Neurogenic Bladder

Neurogenic Bladder

Article
Brain & Nerve
Kidney & Bladder Health
+4
Contributed byKrish Tangella MD, MBADec 08, 2018

What are the other Names for this Condition? (Also known as/Synonyms)

  • Lack of Bladder Control due to Neurogenic Bladder
  • Neuropathic Bladder
  • Urinary Incontinence due to Neurogenic Bladder

What is Neurogenic Bladder? (Definition/Background Information)

  • Neurogenic Bladder is a condition where there is loss of control over urination due to damage to the brain, spinal cord, or the nerves regulating the bladder and urination
  • It is mainly classified into 2 types depending on the site of the injury:
    • Hypertonic, spastic, or overactive bladder: It is due to increased contraction of the bladder muscle or problems with control of urinary sphincter secondary to damage to the brain or spinal cord
    • Hypotonic, flaccid, or underactive bladder: It is due to the failure of bladder muscles to contract secondary to peripheral nerve damage             
  • Neurogenic Bladder mainly occurs in elderly adults and individuals affected by stroke, multiple sclerosis, or neurodegenerative disorders such as Parkinson’s and Alzheimer’s disease, and even by trauma due to accidents
  • These conditions damage the neuronal network regulating urination, resulting in Neurogenic Bladder. The individuals are unable to control urination causing an over-accumulation or dribbling of urine with complications such as urinary tract infection, renal failure or skin infection in genital areas
  • Even though most of the cases of Neurogenic Bladder cannot be cured completely, with appropriate medical and nursing care the patients are able to lead a normal life

Who gets Neurogenic Bladder? (Age and Sex Distribution)

  • Neurogenic Bladder is commonly seen in older individuals
  • Both males and females are equally affected
  • Due to an increase in road traffic accidents, Neurogenic Bladder is also on the rise among younger individuals

What are the Risk Factors for Neurogenic Bladder? (Predisposing Factors)

The following are the risk factors for Neurogenic Bladder:

  • Uncontrolled diabetes can cause damage to the nerves controlling the urinary bladder
  • Damage to the area of the brain regulating urination during a stroke, can result in Neurogenic Bladder
  • In spina bifida the nerves that control the bladder are not formed properly

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Neurogenic Bladder? (Etiology)

Neurogenic Bladder is mainly caused by damage to certain areas of the brain, spinal cord, or the nerves regulating urination. The damage or injury may be due to the following disorders and conditions:

  • Neurodegenerative diseases, such as Alzheimer’s disease, Parkinson’s disorder, and Shy-Drager syndrome, due to the degeneration of neurons controlling urination function
  • Demyelinating disorders, such as multiple sclerosis, where there is damage to the insulating cover of the nerve cells in the brain and spinal cord, affecting their ability to communicate
  • Encephalitis due to inflammation of the brain
  • Stroke due to poor blood supply causing neuronal cell death
  • Cerebral palsy
  • Learning disabilities such as attention deficit hyperactivity disorder (ADHD)
  • Brain or spinal cord tumors
  • Birth defects of the spinal cord
  • Spinal cord injury
  • Nerve damage due to pelvic surgery, herniated disc, or spinal stenosis
  • Diabetic neuropathy due to injury of the blood vessels supplying the nerves
  • Vitamin B12 deficiency
  • Syphilis and herpes zoster

What are the Signs and Symptoms of Neurogenic Bladder?

The most common symptom of Neurogenic Bladder is the inability to control urination. Other signs and symptoms depend on the underlying cause and may include:

  • Urinating too often
  • Sense of incomplete evacuation of the urinary bladder, inability to completely empty the bladder
  • Increased urge to urinate or painful urination
  • Urinary retention
  • Dribbling of urine
  • Inability to sense bladder fullness

How is Neurogenic Bladder Diagnosed?

The diagnosis of Neurogenic Bladder may involve:

  • A complete medical history and a thorough physical examination, which may include abdominal, genital, and rectal examination (checking for bladder enlargement) and a neurological examination
  • Maintaining a voiding diary containing a 24 hour record of urination, fluid intake, and episodes of leakage
  • Urine cytology
  • Blood urea and serum creatine levels to examine kidney function
  • Imaging tests of the kidneys, urinary bladder, spine, and the nervous system using x-rays, ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) scans
  • Urodynamic studies to measure the pressure and amount of urine in full, empty, or contracting bladder
  • Cystoscopy (visualization of the urinary tract using a fiber-optic camera)

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Neurogenic Bladder?

The most common complication of Neurogenic Bladder is frequent urinary tract infection (UTI) due to the inability to empty urinary bladder normally. Other complications may include:

  • Formation of kidney stones (renal calculi)
  • Kidney damage due to transmission of abnormally high pressure from the bladder
  • Irritation and lesions of skin due to constant dribbling of urine around the genital region and buttocks
  • Urethral injuries, infections, or strictures due to catheterization

How is Neurogenic Bladder Treated?

Treatment of Neurogenic Bladder is based on the cause, severity, and type of symptoms present. The treatment measures may include:

  • Maintenance of optimum level of fluid intake
  • Avoidance of spicy food and caffeinated beverages such as coffee and tea
  • Usage of absorbent undergarments such as diapers and pads
  • Catheterization to empty the bladder
  • Exercise and delayed voiding to prevent premature contraction of the bladder muscles
  • Medication to relax or contract the bladder muscles
  • Surgical intervention may be needed in some cases depending on the underlying cause of Neurogenic Bladder

How can Neurogenic Bladder be Prevented?

  • In most cases, Neurogenic Bladder is a disorder that cannot be prevented
  • However individuals with diabetes can prevent it by maintaining their blood sugar levels under constant control

What is the Prognosis of Neurogenic Bladder? (Outcomes/Resolutions)

  • The prognosis of Neurogenic Bladder depends on the underlying cause
  • Most individuals are able to lead a very good quality of life with appropriate treatment measures

Additional and Relevant Useful Information for Neurogenic Bladder:

  • www.sitorsquat.com is a website that maintains a worldwide free database of public toilets and provides a mobile apps or SMS/text service to get results on one’s phone
  • Online support groups, such as National Association for Continence, provide contacts of caregivers, physicians, connections with other patients, discussion forums, and blogs to improve the quality of life of people affected by Neurogenic Bladder
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Krish Tangella MD, MBA

Pathology, Medical Editorial Board, DoveMed Team

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