Neurogenic Bladder - Types, Causes, Diagnosis, and Treatment

What Is a Neurogenic Bladder?

A neurogenic bladder is a problem in your brain, spinal cord, or central nervous system that causes you to lose control of the nerves and muscles of the urinary system that work together to hold and release urine on time. Usually, signals are sent to the bladder muscles to tighten or loosen them. However, in the neurogenic bladder, these signals do not work as they should, causing bladder control problems.

What Are the Types of Neurogenic Bladder?

There are two significant types of bladder control problems linked to neurogenic bladder. Depending on the nerves involved and the damage, your bladder may become overactive (spastic or hyper-reflexive) or less active (flaccid or hypotonic).

• Hyper-Reflexive Bladder: In the case of the overactive bladder, the muscles of the bladder contract and are squeezed too much even when the bladder is not full, which makes the urine leak.

• Hypotonic Bladder: In the hypotonic bladder, the muscles become underactive and do not contract, and the release of the urine becomes difficult.

How Frequent or Common Is the Neurogenic Bladder?

Neurogenic bladder dysfunction is more common in people with spinal cord injuries, affecting more than 90 %. Around 95 % of people with spina bifida have some neurogenic dysfunction. This condition also affects 50 % to 80 % of people with multiple sclerosis (a condition in which the immune system destroys the protective covering of the nerves). In addition, the neurogenic bladder affects people with stroke and Parkinson's disease, and many other neurological disorders. Neurological conditions such as advanced diabetes can also cause neurogenic bladder.

What Causes Neurogenic Bladder?

The neurogenic bladder can be caused due to congenital disabilities (defects that the person is born with) or other neurogenic causes and illnesses.

Congenital Disabilities: Below congenital disabilities can cause neurogenic bladder:

• Spina Bifida: This disorder occurs when the spine does not fully develop during the first month of pregnancy. Babies born with spina bifida often have a disability or weakness that affects how the bladder works.

• Sacral Agenesis: An abnormality in which parts of the lower spine are absent.

• Cerebral Palsy: Cerebral Palsy is a group of chronic (long-term) problems that reduce a person's ability to control body movements and posture. They are caused due to damage to the areas of the brain.

Non-Congenital Causes: The non-congenital causes for neurogenic bladder include:

• Neuropathy (damage to the nerve).

• Nervous damage due to prolonged alcohol use.

• Neurological impairment due to chronic diabetes.

• Vitamin B12 deficiency.

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• Nerve damage due to syphilis (bacterial infection spreading through sexual contact).

• Nerve damage due to pelvic surgery.

• Nerve damage from a herniated disc or spinal canal stenosis (narrow spinal canal).

Disorders of the Central Nervous System That Often Cause Neurogenic Bladder:

• Alzheimer's disease: a brain condition that gradually impairs memory, thinking, and, eventually, the capability to do simple tasks.

• Spinal cord defects (such as spina bifida).

• Brain or spinal cord tumors.

• Cerebral palsy: a set of conditions that impair one's ability to move, balance, and maintain a balanced posture.

• Encephalitis: Inflammation of the brain.

• Learning disabilities such as attention deficit hyperactivity disorder (ADHD).

• Multiple sclerosis (MS).

• Parkinson's disease: a neurological condition that results in unintentional or involuntary movements, including trembling, stiffness, and problems with balance and coordination.

• Spinal cord injury.

• Stroke: brain damage due to the reduced blood supply to the brain.

What Are the Symptoms of Neurogenic Bladder?

The symptoms of the neurogenic bladder vary from one individual to another. Likewise, the symptoms rely upon nerve damage causing the issue. They include:

• Urinary Tract Infection: UTI is usually the first sign of a neurogenic bladder. People with less active bladder may develop recurrent urinary tract infections causing recurrent illnesses by harmful bacteria, germs, or yeast that grow in the urinary tract.

• Urinary Incontinence: Urine leakage occurs when bladder muscles become overworked. Sometimes this causes the urine to leak before it is ready to urinate, causing urinary incontinence in which you drip just a few drops of urine, or it can also be like a flow. Also, sometimes urine leakage occurs while you are sleeping.

• Frequent Urination: The symptom of frequent urination is, urinating more than eight times in 24 hours.

• Dribbling: With symptoms of underlying bladder disease, you may urinate only a small amount of urine means just a few drops, which is known to be dribbling and may not be able to empty your bladder, or sometimes due to blockage, you may not be able to open your bladder at all to urinate. This can happen to people with diabetes, multiple sclerosis, polio, syphilis, or significant pelvic surgery, as bladder muscles may not tighten when needed. In addition, the sphincter muscles around the urethra may not function properly. As a result, they may stay firm and cause difficulty in urinating.

How Is Neurogenic Bladder Diagnosed?

• Physical Examination of the Bladder and Ureter: Includes checking the anatomy of the pelvic organs and looking out for any abnormality. The neurologic aspect of physical examination involves checking the mental state of the patient, sensations, reflexes, and strength.

• Imaging Techniques: Like X-rays and computed tomography (CT) scans, and magnetic resonance imaging (MRIs) are used to visualize the bladder or for any blockage that is present in the system.

• Ultrasound (Sonography): This imaging test uses high-frequency sound waves to create images on a computer screen.

• Cystoscopy: A small, flexible tube is inserted into the urinary tract tube to check the urinary tract to examine structural changes or blocks, such as kidney stones or tumors.

• Urodynamics: These tests examine how your lower urinary tract stores and excretes urine. The patient is asked to urinate in a particular container to see how much urine they produce and how long it takes.

How Is Neurogenic Bladder Treated?

Treatment for another neurogenic bladder will be determined by your healthcare provider based on the following;

• Age, overall health, and medical history.

• Cause of nerve damage.

• Type and severity of the symptoms.

• Tolerance of certain drugs, procedures, or treatments.

1. Treatment of Urinary Incontinence: Depending on the symptoms, it can be of various types. The following are the treatment modalities available:

   • Stress incontinence is treated with surgical and some non-surgical approaches.

   • Behavioral modification, pharmacotherapy, or third-line procedures may help.

   • Mixed incontinence may require medications as well as surgery.

   • Overflow incontinence is generally treated by emptying the bladder with a catheter.

   • Other forms of incontinence may be resolved by treating the underlying cause (e.g., urinary tract infection, constipation).

   • Lifestyle changes.

   • Surgery for urinary incontinence - The surgeon opens a stoma (hole) in the abdomen in this procedure. The catheter can be passed through a stoma to remove it from the bladder or an outer collection bag placed over the stoma to hold urine.

2. Drugs: Drugs that treat neurogenic bladder include Oxybutynin, Tolterodine, Mirabegron, Solifenacin Succinate, and others.

3. Botulinum Injections: Injected into the bladder muscle to help assist the bladder from contracting too often. It might also want to be repeated in six months or a year.

4. Catheters: This is a treatment used for underactive bladder. A tiny tube is inserted into your urethra to help your bladder empty fully. There are two types:

   • Clean Intermittent Catheterization (CIC) - The type of technique in which a removable type of catheter is placed depending on your symptoms, the patient is asked to perform self-catheterization at regular intervals, usually three to four times a day; sometimes, clean intermittent catheterization can help improve how your bladder works after several weeks or months. However, intermittent catheters may be hard to use for some people with hand coordination problems.

   • Continuous Catheterization - Insertion of the catheter, whichstays in place to drain urine. The catheter can be placed through the urethra or surgically placed through a small incision in the lower belly directly into the bladder (called a suprapubic tube). The catheter needs to be changed every four to six weeks.

5. Lifestyle changes: Avoid certain foods or drinks that may irritate your bladder. These include alcohol and certain caffeinated beverages such as coffee and soda. Proper blood sugar control in people with diabetes and constipation can also help.

6. Surgery: Some of the surgeries that are performed to help patients to cope with neurogenic bladder include:

   • Artificial Sphincter - This device is inserted to treat severe urinary incontinence when the urethral sphincter muscle is not functioning correctly. Surgery is needed to place the sphincter cuff around the urethra while the pump is inserted under the skin into the scrotum.

   • Augmentation Cystoplasty - In this procedure, the surgeon removes parts of the intestines (sigmoid colon) and attaches them to the bladder's walls. This reduces the internal pressure in the bladder and increases its ability to retain urine.

What Are the Complications of Neurogenic Bladder?

Patients with neurogenic bladder are at risk for several urologic complications, including:

• Hydronephrosis: swelling of the kidneys due to urine build-up.

• Vesicoureteral reflux: an atypical flow of urine from bladders to ureters.

• Kidney failure.

• Urinary tract infections: an infection of the kidneys, bladder, urethra, or any other component of the urinary system.

• Calculus (kidney stones).

• Bladder cancer.

• Sexual dysfunction.

• Infertility.

• Other malignancies.

Conclusion:

The neurogenic bladder has no permanent cure; however, it can be managed through lifestyle changes and nutritional choices. Talk to your physician if you experience new or worse concerns, including things that may indicate an infection, such as pain or fever.