Introduction
Neurogenic bladder in the elderly is a common and challenging medical condition characterized by a loss of bladder control due to nerve damage. It has several types of neurogenic bladder in the elderly. This condition arises from nerve damage that disturbs the normal functioning of the bladder, leading to a wide range of urinary symptoms and complications in the body of elderly people.
What Are the Types of Neurogenic Bladder in the Elderly?
1. Overactive Bladder (OAB):
In this type, the nerves controlling the bladder become overactive, leading to frequent and sudden urges to urinate. This often results in urinary incontinence episodes, where the individual cannot control the urge to urinate in time.
2. Underactive Bladder:
Conversely, an underactive bladder is characterized by weakened or damaged nerves that hinder the bladder's ability to contract effectively. As a result, individuals may experience difficulty fully emptying their bladders, leading to incomplete voiding and a persistent feeling of not emptying the bladder.
3. Mixed Bladder Dysfunction:
Some elderly individuals may exhibit a combination of overactive and underactive bladder symptoms. This mixed bladder dysfunction can present complex challenges, with symptoms of urgency, frequency, and incomplete voiding coexisting.
What Are the Causes of Neurogenic Bladder in the Elderly?
The central nervous system (CNS) is mainly affected by autoimmune disease like multiple sclerosis in the body and can disrupt nerve signals to the bladder. Neurological changes in Parkinson's disease can affect bladder control and lead to bladder dysfunction. A stroke can damage the brain's control centers for bladder function, causing urinary problems.
Trauma or spinal cord degeneration can result in a neurogenic bladder, as it disrupts communication between the bladder and the brain. Normal aging processes can contribute to the neurogenic bladder in the elderly.
Bladder-controlling muscles and nerves become weakened or less responsive, leading to bladder issues. Certain medications also affect bladder function as a side effect. These medications may include diuretics, anticholinergic drugs, or muscle relaxants.
Long-standing diabetes can cause nerve damage, a condition known as diabetic neuropathy. When these neuropathies affect the nerves controlling the bladder, it can result in neurogenic bladder symptoms.
In elderly men, an enlarged prostate gland (benign prostatic hyperplasia or BPH) can obstruct the urethra and disrupt normal bladder emptying, leading to neurogenic bladder symptoms. Conditions like Alzheimer's disease, which predominantly affect the brain but can also impact the nervous system, may contribute to the neurogenic bladder in the elderly. Certain infections, particularly those affecting the nervous system or spinal cord, can lead to nerve damage that affects bladder function.
What Complications Occur in Neurogenic Bladder Dysfunction?
Incomplete bladder emptying is a common issue in neurogenic bladder, which can result in stagnant urine in the bladder. This stagnant urine enhances bacterial growth, which increases the risk of recurrent UTIs. If left untreated, UTIs can cause discomfort and fever and may lead to more severe kidney infections.
Chronic or severe cases of neurogenic bladder can lead to kidney damage. When the bladder doesn't empty properly, the pressure within the urinary tract can go back into the kidneys, causing hydronephrosis (swelling of the kidneys) and impairing their function over time.
Chronic incontinence can lead to skin irritation and breakdown, particularly in elderly individuals with fragile skin. This leads to increased infection of the skin and causes more discomfort. Fear of incontinence episodes can limit an elderly person's participation in social activities, travel, and outings, reducing their overall enjoyment of life.
Some medications used to manage neurogenic bladder symptoms may have side effects impacting the elderly's well-being. Mouth becomes dry and sometimes makes people dizzy and constipated, these are the symptoms occurring in the elderly.
What Is the Diagnostic Procedure for Neurogenic Bladder in the Elderly?
The procedure starts by taking the patient's medical history, including information about urinary symptoms, previous medical conditions, surgeries, and medications. Elderly individuals may be asked about recent changes in urinary habits, such as increased urgency, frequency, or incontinence.
Physical examination determines the neurological signs and rules out other potential causes of urinary symptoms. The examination may include checking reflexes, muscle strength, and sensation in the lower extremities.
Urinalysis is a urine sample taken to check infection, blood, and other abnormalities contributing to urinary symptoms. Urodynamic tests are specialized procedures that evaluate bladder function.
These tests may include: Cystometry, which Measures bladder pressure during filling and emptying. Pressure-Flow Study determines the bladder's ability to empty efficiently. Electromyography (EMG) is used for the Measurement of electrical activity in the bladder and pelvic floor muscles. These tests help assess bladder capacity, detrusor muscle function (the muscle that contracts the bladder), and bladder pressure during urination.
Imaging tests (ultrasound, CT scans) may be ordered to assess the urinary tract and rule out structural abnormalities or tumors that could be causing neurogenic bladder symptoms. Sometimes, video urodynamics may be performed to record and visualize bladder and urethral function during urination. This can provide additional insights into bladder dysfunction. Video urodynamics may be performed to record and visualize bladder and urethral function during urination. Cystoscopy involves using a thin, flexible tube with a camera (cystoscope) to examine the inside of the bladder. It can help detect structural abnormalities or bladder tumors.
What Is the Therapeutic Management of the Neurogenic Bladder in the Elderly?
Anticholinergic Medications are used to treat overactive bladder symptoms. Bladder muscles are relaxed and reduce frequency and urgency. Beta-3 Agonists can also help manage overactive bladder by relaxing the bladder muscle, allowing for increased bladder capacity. In severe cases where the bladder cannot empty properly, intermittent self-catheterization is required to ensure complete bladder emptying. A healthcare professional can teach the individual or their caregiver the proper technique for catheterization.
Pelvic Floor Exercises known as Kegel exercises, increase the power (strength) of pelvic floor muscles and improve bladder control. Bladder Training is a technique involving scheduled voiding to gradually increase the time between bathroom visits, helping individuals regain better control over their bladder.
Surgical procedures may be recommended to address the underlying causes of neurogenic bladder. This may include surgeries to repair spinal cord injuries or correct anatomical abnormalities that affect bladder function.
Botulinum toxin injections into the bladder wall can help relax overactive bladder muscles and reduce urgency and incontinence episodes. This treatment is typically considered when other options have been ineffective. Adjusting fluid intake, particularly in the evening, can help reduce nighttime bathroom trips. Caffeine, alcohol, and acidic foods, these foods can be avoided because these are the irritants of the bladder, and can minimize symptoms.
Conclusion
Ongoing monitoring by healthcare providers for neurogenic people is essential to track progress, adjust treatment plans as needed, and address any emerging complications or concerns. The therapeutic management of the neurogenic bladder should be tailored to the individual's specific type of bladder dysfunction, underlying causes, and overall health of the elderly.
