Neurogenic bladder is not one specific disease, but a group of disorders of the urinary system in which the emptying process is disrupted. However, there are usually no anatomical abnormalities in the structure of the organs.
The disease has another name - neurogenic bladder dysfunction (NDBD). Two groups of factors lead to the development of pathology. One of them is associated with various diseases of the central nervous system and urinary tract, and the second with organic damage to the spinal cord.
Symptoms and clinical picture of a neurogenic bladder
Depending on the type of injury to the central nervous system, there are 2 types of symptoms of neurogenic bladder.
- Hypertensive . It is characterized by a small amount of urine excreted with frequent urges and painful hypertonicity of the organ.
- Hypotonic . It is characterized by an overflowing bladder and the inability to urinate.
Considering that any type of this pathology becomes a severe shock for the patient, the signs of a neurogenic bladder are complemented by a mental disorder.
general information
The occurrence of neurogenic bladder dysfunction can be diagnosed not only in young children, but also in adult patients. The disease occurs against the background of disturbances in the functioning of the nervous system.
When the disease occurs, various disorders in the functioning of the organ are observed against the background of exposure to a certain provoking factor.
Causes
A disruption in the functioning of an organ is observed when the nervous system does not function properly. Against this background, insufficient coordination of detrusor activity is diagnosed.
A common cause of the development of pathology in childhood is hereditary predisposition. If tumor or inflammatory-degenerative diseases occur in the human body, then pathology develops.
Dysfunction can be diagnosed against the background of various organ injuries. The disease is diagnosed when:
- cerebral palsy;
- birth injuries;
- spinal injuries;
- agenesis in the coccyx, etc.
If the formed urination reflex is unstable and functionally weak, then this leads to pathology. Since estrogen saturation is higher in the fairer sex, the disease is diagnosed in them more often.
Symptoms
Signs of NDMP develop in accordance with the severity of the pathology. Patients may experience discomfort or pain of varying severity.
If the disease develops in the early stages, the patient is diagnosed with urinary at night. If the pathology is not treated in a timely manner, atrophy of the muscles with which the organ functions is observed.
People with the disease are diagnosed with increased urination. At the same time, the amount of urine decreases significantly. Symptoms are more pronounced at night.
Patients complain of sudden attacks of urinary incontinence. The disease is accompanied by unpleasant symptoms in the pelvic area. If the organ is very full of urine, it can be released spontaneously.
When the bladder is underactive, discomfort in the pelvic area is diagnosed.
Diagnosis of neurogenic bladder
For the correct diagnosis of a neurogenic bladder, it is important for the patient to daily record the volume of urine excreted and the frequency of urination. The primary diagnosis is made by a urologist after examining the patient. To confirm it, instrumental studies and tests for a neurogenic bladder are prescribed.
Diagnostic methods
The following diagnostic measures are carried out:
- cystoscopy, MRI, excretory urography, ultrasound of the urinary system, uroflowmetry, profilometry;
- neurological studies of the spinal cord and brain: MRI, CT, electroencephalography, radiography;
- differential diagnosis;
- laboratory tests: blood and urine tests (general and biochemical), urine tests for infections, according to Zimnitsky, according to Nechiporenko.
Symptoms
The clinical picture in patients is diverse and is determined by the type of neurogenic bladder, the degree of severity and disorders in the functioning of the central nervous system. Neurogenic dysfunction is manifested mainly by a violation of the process of accumulation and excretion of urine.
The hypertensive type of neurogenic bladder appears against the background of hyperreflexia of the organ in combination with increased intravesical pressure and spasticity. The hypertensive type is characterized by symptoms:
- frequent urge to urinate, followed by the release of a meager volume of urine, or complete inability to urinate;
- increased urinary tone - constant tension, manifested as discomfort in the suprapubic area;
- frequent urge to urinate at night, especially in men;
- the act of urination occurs with difficulty, the patient is forced to strain to completely empty the bladder;
- accumulation of residual urine;
- general malaise - weakness, profuse sweating.
A neurogenic bladder of the hypotonic type has other clinical manifestations - the organ becomes full, there is no opportunity to urinate normally - the person cannot bring himself to excrete urine. The contractility of the muscular layer of the bladder is completely lost, and intravesical pressure is reduced.
Symptoms:
- complete retention of urine or sluggish urination;
- straining when urinating;
- constant feeling of a full bladder;
- development of paradoxical ischuria;
- accumulation of large volumes of residual urine, resulting in heaviness in the lower abdomen.
Complications
Neurogenic dysfunction is dangerous due to complications. With any form of pathology, the risk of developing mental disorders increases. Patients begin to feel shame in front of others, fear of the act of urination. Severe moral suffering can lead to suicide attempts, especially in young people.
A serious complication is atrophy of the urinary tract followed by sclerosis and wrinkling. Atrophy occurs against the background of a long course of pathology due to the development of trophic disorders. The bladder completely loses all functions and cannot be restored.
Serious inflammatory processes with infection of the urinary system often accompany neurogenic dysfunction - the formation of stones with subsequent blockage of the ureters, purulent pyelonephritis, acute bacterial cystitis. With increased spasticity, vesicoureteral reflux develops, a condition that leads to the backflow of urine into the kidneys.
The extreme outcome in the absence of treatment for dysfunction is rupture of the walls of the bladder. This complication is typical for the hypertensive type. Rupture can cause abdominal infection and peritonitis. This condition is life-threatening for the patient and requires immediate hospitalization.
A frequent complication during the hypotonic form of the disease is uremia - a dangerous pathological condition associated with the body's release of protein metabolic products. Uremia occurs due to the accumulation of large volumes of urine and the inability to excrete it. Against the background of uremia, acute renal failure may additionally develop.
Treatment regimen for neurogenic bladder
How to treat a neurogenic bladder is decided jointly by a urologist and a neurologist, taking into account anamnestic information, the results of diagnostic studies and the age characteristics of the patient. Self-medication is excluded.
Basic treatment methods and contraindications
Treatment of neurogenic bladder is complex and is carried out using medicinal, non-medicinal and surgical means.
- Drug therapy involves the use of antidepressants, adrenoblockers, calcium antagonists, intravesical injections of Capsaicin, Resinferatoxin.
- Non-drug therapy is represented by physical therapy, psychotherapy, and a balanced diet.
- Surgical intervention is performed if it is necessary to install a cystostomy drainage, increase the capacity of the bladder, or evacuate urine.
Physiotherapy helps to increase the effectiveness of treatment: sessions of electrical stimulation, laser therapy, and thermal applications.
Causes of pathology
Urinary dysfunction has many causes . Sometimes the disease is congenital, sometimes it is a consequence of other ailments.
Often the culprit is a long-existing psycho-emotional factor. It has been noted that people who are anxious, suspicious, and have a “mobile” nervous system are prone to neurogenic bladder dysfunction.
The main reasons leading to this disorder are:
- Congenital lesions of the brain or spinal cord;
- cord or brain injuries. In this case, the interaction between the cortical centers of the brain, genitourinary system, ureter and bladder is disrupted;
- Pathologies of the central nervous system and its parts. This includes a whole group of diseases (encephalitis, various types of polyneuropathy, multiple sclerosis, Parkinson’s disease and others);
- Difficult childbirth in women;
- Malignant formations of various etiologies, most often in the spine;
- Prostate adenoma in men;
- Chronic stress;
- HIV;
- Spinal diseases . These include hernias, complex forms of osteochondrosis, spinal injuries, tumors and complications after surgical interventions.
With long-term bladder infections, changes in the sphincter may occur, leading to dysfunction.
Also, any chronic disease of the genitourinary system, be it cystitis or pyelonephritis, is a risk factor for developing a neurogenic bladder.
Clinical picture
Manifestations of pathology depend on the nature of the dysfunction.
Hyperreflexive
Frequent urination - the normal number of urges is 3-5 during wakefulness and 1-2 during sleep. The urge is felt when the bladder is filled by more than 66% - 250-300 ml during wakefulness and more than 80% - 300 ml or more - during sleep.
A hyperreflex bladder is characterized by an increased number of urges by 3-5 times during wakefulness, and during sleep the bladder involuntarily empties.
The urge continues after urination for 1-3 minutes. At the acute stage or during an exacerbation, a cutting pain is felt before and after bowel movement.
An urge that lasts more than 5 minutes causes a headache.
With a long course of the disease - 3 months or longer - circles or dots with blurred vision, weakness, short-term fainting are possible.
Hyporeflexory
With this type of dysfunction, the following symptoms appear:
- no urge to urinate or feeling that the bladder is not empty;
- involuntary urination without the sensations inherent in this process;
- intermittent flow, the act is accompanied by cutting pain;
- low-grade fever, nausea, weakness due to stagnation of urine.
Manifestation
The condition in question is a specific disorder in which all patients complain that they have problems with the process of removing biological fluid (urine) from the body. However, it is worth understanding that all the signs that will be described below can occur singly or in combination, and also have varying degrees of severity.
The pathological condition is accompanied by various unpleasant symptoms. Source: 1lustiness.ru
Among the main symptoms, experts identify the following:
- Sudden urge to defecate;
- Feeling of pressure in the lower abdomen;
- Lack of urge to urinate or it is extremely weak;
- Inability to hold urine;
- Retention of biological fluid in the body;
- Difficulty urinating.
Almost all patients, when talking with a urologist, pay attention to the fact that the previously reliable stream has become sluggish or weakened. Also, people are often tormented by the feeling that the organ has not completely defecated, which causes a feeling of increased pressure in the abdomen. Less often, people are faced with the fact that they have to make some effort to start the process of urination.
Along with this, other unpleasant accompanying symptoms appear:
- Irritable bladder syndrome in women, men and children
- Inability to perform an act of defecation;
- Fecal incontinence;
- Menstrual irregularities;
- Decreased level of sexual desire;
- Development of erectile dysfunction;
- Paralysis or paresis of the lower extremities;
- Formation of trophic ulcers and bedsores;
- Changes in a person's gait;
- Fluctuations in temperature and pain sensitivity of the legs.
In situations where neuromuscular dysfunction of the bladder is not diagnosed in a timely manner and the pathology progresses, the upper parts of this system may be involved in the process. This becomes the reason that the described symptoms are joined by conditions characteristic of kidney damage: increased body temperature, pain in the lumbar back, loss of appetite, dry mouth, nausea and vomiting (CRF).
