Neurogenic Bladder

The normal bladder function is to store and pass urine in a coordinated and controlled way. This coordinated activity is regulated by the central and peripheral nervous systems. But what happens when the bladder does not work correctly as a result of a dysfunction, trauma, illness or injury?

What happens under normal conditions?

The urinary bladder is a spherical body that has an inner lining of soft consistency (similar to the inside of the cheek) and a muscular outer layer.

With the bladder, the lower urinary tract (or lower urinary tracts) is composed of the bladder neck (output with a funnel shape of the bladder that leads to the urethra), the urethra (tubular structure that serves as a channel for transporting urine from the bladder to the outside of the body) and the external muscular sphincter of the urethra (group of muscles that surrounds the urinary tract below the neck of the bladder). The muscles and nerves of the urinary system must operate in a coordinated manner with the bladder to perform two important functions of storage and disposal of the urine. Nerves carry messages from the bladder to the brain and then from the brain to the muscles of the bladder telling them that they must contract or relax, which allows the bladder to drain during urination.

What is the neurogenic bladder?

The neurogenic bladder is the loss of normal bladder function because of a partial damage to the nervous system. The damage can cause the bladder present lower activity, in which case you will not be able to contract and be fully drained, or that present a greater activity, in which case collapses too quickly or frequency.

What are some of the risk factors for the development of a neurogenic bladder?

Risk factors for neurogenic bladder include various birth defects that affect the spinal cord and the function of the bladder in a negative way, including spina bifida and other abnormalities of the spinal cord. Tumours of the spinal cord or pelvis may also affect the normal function of the nervous tissue and put a person at risk. Lesions by spinal cord trauma also represent a significant risk for the development of neurogenic bladder.

What are the symptoms of neurogenic bladder?

 The inability to control urination, also known as urinary incontinence, is perhaps the most common symptom associated with neurogenic bladder. This may be the result of abnormalities in bladder capacity or malfunction of the control mechanisms in certain structures such as the bladder neck, the external muscular sphincter of the urethra, or both, since they are important structures for the storage function of the bladder.

Some symptoms such as the elimination of urine in drops, the need for great efforts to urinate or the inability to urinate may also be associated with neurogenic bladder. Urinary retention may be the result of both the loss of ability of bladder muscle contraction as the loss of adequate coordination between the bladder muscle and the external urethral sphincter muscle. The presence of annoying symptoms such as the increased frequency of urination and urgency to urinate may indicate an overactivity of the bladder. Other unpleasant symptoms may include painful urination (dysuria), which may be a result of a urinary tract infection (UTI), caused by the prolonged retention of urine in the bladder. A UTI with fever is a sign of a possible kidney infection (pyelonephritis) and is a more worrying situation, because it may result in permanent damage to the kidney or kidneys.

Patients with neurogenic bladder can also form stones in the urinary tract because of the block of the urinary flow, an infection or both.

An abnormal return of urine from the bladder to the kidneys, known as vesicoureteral reflux (VUR), may also happen as a means to reduce the high pressure that was developed within the bladder. Special attention should be given to the ITU, because VUR can expose the patient to a significant risk of severe kidney infection when infected urine is transported from the bladder directly to the kidneys.

What are the symptoms of neurogenic bladder?

When presence of neurogenic bladder is suspected, you need to submit to tests both of the nervous system as urinary tract infections. In addition to the detailed medical history and physical examination, the procedures to achieve the diagnosis can include a complete neurological assessment as well as a functional test of the bladder, the urodynamic study.

What is the treatment of neurogenic bladder?

There are medications for the treatment of overactive bladder that can improve or alleviate bothersome symptoms, incontinence or both. Antibiotics are important for the treatment and prevention of urinary tract infections (UTI), especially in patients with vesicoureteral reflux. Other medications can improve bladder control to increase the resistance in the bladder neck. Clean intermittent catheterization (CIL) was developed by Dr. Jack Lapides in the early 1970s as a means to empty the bladder in cases in which the bladder muscle cannot contract or for patients with loss of proper coordination between the bladder muscle and the external urethral sphincter muscle.

However, there are times when the damage in the anatomy and function of the bladder is so serious the capacity needs to be increased by bladder augmentation (increase in the size of the bladder with various tissues) or vesicoureteral reflux must be corrected and/or an alternative tube must be built to empty the bladder.

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