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Address : UROCLINIC 25/34, Ground Floor, Govind Lal Sikka Marg, Near Rajendra Place Metro Station (Pillar No. 161), East Patel Nagar New Delhi 110008

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Urology Disease

Neurogenic Bladder

Neurogenic bladder is a condition characterized by dysfunction of the urinary bladder due to nerve damage or neurological disorders. This condition can lead to various urinary symptoms, such as urinary incontinence, urinary retention, and bladder overactivity, and may significantly impact an individual’s quality of life. Understanding the causes, symptoms, diagnosis, and treatment options for neurogenic bladder is crucial for effective management and improvement of urinary function.

Understanding Neurogenic Bladder:

Neurogenic bladder is a dysfunction of the urinary bladder resulting from neurological damage or disorders affecting the nerves that control bladder function. This condition can manifest as either underactive bladder (hypotonic or flaccid bladder) or overactive bladder (hyperreflexic or spastic bladder), depending on the nature and location of the neurological injury. 

Causes and Risk Factors:

Neurogenic bladder can result from a variety of neurological conditions or injuries, including:

  • Spinal Cord Injury: Traumatic injury to the spinal cord, such as from a spinal fracture or compression, can disrupt nerve signals between the brain and the bladder, leading to neurogenic bladder.
  • Multiple Sclerosis (MS): MS is an autoimmune disorder that affects the central nervous system, including the spinal cord and brain. Damage to the nerves controlling bladder function can result in neurogenic bladder symptoms.
  • Spina Bifida: Spina bifida is a congenital condition characterized by incomplete closure of the spinal column during fetal development. Individuals with spina bifida often experience neurogenic bladder due to abnormalities in spinal cord development.
  • Stroke: Stroke can cause damage to areas of the brain involved in bladder control, leading to neurogenic bladder symptoms such as urinary incontinence or retention.
  • Parkinson’s Disease: Parkinson’s disease is a progressive neurological disorder that can affect bladder function, leading to urinary symptoms such as urgency, frequency, and difficulty emptying the bladder.
  • Diabetes: Long-term uncontrolled diabetes can cause peripheral nerve damage (neuropathy), including nerves that control bladder function, resulting in neurogenic bladder symptoms.

Common Symptoms:

The symptoms of neurogenic bladder can vary depending on the underlying cause and the type of bladder dysfunction present. Common symptoms may include:

  • Urinary Incontinence: Involuntary leakage of urine due to loss of bladder control, which may occur during activities such as coughing, sneezing, or lifting.
  • Urinary Retention: Inability to empty the bladder completely, leading to urinary hesitancy, dribbling, or a sensation of incomplete voiding.
  • Urinary Frequency: Increased frequency of urination, often with small volumes of urine expelled each time.
  • Urinary Urgency: Sudden and intense urge to urinate, sometimes accompanied by leakage if the individual cannot reach a toilet in time.
  • Nocturia: Waking up at night to urinate multiple times, disrupting normal sleep patterns.
  • Bladder Pain: Some individuals with neurogenic bladder may experience discomfort or pain in the lower abdomen or pelvis.

Diagnosis and Evaluation:

1. Medical History and Physical Examination: A healthcare provider, such as a urologist or neurologist, will begin by obtaining a detailed medical history and performing a physical examination. Key aspects of the medical history may include asking about symptoms, neurological conditions, past medical history, medications, and any history of trauma or surgery involving the spine or nervous system. During the physical examination, the healthcare provider may assess bladder function, pelvic floor muscle tone, and neurological status.

2. Urodynamic Study : Urodynamic study is a series of diagnostic tests used to evaluate bladder function and diagnose neurogenic bladder. These tests may include:

  • Cystometry: A test to measure bladder pressure and capacity during filling and emptying, providing information about bladder storage and emptying function.
  • Uroflowmetry: A test to measure the rate and pattern of urine flow during voiding, helping to assess bladder emptying and detrusor muscle function.
  • Pressure-Flow Studies: A combination of cystometry and uroflowmetry to evaluate the relationship between bladder pressure and urine flow during voiding, aiding in the diagnosis of bladder outlet obstruction or detrusor overactivity.

3. Imaging Studies: Imaging modalities such as ultrasound,RGU, MCUG, computed tomography (CT), or magnetic resonance imaging (MRI) may be used to evaluate the urinary tract and assess for any structural abnormalities, such as bladder diverticula, urinary calculi, or spinal tumors, that may contribute to primary or secondary neurogenic bladder symptoms.

Treatment and Management:

1. Bladder Management Strategies: Bladder management strategies aim to optimize bladder function and minimize urinary symptoms, and may include:

  • Intermittent Catheterization: Individuals with urinary retention may need to perform intermittent catheterization to empty the bladder completely at regular intervals.
  • CleanIntermittentCatheterization (CIC): CIC involves using a clean catheter to empty the bladder several times a day, reducing the risk of urinary tract infections (UTIs) and bladder overdistension.
  • Indwelling Catheter: In some cases of severe urinary retention or incontinence, an indwelling urinary catheter may be necessary to continuously drain urine from the bladder.

2. Medications: Medications may be prescribed to help manage symptoms of neurogenic bladder, including:

  • Anticholinergic Drugs: Medications that block the action of acetylcholine, a neurotransmitter involved in bladder contractions, to reduce bladder overactivity and control symptoms of urgency and incontinence.
  • Alpha-Blockers: Medications that relax the smooth muscle of the bladder neck and prostate (in men), improving urine flow and reducing urinary retention.

3. Botulinum Toxin (Botox) Injections: Injections of botulinum toxin (Botox) into the bladder muscle may be considered for individuals with refractory symptoms of overactive bladder or urinary incontinence who have not responded to other treatments. Botox works by temporarily paralyzing the bladder muscle, reducing bladder contractions and improving symptoms.

4. Neuromodulation Therapies: Neuromodulation therapies, such as sacral nerve stimulation (interstim) or percutaneous tibial nerve stimulation (PTNS), may be recommended for individuals with refractory neurogenic bladder symptoms who have not responded to conservative treatments. These therapies involve delivering electrical stimulation to nerves that control bladder function to modulate bladder activity and improve symptoms.

5. Surgical Options: In select cases of neurogenic bladder with severe or refractory symptoms, surgical procedures such as bladder augmentation or urinary diversion may be considered to improve bladder capacity, reduce urinary incontinence, and improve quality of life. 

6. Lifestyle Modifications: Making certain lifestyle modifications can help manage symptoms of neurogenic bladder and improve overall bladder health, including:

  • Maintaining a Healthy Weight: Excess weight can put pressure on the bladder and worsen urinary symptoms, so maintaining a healthy weight through diet and exercise is important.
  • Dietary Changes: Avoiding bladder irritants such as caffeine, alcohol, spicy foods, and acidic foods can help reduce urinary urgency and frequency.
  • Fluid Management: Maintaining adequate hydration while avoiding excessive fluid intake.
  • Consultation with neurologist/spine surgeon or neurosurgeon is necessary to get treatment for the primary cause of neurogenic bladder and to prevent further damage .

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