of the kidneys.
- Conducting ascending pyelography. It must be said that they rarely resort to this procedure directly today.
- Performing radioisotope renography. As part of this study, the condition and functioning of the kidneys is assessed.
An ultrasound scan is also performed along with various urodynamic studies in the form of cystometry, uroflowmetry, sphincterometry and profilometry. Neurogenic bladder, whose causes of development, despite research, remain unknown, doctors call idiopathic.
Bladder neurogenic treatment
After diagnosis, a neurologist and a urologist conduct therapy at the same time. Treatment depends on the number of disorders, the presence of certain complications, the presence of background pathologies, and in addition, on the duration of this dysfunction in the patient. Treatment of this disease involves medication, non-medication and surgery. The treatment of neurogenic bladder in children with the most sparing methods begins.
Speaking about the types of dysfunction, it should be noted that the hyperactive option is easier to treat. As a rule, medications that relieve tension in the muscles of the bladder and improve blood circulation help patients. Often, patients are prescribed tricyclic antidepressants, for example, Melipramin. Also, doctors can prescribe various adrenergic blockers or anticholinergic medicines in the form of “Propantheline”, “Buscopan” or “Oxybutynin”.
Non-drug treatment options for neurogenic bladder include physiotherapy exercises, which is great for training pelvic muscles. In addition, patients are prescribed stabilization of the drinking regime along with the correct daily routine, physiotherapy and psychotherapeutic methods.
A hypoactive disease is associated with a risk of various infections. As part of the treatment of neurogenic bladder in women and men, it is necessary to regularly empty the bladder, sometimes resorting to catheterization. Among medications, various cholinomimetics are considered effective, which improve the motility of the bladder and reduce the volume of residual urine. Also, in some situations, doctors prescribe alpha sympathomimetics with alpha adrenergic blockers. Mandatory is the treatment with antibacterial drugs.
With the development of hypotension of the bladder, one often has to turn to surgical intervention. For example, a transurethral funnel resection of the neck of the bladder is performed, which allows you to get rid of the contents by pressing on the bladder. In the case of a hyperactive form of pathology, an incision is made in the external sphincter, due to which the pressure decreases. After such an operation, the detrusor function is adjusted over time.
What else involves the treatment of neurogenic bladder in women and men?
With this syndrome, with the help of the surgical method, doctors can resort to an increase in the bladder. For this, plastic tissue is applied and ureteral reflux is eliminated. During the operation, doctors install cystostomy drainage, which will ensure the emptying process.
As part of the prevention of neurogenic bladder dysfunction in children, doctors are advised to monitor the overall frequency of urination, urges, and also to monitor the intensity of the stream. When the slightest disturbances or sensations appear that the bubble is not completely empty, you need to make an appointment with a neurologist with a neurologist. Such treatment will help to identify the development of the disease at its early stage, which will make it possible to subsequently avoid surgical intervention in the treatment of neurogenic bladder in children.