What Is an Uninhibited Neurogenic Bladder?
An uninhibited neurogenic bladder or simply neurogenic bladder is when a person has trouble with bladder control due to brain, spinal cord, or neurological problems in general. Many muscles and nerves must cooperate to hold urine until a person is ready to empty it. Between the brain and the muscles that control when the bladder empties, nerve messages flow back and forth. The muscles might be unable to relax or tighten at the right time if these nerves are damaged by illness or injury. The muscles and the nerves do not work together well in people with neurogenic bladder. The bladder might not fill or empty correctly.
Millions of people have a neurogenic bladder. This includes people with the following conditions-
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Multiple Sclerosis- The immune system starts attacking the protective nerve covering.
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Parkinson’s disease- It is a central nervous system disorder affecting movement.
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Spina Bifida- A congenital disability in which the spinal cord fails to develop correctly.
It also includes people who have had-
Another name for the neurogenic bladder is neurogenic lower urinary tract dysfunction.
What Causes an Uninhibited Neurogenic Bladder?
If the nerves that control the bladder emptying get damaged by some illness or injury, the muscles that hold the urine may not be able to relax or tighten at the right time.
The muscles and nerves in people with neurogenic bladder work poorly together. Consequently, the bladder may not correctly fill or empty. Muscles may be overactive and constrict more frequently than usual with an overactive bladder before the bladder is full of urine. Sometimes the sphincter muscles of the urinary bladder that controls the involuntary flow of urine are not strong enough and let the urine pass before a person is ready to go to the bathroom. This condition is called incontinence.
The bladder muscle may be underactive in other people. When filled with urine, it will not constrict and will not empty completely or at all. It is also possible that the sphincter muscles around the urethra do not work right. They may remain tight when a person tries to empty their bladder. Some people experience both underactive and overactive bladders.
What Are the Symptoms of an Uninhibited Neurogenic Bladder?
Neurogenic bladder symptoms vary from person to person. The kind of nerve damage causing the problem also affects the symptoms. Symptoms may include-
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Urinary Tract Infection:
A common symptom of a neurogenic bladder is a urinary tract infection (UTI). Multiple urinary tract infections can occur in people with either an overactive or underactive bladder. The growth of harmful bacteria, viruses, or yeast in the urinary tract is the source of this persistent illness.
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Leaking Urine:
The bladder muscles may be overactive and constrict more frequently than usual, resulting in urine leaks. Occasionally, this constriction causes a person to pass urine before they are ready to do so. Urinary incontinence is the name given to this condition. There might be a leak of just a few drops of urine. Sometimes it may cause a gush of a large amount of urine. Sometimes urine will leak while sleeping.
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Passing Urine Frequently:
Passing urine often may happen with an overactive bladder. This condition occurs when there is a feeling of a sudden urge to pass urine. After this feeling, some people leak urine, a few drops, or a copious amount. Another symptom is passing urine frequently, more than eight times in 24 hours.
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Urine Dribbles:
With underactive bladder symptoms, one may only dribble a bit of urine. It may be difficult to empty the bladder fully or may not be able to empty the bladder at all (urinary retention). This condition may occur in people with diabetes, multiple sclerosis, polio, syphilis (sexually transmitted bacterial infection), or who had significant pelvic surgery, as the bladder muscle may not squeeze when needed. The sphincter muscles surrounding the urethra also may not work the right way. When attempting to empty the bladder, they might stay tight.
How Is Neurogenic Bladder Diagnosed?
Due to the fact that the neurogenic bladder involves both the bladder and the nervous system, the doctor may conduct numerous tests to assess the health of both. Talking to the doctor about the symptoms can be a vital first step.
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Medical History
The doctor may ask for medical history and daily habits. This may include information about the symptoms, when they started appearing, and how they affect the lifestyle. A medical history may also consist of information about past and current health problems. It is vital to make a list and inform about the intake of all the over-the-counter and prescription drugs. The healthcare provider may also ask about the diet and the amount and different kinds of liquids taken during the day.
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Bladder Diary
Sometimes, doctors suggest using an assessment tool or keeping a bladder diary to help diagnose this condition. The affected individual may be asked to keep a bladder diary assessment tool, where they will note how often they go to the bathroom and any time they leak urine. This may help the healthcare provider learn more about their day-to-day symptoms.
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Pad Test
A pad test involves wearing a pad that has been treated with a special dye. The pad will change color when there is a leakage of urine.
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Physical Exams
Physical examinations may also be required. The doctor may examine the rectum, pelvis, and belly in women. The prostate, rectum, and abdomen can all be examined for men.
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Other Tests
Two other options are a urine test to check for an infection or a urodynamic test to check how the urinary tract works. An X-ray or scan may also help with the diagnosis.
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Urine culture tests urine for infection or blood.
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Bladder scans are a type of ultrasound that shows the amount of urine that remains in the bladder after passing urine.
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A cystoscopy is a procedure in which a healthcare professional inserts a small lens-filled tube through the urethra into the bladder.
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Urodynamic testing checks how well the lower urinary tract stores and releases urine. There are several urodynamic tests that the doctor may ask to get done. The test may involve passing urine into a particular funnel to see how much urine is produced and how long it takes. A catheter might be inserted in the bladder to drain or add water and check the resulting pressure.
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Imaging tests such as X-rays, ultrasounds, and CT (computed tomography) scans may also be done to diagnose this condition.
How to Treat an Uninhibited Neurogenic Bladder?
The treatment goals are to control the symptoms and prevent kidney damage. Treatments are aimed at improving the quality of life. When the neurogenic bladder is monitored closely and treated, patients can notice significant improvements in their quality of life.
The healthcare provider will decide on treatment for neurogenic bladder based on the following -
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Age of the person, medical history, and overall health.
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Cause of neurological damage.
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Types of symptoms.
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The severity of symptoms.
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The tolerance capacity for certain drugs, procedures, or therapies.
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The expectations of the patient for the course of the condition
Changing lifestyle or receiving medical treatment are two options for managing neurogenic bladder.
Lifestyle Changes
Changes to lifestyle, also known as behavioral therapies, may be an excellent first step for those with less nerve damage. People can control their symptoms by making these adjustments to their daily lives. Some lifestyle changes for treating neurogenic bladder are -
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Scheduled Voiding- This means holding the urine to pass it at set times instead of going to the bathroom immediately when one feels the urge. This step can lengthen the amount of time one can hold their urine. In some cases, the doctor may ask to try to go to the toilet, even if one does not feel the need, to try to empty the bladder at routine times.
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Limit Certain Foods and Drinks- Some foods and drinks irritate the bladder. Some people have found coffee, tea, spicy foods, and colas to be bothersome. Observing how food and beverages affect people and their symptoms is of great value.
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Double Voiding- This can be helpful for those who have difficulty getting their bladder empty or have the continuous urge to void after passing urine. After passing urine through double voiding, one must wait a few seconds to a minute before relaxing and attempting to empty the bladder once more.
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Delayed Voiding- If there are symptoms of an overactive bladder, it is advised to start by delaying urination for a few minutes and then slowly increasing the time to a few hours. This helps to learn how to avoid voiding, even if there is an urge.
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Pelvic Floor Exercises- These may help relax the bladder muscle when it starts to squeeze or can increase the strength of the sphincter muscles. The nurse or doctor can give information about these exercises in more detail, or they may refer to a specialized physical therapist.
Medical Treatments
When lifestyle changes do not help enough, the doctor may advise medical treatments such as prescription drugs, catheters, and even surgery.
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OAB (Overactive Bladder) Drugs- These drugs help to relax overactive bladder muscles. The drugs can be taken orally or delivered through the skin as a gel or a patch.
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Catheters- Catheters are often a treatment for underactive bladder. It consists of a small tube that is inserted into the urethra to help the bladder empty fully.
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Botulinum Toxin- These are shots injected into the bladder muscle. This medication may help prevent excessive bladder contractions. This treatment wears off over time. It might need to be done again in a year or six months.
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Sacral Neuromodulation (SNS) Therapy- It is used in patients with overactive bladder when other treatment options fail to help. The sacral nerves transmit signals between the bladder and the spinal cord. Overactive bladder symptoms can be alleviated by altering these signals. A thin wire is attached to the sacral nerves by the surgeon. The wire is then connected to a tiny battery hidden beneath the skin. It stops the wrong signals that can lead to an overactive bladder by sending harmless electrical impulses to the bladder.
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Percutaneous Tibial Nerve Stimulation (PTNS)- This involves inserting a needle into the tibial nerve of the leg. An electrical impulse-sending device is connected to the needle. The impulses reach the sacral nerve after passing through the tibial nerve. Most patients receive 12 treatments every week, followed by treatments every month.
Some patients require surgery. The surgical procedures may include -
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Artificial Sphincter- When the urethral sphincter muscle is not functioning correctly, an artificial sphincter helps treat severe urinary incontinence. Sphincter cuff placement around the urethra and pump placement under the skin in the scrotum or labia both require surgery. The pump opens the sphincter, allowing urine to pass through.
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Urinary Diversion Surgery- The surgeon makes an opening in the belly known as a stoma during this procedure. To empty the bladder, a catheter can be inserted through the stoma, or an external collection pouch can be placed over the stoma to collect urine, depending on the surgery.
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Bladder Augmentation (Augmentation Cystoplasty)- In this procedure, a portion of the intestine is removed and grafted onto the bladder's walls. The bladder becomes more prominent, allowing it to store more urine.
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Sphincter Resection- This procedure involves the removal of the weakened part of the urethral sphincter muscle. In some cases, sphincterotomy may be performed, in which the entire muscle may be cut.
Conclusion:
Despite the fact that the neurogenic bladder cannot be treated, it can be managed. The treatment of neurogenic bladder dysfunction is being improved. Following the suggestions provided by healthcare professionals about dietary and lifestyle changes can help. Also, maintaining a healthy weight is helpful. If the lifestyle modifications are insufficient, the doctors advise prescribed medications and other treatment options, including catheters and surgical procedures.
