Neurogenic Bladder Dysfunction Causes and Treatment

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Man with Neurogenic Bladder Dysfunction

Neurogenic bladder is a common ailment that afflicts millions of Americans. It is a medical condition where the bladder functioning is impacted due to neurological conditions.

This can be due to problems related to the brain, nerves, or spinal cord, which can be a result of conditions such as diabetes, Parkinson’s disease, or multiple sclerosis (MS).

It can also be a result of infection to either the spinal cord or brain, major surgery to the pelvis, stroke, or heavy metal poisoning. Congenital conditions like spina bifida can also result in neurogenic bladder.

There are two significant types of bladder control issues related to neurogenic bladder. Based on the nerves involved as well the kind of nerve injury, it can either be classified as an overactive (hyper-reflexive or spastic) bladder or an underactive (hypotonic or flaccid) bladder.

Human Bladder

A hollow organ, the human bladder is located in the lower abdomen or the pelvis. The human bladder performs two vital functions:

  • Storage of urine
  • Removal of urine through the excretory system. This is done through a complex communication circuit present in the brain and the spinal cord.

A person suffering from urinary incontinence has problems controlling urine flow. Storing of urine becomes an issue if the bladder is unable to void completely or voids before one reaches the toilet.

Urine can also leak if the sphincter muscles controlling the urination become weak or does not work, or if a person has spastic bladder causing contraction before one reaches the toilet.

Causes of Neurogenic Bladder

Common Causes

Some of the common causes of neurogenic bladder include:

  • Stroke
  • Central nervous system tumors
  • Multiple sclerosis
  • Parkinson’s disease
  • Trauma/accidents
  • Spinal surgeries
  • Spinal cord injuries
  • Erectile dysfunction
  • Heavy metal poisoning

Congenital Causes

These can also be present during birth (congenital). Congenital disabilities that could result in neurogenic bladder include:

  • Sacral agenesis: A rare condition characterized by lack of lower spinal parts.
  • Myelomeningocele (spina bifida): Spina bifida occurs in the fetal stage. This is a condition where the fetal spine does not develop fully during the development phase. Babies born with spina bifida often have weakness or paralysis which results in improper functioning of the bladder.
  • Cerebral palsy: Cerebral palsy is a collection of long-term disorders that weakens the ability of a person to control body posture and movement. These disorders can be caused by injury to the area of the brain that controls the motor functions. Cerebral palsy may occur during the developmental phase of the fetus or after birth.

Neurogenic Bladder Symptoms

Urinary Tract Infection

People who suffer from either underactive or overactive bladder can be susceptible to frequent urinary tract infections. These repeated infections are most often the first symptoms of problems with the bladder. These frequent illnesses are caused either due to viruses, harmful bacteria or yeast in the urinary tract.

Incontinence (leaking urine) with overactive bladder

When a person has overactive bladder (frequently accompanied by brain disease, strokes, and Parkinson’s disease), the sphincter muscles contract more than normal. Sometimes, this can result in leakage before one reaches the bathroom.

Overactive Neurogenic Overactive-Neurogenic Bladder Dysfunction Bladder Dysfunction

An overactive bladder causes a person to feel the urge to void immediately or risk leaking urine. Sometimes, it can result in passing a few drops inadvertently, and at other times, it can even result in heavy flow. There are also situations where one might end up leaking during sleep.

The normal frequency of urination also varies from one individual to another. But the golden rule that determines whether the visits are too frequent is when one has to visit the bathroom more than 6-8 times in 24 hours.

Obstruction/Urinary Retention With Underactive Bladder

In a person with underactive bladder the the muscles do not contract as required to pass urine. Often seen in people with MS, diabetes, syphilis, polio, or major pelvic surgery, the underactive bladder may also result if the sphincter muscles present around the urethra stops working the way it is supposed to.

A person with an underactive bladder may only be able to pass a dribble. It can also result in incomplete bladder emptying (urinary retention) or inability to void at all (obstruction).

Diagnosis of Neurogenic Bladder

A healthcare provider can diagnose a person with neurogenic bladder after conducting a thorough physical examination and several tests related to bladder and nervous system.

Medical History

The healthcare provider will ask several questions related to medical history, such as symptomatology, frequency, duration and its impact on normal life. It can also include information about the past as well as current health problems. The healthcare provider also makes a note of all the drugs (prescription and OTC) that are being taken.

Physical Exam

Once the medical history is obtained, the healthcare provider will perform a detailed physical examination to identify the source of the symptoms. In women, the exam will include an abdominal, pelvic and rectal examination. In males, it consists of abdominal, prostate and rectal examination.

Bladder Diary

The healthcare provider might also ask to maintain a voiding diary that will keep track of the number of bathroom visits. This helps in determining the day-to-day symptomatology.

Pad Test

This involves using a pad treated with a special dye. Whenever there is a leakage, the color of the pad changes.

Other Tests

  • Bladder scan: This shows the amount of urine present in the bladder after voiding.
  • Urine culture: A urine sample is collected to test for blood or infection.
  • Cystoscopy: In this test, a narrow catheter with a tiny lens is inserted into the bladder to examine the inner workings.
  • Urodynamic testing: These tests determine the ability of the lower urinary tract to store and release urine.

Imaging

The healthcare provider may also conduct additional imaging like CT scans, X-rays, or MRI to diagnose the condition. A referral might also be provided to specialists for brain and spinal imaging.

Treatment of Neurogenic Bladder

The following are the main treatments available for neurogenic bladder:

Clean intermittent catheterization

This involves the insertion of thin, flexible tubes through the urethra to the bladder for draining out the urine.

Bladder Augmentation

It is a surgery where the intestinal segment (sigmoid colon) is removed and attached to the bladder walls to increase the size of the bladder. This helps in reducing the internal pressure of the bladder and increases the storing ability.

Drugs

This includes the use of anticholinergic medications such as Tolterodine, Oxybutynin, and others.

Botox® Injections

This process involves the injection of Botox into the sphincter and bladder.

Ileal conduit

This procedure involves using a portion of the small bowel to make a stoma (an abdominal opening). This stoma helps in draining the urine into a urinary bag that is attached outside the body.

Lifestyle Changes

These might include avoidance of food or drinks that can result in bladder irritation. Caffeinated beverages such as coffee, spicy food, carbonated beverages and citrus fruit are best avoided. Losing weight also helps in reducing stress on the bladder. A type of behavioral treatment known as delayed voiding has also been found useful in a few individuals.

One can also use pads, absorbent undergarments, panty liners and shields, and adult diapers to prevent wetness as well as odors. The use of a bed pad also helps in protecting mattresses and sheets.

The Bottom Line

Neurogenic bladder is a tricky disease. One needs to consult a healthcare provider if they develop any symptoms. A choice of treatment has to be made based on the type and extent of the bladder dysfunction.

Dr Prola is an experienced research biologist specialized in studies of cellular and molecular mechanisms by which energy metabolic pathways regulate disease development. He has keen interest in Urology and Renal function and his research on how Crocin protects human embryonic kidney cells was especially well received.