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Managing Neurogenic Bladder in Spina Bifida - Treatment Options and Considerations

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Spina bifida is a condition leading to cognitive impairment and loss of bladder control. Read below to learn about its management.

Medically reviewed by

Dr. Madhav Tiwari

Published At May 17, 2024
Reviewed AtMay 17, 2024

Introduction

Spina bifida is a condition seen in the newborn baby that affects the spine. It is categorized as Neural Tube Defects, the phenomenon where the brain and spinal cord are not developed properly due to genetic or maternal deficiency of nutrients. Spina bifida can happen at any point anywhere in the spine if the neural tube fails to close. When this tube does not close, the backbone does not form; hence, it damages the spinal cord and its nerves. Spina bifida leads to disabilities that affect the body physically as well as mentally.

What Are the Types of Spina Bifida?

The condition can be categorized into the following categories

  • Myelomeningocele - This is the most common and the most serious type of spina bifida. The presentation for this type is a sac coming out through an opening in the newborn's back. The sac is filled with fluid and has part of the spinal cord and the damaged nerves. It affects life in several ways, such as loss of sensation in the legs and the ability to use the legs.

  • Meningococcal - This type of defect is less severe as the sac coming out of the back does not have a spinal cord within. There is very little damage to the spinal cord and the nerve; hence, this condition comes with minor disabilities.

  • Spina Bifida Occulta - This is an extremely low grade of spina bifida, which is not apparent. This is often referred to as “hidden spina bifida.” This appears as a small gap in the spine but does not have an opening or a fluid-filled sac. The spinal cord and the nerves are not damaged and are discovered in late childhood. This type usually does not cause any disabilities.

What Are the Symptoms of Spina Bifida?

The symptoms are apparent mostly in myelomeningocele and can present as

  • The problems with the bladder and the bowels.

  • It can lead to sexual dysfunction.

  • Inability to move the legs.

  • It can affect the cognitive abilities. Other physical malformations include clubbed feet and problems in knee and hip joints.

  • Weakness at and the area below the defect.

How Does the Spina Bifida Affect the Babies Who Suffer From It?

Spina bifida affects the bladder and bowels.

  • Bladder - Children who are born with this defect always have a neurogenic bladder. Neurogenic bladder is a condition where urinary conditions arise because of loss of control over the bladder due to problems in the brain, spinal cord, or nerve problems. In babies with spina bifida, the bladder is unable to hold the urine in the bladder, or empty the bladder. Such children need intermittent catheterization so that urinary tract infections are prevented from happening.

  • Bowels - The children with spina bifida suffer from constipation on and off. This happens because the nerves that regulate the bowels are not formed properly. This is noticed only after the child is weaned off from breast or formula milk and solid food is introduced to him. As a result, such babies need laxatives to keep them free from constipation which plays an important role in essentially attaining stool continence.

What Is the Treatment of Neurogenic Bladder In Spina Bifida?

The treatment of neurogenic bladder is categorized into various interventions. They are

1. Behavior Intervention - This technique is used in neurogenic bladder patients, including scheduled voiding, habit-making, and pelvic floor exercises. In patients with spina bifida pelvic floor exercises need to be carefully carried out because the excessive pressure over the muscles can increase the risk of kidney damage and renal failure.

2. Medication - Neurogenic bladder is also managed by medication that affects the muscles of the urination. The medication used is the:

  • Alpha-blocker Medications - The alpha-beta blockers help with decreasing the bladder output resistance, decreasing the residual urine volume, and making the incontinence better by reducing autonomic dysreflexia.

  • Anticholinergic Drugs - This medication helps by reducing bladder spasms and the leakage of urine and minimizes the risk of renal damage and uninhibited detrusor contractions. However, the side effects in the form of constipation and dry mouth can be seen in patients who are put on anticholinergic drugs. The complication can develop in some individuals in the form of an increase in post-void residual urine volume. Hence, they start at a low dosage and increase gradually until they reach the tolerance level.

  • Beta-3 Adrenoceptor Antagonist- These are the newer drugs meant to relax the overactive detrusor muscles. They work by targeting the bladder’s natural mechanism. The complications associated with this medicine are minimal.

  • Desmopressin - This is a synthetic vasopressin that decreases urine production by promoting water reabsorption in the tubes of the kidney. It does not have a direct impact on the bladder but is helpful in patients with polyuria. This medication should be used cautiously in patients with congestive heart failure, or renal failure.

3. Catheters - Clean intermittent self-catheterization is a standard and most recommended choice of treatment for patients with neurogenic bladder. Another method of catheterization is Foley's Catheter which is used in patients where intermittent self-catheterization is not possible. Suprapubic tubes are mostly preferred over Foley's Catheter because they reduce urethral irritation, eliminate discomfort at the urethral meat usually, and are easier to change.

4. Neuromodulation - Sacral neuromodulation and percutaneous tibial nerve stimulation treat neurogenic bladder. Sacral neuromodulation involves implanting a device to stimulate the sacral nerves, while PTNS uses a needle to stimulate the nerve near the ankle; both methods are used to stimulate the nerve signals for bladder function.

5. Surgery - In cases of the neurogenic bladder due to spina bifida, surgical interventions may be important to tackle the symptoms and improve life. Common surgical procedures include bladder augmentation, urinary diversion, and artificial urinary sphincter implantation. The specific approach depends on factors such as the severity of the bladder dysfunction, the patient's age, overall health, and individual needs. The goal of the surgery is to improve bladder storage and emptying, reduce urinary incontinence, and prevent complications such as kidney damage.

Conclusion

Neurogenic bladder due to spina bifida presents complex challenges requiring a multidisciplinary approach for effective management. Surgical interventions, including bladder augmentation, urinary diversion, and sphincter implantation, are often necessary to improve bladder function and quality of life. With appropriate medical attention and support, individuals with spina bifida can achieve improved bladder control and hence, there is a decrease in the complications that arise with this condition.

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Dr. Madhav Tiwari
Dr. Madhav Tiwari

General Surgery

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