Bladder Sphincter Dyssynergia is also known as Neurogenic Detrusor Overactivity. The dyssynergia or neurogenic overactivity is observed in patients following neurological injury or damage most often caused by spinal injury. The bladder reflex is modulated by brain, pons and spinal cord. The impulses are carried to and from bladder by sympathetic or autonomic nerves. In this article, we will discuss about the various aspects of Bladder Sphincter Dyssynergia.
How Is Bladder Sphincter Dyssynergia or Neurogenic Detrusor Overactivity Defined?
- Detrusor muscle of urinary bladder and muscles of urethral sphincter contract and relaxes during urination. The muscle contraction and relaxation is coordinated to maintain normal regular flow of urine.1
- Neurogenic disorder causes irregular contraction and relaxation of these two muscles.
- During voiding in normal situation detrusor muscle contract and urethral muscles relaxes. Neurogenic disorder causes muscles to contraction of detrusor muscle and urethral sphincter.1
- The contraction of these muscles during voiding causes obstruction of urine flow.
- Contraction of urinary bladder and obstruction of urinary flow causes increase of bladder pressure.
- Bladder Sphincter Dyssynergia is most often caused by damage or injury of spinal nerve.
- The nerve lesion is observed in patients suffering with multiple sclerosis, which leads to disruption of CNS.
Causes of Bladder Sphincter Dyssynergia or Neurogenic Detrusor Overactivity
- Brain Abnormalities
- Stroke2
- Cancer
- Dementia
- Parkinson’s disease
- Shy-dragger syndrome
- Midbrain Abnormalities: Pons Micturition Center
- Stroke or ischemia of pons.
- Spinal Cord Injury
- Multiple sclerosis
- Spinal cord tumor
- Herniated disc
- Peripheral Nerve Injury
- Diabetes Mellitus
- HIV Infection or AIDs
- Poliomyelitis
- Guillain-Barre Syndrome
- Postherpetic Neuralgia
Symptoms Of Bladder Sphincter Dyssynergia or Neurogenic Detrusor Overactivity
Specific Bladder Sphincter Dyssynergia Symptoms:
- Lower Abdominal Pain-
- Severe colic pain over lower abdomen
- Pain becomes continuous and intense if urine is not voided.
- Daytime and Nighttime Wetting-
- Patient experiences daytime and night time wetting and may not realize.
- Retention may be associated with pain over supra-pubic area.
- Bladder Infection-
- Patient may complain of fever
Associated Symptoms of Bladder Sphincter Dyssynergia or Neurogenic Detrusor Overactivity
- Parkinson’s Symptoms-
- Skeletal muscle tremor
- Cogwheel rigidity
- Mask face
- Shy Dragor Syndrome-
- Cerebellar ataxia
- Orthostatic hypotension (low blood pressure while standing)
- Anhydrosis
- Spinal Cord Injury
- Numbness and tingling of lower leg
- Weakness of lower leg- flaccid paralysis
- Multiple Sclerosis
- Muscle spasticity
- Hyperreflexia
- Spinal Nerve Lesion (Damage)
- Segmental tingling and numbness
- Segmental muscle weakness
Diagnosis of Bladder Sphincter Dyssynergia or Neurogenic Detrusor Overactivity
Cystoscopy for Bladder Sphincter Dyssynergia or Neurogenic Detrusor Overactivity
- Direct vision examination of urinary bladder.
Urodynamic Study3 for Bladder Sphincter Dyssynergia or Neurogenic Detrusor Overactivity
CT Scan- Radiological study is performed to evaluate the cerebral (brain), brain stem and spinal cord abnormalities as a cause of the bladder sphincter dyssynergia.
- Central Nervous System-
- Brain
- Brain stem
- Spinal cord
- Bladder
Magnetic Resonance Imaging (MRI) for Bladder Sphincter Dyssynergia or Neurogenic Detrusor Overactivity
It is often used as alternative to CT scan.
- Central nervous system
- Brain
- Brain stem
- Spinal cord
- Bladder
Ultrasound for Bladder Sphincter Dyssynergia or Neurogenic Detrusor Overactivity
The Procedure is performed to evaluate the external urinary bladder wall and urethra.
- Urinary bladder
- Urethra
Nerve Conduction Study for Bladder Sphincter Dyssynergia or Neurogenic Detrusor Overactivity
- Electromyogram
- Nerve conduction study
Treatment For Bladder Sphincter Dyssynergia or Neurogenic Detrusor Overactivity
There are a large number of individuals with Bladder Sphincter Dyssynergia who need repeat surgery as described in literatures.
A study was conducted on about 20 females who were diagnosed with multiple sclerosis and had Bladder Sphincter Dyssynergia and were treated with baclofen at 15 mg a day and doxazosin 4 mg per day. Around 8 individuals also were given tolterodine at 4 mg per day along with baclofen and doxazosin as they were identified to have detrusor hyperreflexia.
After treatment with the above-mentioned medications, it was found that these medications were helpful in treating Bladder Sphincter Dyssynergia.
- It should also be kept in mind that Bladder Sphincter Dyssynergia may be a start of a neurologic condition.
- Botox injection4
- Surgery- Transurethral incision of the bladder neck5
References:
1. Detrusor-sphincter dyssynergia.
Barsanti JA1, Coates JR, Bartges JW, Brown SA, Oliver JE, Finco DR.
Vet Clin North Am Small Anim Pract. 1996 Mar;26(2):327-38.
2. Causes of urinary incontinence after acute hemispheric stroke.
Gelber DA1, Good DC, Laven LJ, Verhulst SJ.
Stroke. 1993 Mar;24(3):378-82.
3. Urodynamic biofeedback: a new therapeutic approach for childhood incontinence/infection (vesical voluntary sphincter dyssynergia).
Sugar EC, Firlit CF.
J Urol. 1982 Dec;128(6):1253-8.
4. Therapeutic outcome and quality of life between urethral and detrusor botulinum toxin treatment for patients with spinal cord lesions and detrusor sphincter dyssynergia.
Kuo HC.
Int J Clin Pract. 2013 Oct;67(10):1044-9.
5. Transurethral incision of the bladder neck to treat bladder neck dysfunction and voiding dysfunction in patients with high-level spinal cord injuries.
Ke QS1, Kuo HC.
Neurourol Urodyn. 2010 Jun;29(5):748-52.
