What Is Neurogenic Bladder?
Neurogenic Bladder is a common condition involving a number of medical conditions of the urinary tract. This condition is caused as a result of some type of a problem with the nerves whose function is to control the bladder. Some of the medical conditions which come under Neurogenic Bladder are overactive bladder, urine incontinence, and bladder obstruction. Many people may have problems with Neurogenic Bladder including those who have an underlying medical condition involving the brain or the spinal cord. People who have Neurogenic Bladder are those suffering from conditions like Multiple Sclerosis, Parkinson's disease, stroke or an injury to the spinal cord. Certain people with congenital spinal problems like spina bifida also have Neurogenic Bladder.
What Causes Neurogenic Bladder?
Neurogenic Bladder is caused due to malfunctioning of the nerves that control the bladder because of which there is either incomplete filling or incomplete emptying of the bladder. Due to this malfunction the muscles of the bladder may become overactive and contract abnormally even before the bladder is filled with urine. Sometimes the muscles get too loose and there is leakage of urine. In some cases the muscles become underactive and even if the bladder is full the muscles do not contract and the person may not feel a sensation of an urge to go to the bathroom. Sometime both overactive and underactive bladder occurs together.
How Can Neurogenic Bladder Affect Life Of An Individual?
Neurogenic Bladder can significantly impact the life of the affected individual. Because of frequent urges to go to the bathroom there may be frequent interruptions at work or when doing something important. Because of fear of leaking you may prefer to stay confined to the house and be reluctant to go out with friends and family. Neurogenic Bladder can also cause people to stay indoors and remain secluded which may adversely affect relationships. It may also cause depression and anxiety due to staying alone and not participating in any outdoor activity.
What Are The Symptoms Of Neurogenic Bladder?
Some of the symptoms of Neurogenic Bladder include:
- Urinary Incontinence: The person suffering from Neurogenic Bladder will have frequent leakages of urine due to an urgent urge to go to the bathroom which becomes uncontrollable. There may also be leakage of urine while asleep without the individual even knowing it.
- Urinary Urgency: In neurogenic bladder, the affected individual will have frequent urges to go to the bathroom. It may be as close as every 10 minutes or so.
- Urinary Frequency: The frequency of urination of the affected individual is increased due to Neurogenic Bladder.
- Urinary Retention: Sometimes due to an underactive bladder muscle the affected individual may not empty the bladder fully due to lack of sensation or the urge to pass urine.
- Repeated UTIs: Individuals affected with Neurogenic Bladder tend to experience frequent urinary tract infections.
How Is Neurogenic Bladder Diagnosed?
For diagnosing neurogenic bladder, the treating physician will start by taking a detailed history as to when the symptoms started. The physician will also ask about the daily intake of fluids in a day. The physician will then perform a physical examination examining the abdomen, prostate and a rectal examination. The physician will also ask you to keep a dairy of the number of times you void in a day so as to better assess the pattern of urinary frequency. A urinalysis will be performed to look for any type of infection causing symptoms. Apart from this, studies like a bladder scan will be done to look for urinary retention. A cystoscopy will also be done to look for any problems with the bladder. A urodynamic test will also be performed to check whether the urinary tract system is functioning at its optimum or not. Radiologic studies like x-rays and CT scan can also be performed for diagnosis of Neurogenic Bladder.
How Is Neurogenic Bladder Treated?
The main aim of treatment for Neurogenic Bladder is to control the symptoms and prevent any potential damage to the kidneys. Treatment options depend on the symptoms and the cause of neurogenic bladder. Since there are two forms of Neurogenic Bladder which is overactive and underactive bladder the treatment for them is different.
Treatment for Overactive Bladder: The first line of treatment for overactive bladder is lifestyle modifications. In this you are taught how to time your voids so that there are no accidents that take place, especially while you are outside. Another method is delayed voiding which is a method in which the individual learns how to control the urge to void. There are also some exercises for the bladder which can be done to strengthen the bladder muscles to prevent premature contractions of the bladder muscles. A voiding diary is also very helpful in controlling the symptoms of an overactive bladder. In most of the cases, the symptoms generally improve with lifestyle modifications but in some cases the symptoms may not improve which may require further treatments. There are different medications which can be used to relax the bladder muscles. In case if Neurogenic Bladder is caused due to brain or spinal cord injury then Botox injections are given for it. This injection stops the bladder muscles from contracting prematurely.
Treatment for Underactive Bladder: The first line treatment of this is also lifestyle modification with timed voids. You can try to urinate even if you do not feel an urge for it and you find urine just dribbling out but over time this is the best way to control urinary retention. There is also a pattern called double voiding in which after urinating once you need to wait for a few minutes before trying to urinate again. Keeping a voiding diary is also helpful in controlling the symptoms. If these do not control the symptoms then medications may be prescribed for control of symptoms. Another mode of treating urinary retention is by using a catheter. This method is called intermittent self-catheterization. This may be done three to four times a day for complete emptying of the bladder. Sometimes urinary retention gets serious enough that it is not controlled by conservative approaches. For such cases, surgery in the form of implanting an artificial sphincter device or bladder augmentation is very effective in controlling the symptoms of Neurogenic Bladder.