Neurogenic Bladder Causes, Symptoms, Diagnosis, Treatment, Prevention

Neurogenic Bladder Causes, Symptoms, Diagnosis, Treatment, Prevention

What is a neurogenic bladder?

Neurogenic bladder is impaired bladder function resulting from damage to the nerves that govern the urinary tract. Various nerves converge in the area of the bladder and serve to control the muscles of the urinary tract, which includes the sphincter muscles that normally form a tight ring around the urethra to hold urine back until it is voluntarily released.

A variety of factors can damage these nerves and cause urinary incontinence. In some cases, spontaneous nerve impulses to the bladder trigger spastic unexpected bladder contractions, resulting in accidental voiding of sometimes large amounts of urine.

In other types of neurogenic bladder conditions, the bladder may become flaccid and distended and cease to contract fully, resulting in only partial emptying and continual dribbling of small amounts of urine. Rashes may erupt in areas of the skin irritated by urine.

Stagnant urine in the bladder also increases the risks of bladder stone formation and urinary tract infections. Such infections, when severe, can lead to life-threatening kidney failure. In some patients, there is a partial loss of anal sphincter control as well.

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Complications of a neurogenic bladder

The following problems are often associated with a neurogenic bladder:

  • urine leakage
  • Urine leakage often occurs when the muscles holding urine in do not get the right message.
  • urine retention
  • Urine retention often happens if the muscles holding urine in do not get the message that it is time to let go.
  • damage to the tiny blood vessels in the kidney
  • Damage to the tiny blood vessels in the kidney often happens if the bladder becomes too full and urine backs up into the kidneys, causing extra pressure.
  • infection of the bladder or ureters
  • Infection of the bladder or ureters often results from urine that is held too long before being eliminated.

What causes neurogenic bladder?

Neurogenic bladder can occur at any age, but it is especially common among the elderly.

There are numerous causes for neurogenic bladder dysfunction and symptoms vary depending on the cause. An overactive bladder is caused by interruptions in the nerve pathways to the bladder occurring above the sacrum (five fused spinal vertebrae located just above the tailbone or coccyx). This nerve damage results in a loss of sensation and motor control and is often seen in stroke, Parkinson's disease, and most forms of spinal-cord injuries. An underactive bladder is the result of interrupted bladder stimulation at the level of the sacral nerves. This may result from certain types of surgery on the spinal cord, sacral spinal tumors, or congenital defects.

Among the various causes are:

  • Genetic nerve problems
  • Spinal cord injuries resulting in paralysis
  • Other disorders such as syphilis, diabetes mellitus, stroke, ruptured or herniated intervertebral disk
  • Degenerative neurological diseases such as multiple sclerosis and amyotrophic lateral sclerosis
  • Congenital spine abnormalities such as spina bifida
  • Acute infections
  • Long-term effects of alcoholism

Neurogenic Bladder Risks

The following medical conditions increase your chance of developing neurogenic bladder. If you have any of these risk factors, tell your doctor.

  • Nerve or spinal cord conditions present since birth (such as spina bifida or spinal cord tumor )
  • Diabetes
  • Stroke

What are the symptoms of neurogenic bladder?

The following are the most common symptoms of neurogenic bladder. However, each individual may experience symptoms differently. Symptoms may include:

  • urinary tract infection
  • kidney stones - these may be difficult to determine because you may not be able to feel pain associated with kidney stones if you have spinal cord abnormalities. Symptoms of kidney stones include:
                  1.  chills
                  2.  shivering
                  3.  fever
  • urinary incontinence
  • small urine volume during voiding
  • urinary frequency and urgency
  • dribbling urine
  • loss of sensation of bladder fullness
The symptoms of neurogenic bladder may resemble other conditions and medical problems. Always consult your physician for a diagnosis.

How is neurogenic bladder diagnosed?

A thorough patient history is essential to record 24-hour urination patterns, including the actual volume of urine voided, how urgent the feeling is to urinate and any factors that aggravate incontinence.

Physical examination will likely include a rectal, genital, and abdominal exam to check for enlargement of the bladder or other abnormalities. A complete neurological examination is also essential. Tests to measure urine output are conducted.

To determine whether urine is retained after voiding, the doctor may use an ultrasound-like instrument that estimates the amount left in the bladder or insert a catheter into the bladder.

In order to detect whether leakage occurs, a full-bladder stress test may be necessary. The bladder is filled to capacity via a catheter and the patient is then asked to bend over, cough, or walk. Urine or blood samples may be taken to look for abnormalities including infection and underlying disorders that might be causing or aggravating the condition.

Treatment for neurogenic bladder

Doctors begin treating neurogenic bladder by attempting to reduce bladder stretching (distension) through intermittent or continuous catheterization. In intermittent catheterization, a small rubber catheter is inserted at regular intervals (four to six times per day) to approximate normal bladder function. This avoids the complications that may occur when a catheter remains in the bladder's outside opening (urethra) continuously (an indwelling catheter). Intermittent catheterization should be performed using strict sterile technique (asepsis) by skilled personnel, and hourly fluid intake and output must be recorded. Patients who can use their arms may be taught to catheterize themselves.

Indwelling catheters avoid distension by emptying the bladder continuously into a bedside drainage collector. Individuals with indwelling catheters are encouraged to maintain a high fluid intake in order to prevent bacteria from accumulating and growing in the urine. Increased fluid intake also decreases the concentration of calcium in the urine, minimizing urine crystallization and the subsequent formation of stones. Moving around as much as possible and a low calcium diet also help to reduce stone formation.

Drugs may be used to control the symptoms produced by a neurogenic bladder. The unwanted contractions of an overactive bladder with only small volumes of urine may be suppressed by drugs that relax the bladder (anticholinergics) such as propantheline (Pro-Banthine) and oxybutynin (Ditropan). Contraction of an underactive bladder with normal bladder volumes may be stimulated with parasympathomimetics (drugs that mimic the action resulting from stimulation of the parasympathetic nerves) such as bethanechol (Urecholine).

Long-term management for the individual with an overactive bladder is aimed at establishing an effective spontaneous reflex voiding. The amount of fluid taken in is controlled in measured amounts during the waking hours, with sips only toward bedtime to avoid bladder distension. At regular intervals during the day (every four to six hours when fluid intake is two to three liters per 24 hours), the patient attempts to void using pressure over the bladder (Crede maneuver). The patient may also stimulate reflex voiding by abdominal tapping or stretching of the anal sphincter. The Valsalva maneuver, involving efforts similar to those used when straining to pass stool, produces an increase in intra-abdominal pressure that is sometimes adequate to completely empty the bladder. The amount of urine remaining in the bladder (residual volume) is estimated by a comparison of fluid intake and output. The patient also may be catheterized immediately following the voiding attempt to determine residual urine. Catheterization intervals are lengthened as the residual urine volume decreases and catheterization may be discontinued when urine residuals are at an acceptable level to prevent urinary tract infection.

For an underactive bladder, the patient may be placed on a similar bladder routine with fluid intake and output adjusted to prevent bladder distension. If an adequate voiding reflex cannot be induced, the patient may be maintained on clean intermittent catheterization.

Some individuals who are unable to control urine output (urinary incontinence) due to deficient sphincter tone may benefit from perineal exercises. Although this is a somewhat dated technique, male patients with extensive sphincter damage may be helped by the use of a Cunningham clamp. The clamp is applied in a horizontal fashion behind the glans of the penis and must be removed approximately every four hours for bladder emptying to prevent bacteria from growing in the urine and causing an infection. Alternation of the Cunningham clamp with use of a condom collection device will reduce the skin irritation sometimes caused by the clamp.

Surgery is another treatment option for incontinence. Urinary diversion away from the bladder may involve creation of a urostomy or a continent diversion. The surgical implantation of an inflatable sphincter is another option for certain patients. An indwelling urinary catheter is sometimes used when all other methods of incontinence management have failed. The long-term use of an indwelling catheter almost inevitably leads to some urinary tract infections, and contributes to the formation of urinary stones (calculi). Doctors may prescribe antibiotics preventively to reduce recurrent urinary tract infection.

Alternative treatment. The cause of the bladder problem must be determined and treated appropriately. If nerve damage is not permanent, homeopathy and acupuncture may help restore function.

How to Prevent Neurogenic Bladder

While most cases of neurogenic bladder cannot be prevented, people with diabetes may be able to delay or avoid the problem by carefully controlling their blood sugar levels over the long-term. Also, wearing seat belts and avoiding activities that increase the risk of spinal cord injuries will prevent neurogenic bladder from this cause.