Neurogenic bladder is a term used to refer to a whole range of urinary disorders. These disorders are united by only one reason, which is a violation of the functioning of the nervous system. At the same time, that part of the system that is responsible for the excretion of urine is violated. As 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
There are only two types of this pathology: hyporeflex and hyperreflex form. Each of these forms is determined by the state of the detrusor. The development of the disease, the symptoms of which give patients a lot of inconvenience, is diagnosed through a whole list of various medical studies. First, neurological and urological examinations are prescribed. TherapyThe neurogenic bladder is treated through drug and non-drug treatment, sometimes doctors resort to catheterization, and in other cases, the intervention of surgeons is required.
Doctors encounter such dysfunction quite often, and it can manifest itself in the inability to carry out voluntary reflex accumulation with urine output. This is primarily provoked by functional, and in addition, organic lesions of the nerves, as well as centers that are responsible for controlling such processes.
What is the pathology accompanied by?
The presence of a neurogenic bladder, the causes of which are far from always clear, is accompanied by various disorders that force a person to abandon many social activities and joys of life, thus violating his relationship with society.
Often, against the background of the development of neurogenic dysfunction of the bladder, specialists observe signs of venous congestion in the pelvic region. Often, along with it, there are various changes in the functioning of the urinary system, which are dystrophic or inflammatory in nature. For example, this happens with pyelonephritis and ureteral reflux, which provokes severe pathologies like chronic renal failure, arterial hypertension and nephrosclerosis. Next, 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 failure that occurs on one oflevels of regulation of urinary processes. Among the adult population, this syndrome often occurs against the background of spinal injuries, and in addition, the brain, which are caused by a stroke, surgery, compression or fractures of the spine. Also, the cause of the neurogenic bladder (ICD N 31.2) may be certain diseases of the nervous system of a predominantly inflammatory or degenerative nature. It happens that the cause is a tumor, such as tuberculoma, along with polyneuropathy, which has a post-vaccination, diabetic or toxic origin. Also, cholesteatomas are often the cause, along with disseminated encephalomyelitis, encephalitis, or polyradiculoneuritis.
Neurogenic bladder in children is very common. Such a pathology can be a consequence of birth trauma or a congenital disorder in the urinary organs. In addition, the cause of the presence of this syndrome in children can be congenital problems with the nervous system. After suffering a neurological disease, and in addition, after cystitis, the elasticity of the bladder may decrease, and at the same time its capacity decreases. Such processes provoke his incontinence.
Symptoms of pathology
The most common symptom of a neurogenic bladder that occurs when lesions are located above the center, doctors consider constant urination, which occurs more often than in he althy people. Stranguria, which is frequent and difficult urination, may also occur.pain is observed. Urinary incontinence is also possible.
There is no well-established system in the manifestation of the symptoms of this pathology. This factor especially affects the social activity of sick people who are constantly forced to experience awkwardness and fear when the corresponding 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. It 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, while independent urination 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, then detrusor hyperreflexia may occur. Urgent urinary incontinence often occurs, for example, this is possible with cerebral disorders. The peculiarity of spinal injury is 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, there is an involuntary process of contraction of the urethral sphincter. Against this background, urination may be delayed and the pressure inside the bladder itself increases.
With such pathologies of the spinal cord, frequenturination. In addition, there are imperative urination. Thus, imperative urinary incontinence is not excluded, against the background of which stranguria is observed. An equally popular sign of a neurogenic bladder (according to the ICD 10 code we have already mentioned it) is intermittent urination, which passes at intervals. During the interruption of the jet, a person experiences pain in the perineum and lower abdomen. In such a situation, the bladder may not empty completely. The remaining urine leads to various inflammations that form in the bladder and its pathways. When these lesions are present, the striated sphincter may not fully relax, causing people to become paralyzed. This paralysis leads to sphincter incontinence.
Symptoms of the disease in the presence of a lesion in the sacrum
In cases where the lesion is formed directly in the region of the sacrum, the reflex contractions fade. In addition, the striated sphincter also loses its ability to contract. In such situations, the patient may lose the urge to urinate. In the event that, against the background of the absence of urges, the patient does not perform forced emptying, the bladder may overflow and urinary incontinence will occur. There may also be difficulty urinating, which will be expressed in the form of 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 performed on time, can be the cause of various diseases, andin addition, violations. Examples of such disorders include the development of vesicoureteral reflux, chronic kidney failure and pyelonephritis.
I must say that serious violations are observed with any denervation of the bladder. Neurogenic dysfunction of the bladder in children and adults can often be combined with cystitis, which is the cause of sclerosis of the bladder, and in addition, its wrinkling. In the event of such a complication, it is very often necessary to resort to increasing 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. It is also necessary to find out exactly what changes have taken place and in which organs.
First of all, doctors carefully analyze the history of patients. This makes it possible to learn about the nature of the urination disorder, to determine if there are any other signs in the form of general malaise, thirst, visual disturbances, and in addition, intestinal disorders. In addition, it is required to clarify information about the dynamics of urinary disorders. The establishment of 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 lowerbody region. The presence of head injuries and spinal hernias should also be considered.
Examination of the patient
At the appointment, the doctor examines the patient, evaluating, first of all, his appearance. For example, sometimes there is uncertainty in gait, while a person can roll over from side to side. This walk is also called a duck. In addition, doctors conduct a study of reflexes with general sensitivity. Conducting a visual examination with palpation reveals 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 out an odor along with stains on linen and hypertrophy of the foreskin. It is equally important to assess the condition of the bladder (its distension) and check for kidney tenderness. In addition, the doctor determines the presence of sphincter atony.
Carrying out X-ray examinations
As part of laboratory tests, a mandatory for neurogenic bladder (ICD code N 31.2) is a urine test 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 imbalances that occur with kidney failure. Among other things, clearance tests are performed.
An equally important aspect in the process of diagnosing this syndrome isx-ray examinations:
- 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 a spinal canal split along with underdevelopment of the coccyx. It can also confirm the presence of spinal hernias and other deformities.
- Urethrocystography for 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 changes in the size of the pelvic system, while assessing the activity of the kidneys.
- Ascending pyelography. I must say that today this procedure is rarely resorted to directly.
- Performing radioisotope renography. This study assesses the condition and functioning of the kidneys.
Ultrasound scanning is also performed along with various urodynamic studies in the form of cystometry, uroflowmetry, sphincterometry and profilometry. The neurogenic bladder, whose causes remain unknown despite research, is called idiopathic by doctors.
Treatment of neurogenic bladder
After the diagnosis is made, the neurologist and the urologist carry out 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 for this disease includesmedical, non-pharmacological and surgical interventions. The treatment of neurogenic bladder in children begins with the most gentle methods.
Speaking about the types of dysfunction, it should be noted that the hyperactive variant is easier to treat. As a rule, medications that relieve bladder muscle tension and improve blood circulation help patients. Often, patients are prescribed tricyclic antidepressants, for example, Melipramin. Doctors can also prescribe various adrenergic blockers or anticholinergic drugs in the form of Propanthelin, Buscopan or Oxybutynin.
Non-drug treatment options for neurogenic bladder include exercise therapy, which is great for pelvic muscle training. In addition, patients are prescribed stabilization of the drinking regime along with the correct daily routine, physiotherapy and psychotherapeutic methods.
The hypoactive form of the disease is associated with the risk of various infections. As part of the treatment of neurogenic bladder in women and men, it is necessary to empty the bladder regularly, sometimes resorting to catheterization. Among medications, various cholinomimetics are considered effective, which improve bladder motility and reduce the volume of residual urine. Also, in some situations, doctors prescribe alpha-sympathomimetics with alpha-blockers. Treatment with antibacterial drugs is mandatory.
With the development of bladder hypotension, it is often necessary to turn tosurgical intervention. For example, a transurethral funnel resection of the bladder neck is performed, which allows you to get rid of the contents by pressing on the bladder. In the case of a hyperactive form of the pathology, an incision is made in the external sphincter, due to which the pressure decreases. After such an operation, the function of the detrusor is adjusted over time.
What else does the treatment of neurogenic bladder in women and men involve?
With this syndrome, doctors can resort to an enlargement of the bladder using a surgical method. To do this, plastic tissue is used and ureteral reflux is eliminated. During the operation, doctors install a cystostomy drain, which will ensure the emptying process.
As part of the prevention of neurogenic bladder dysfunction in children, doctors advise monitoring the overall frequency of urination, urges, and also to monitor the intensity of the jet. If there are the slightest disturbances or sensations that the bladder is not fully emptied, you need to make an appointment with a urologist with a neurologist for an appointment. 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.
