What is Neurogenic Bladder?
The activities and functions of human urinary system are very tightly regulated by the close-knit circuitry of central nervous system. For example, as soon as the urine accumulates in the bladder, a message or reflex is initiated from the walls of the urinary bladder that travels to the brain in order to serve following functions:
- To inform the brain that the bladder contains sufficient amount of urine.
- To initiate the signals for the voluntary relaxation of sphincters in order to excrete the urine; when the place and time is right.
But it is imperative to mention that there are some pathological instances when this signal regulation does not work effectively and the message to urinate is not transmitted to the brain in time. This condition of poor neural regulation is referred to as Neurogenic Bladder. In simple words, neurogenic bladder refers to the loss of voluntary control over the bladder due to a transient or permanent defect in the neural/ nervous regulation.
Most cases of neurogenic bladder are reported in elderly. According to a new study reported in the Neuroepidemiology journal (1), investigators suggested that the mean age of occurrence of neurogenic bladder is 62.5 years. Additionally, at an average, a case of neurogenic bladder leads to approximately 16 office visits and 0.5 emergency center visits; suggesting a high economic cost.
Fortunately, in most cases, this condition can be managed with conservative and/or surgical treatments to restore normal urinary activities.
Classic Symptoms of Neurogenic Bladder
The presentation of neurogenic bladder is classic for an inability to voluntarily control the urination. The resultant effect is; too much or too less urination that may lead to deleterious complications. These symptoms include:
- A salivating stream while urination.
- You may not be able to completely void your bladder.
- Straining while urination.
- Inability to voluntarily control bladder may lead to urinary leakage.
- A higher risk of urinary tract infections.
- Absence of signaling or stimulus when your bladder is ready to urinate.
You must consult your physician as soon as you face these symptoms.
What Causes Neurogenic Bladder?
Neurogenic bladder is the result of a miscommunication or disconnect between neuronal circuitry and bladder receptors. In simple words, nerves that are responsible for conducting or transmitting the information between brain and urinary bladder are usually damaged in the setting of neurogenic bladder. Additionally, isolated brain disorders or spinal defects that are also implicated as a cause of neurogenic bladder include:
- Alzheimer’s disease
- Spinal cord or brain tumor
- Condition of multiple sclerosis.
- Parkinson’s disease
- Spinal cord injury
- By birth defects in spinal cord like spina bifidia.
- Disabilities in learning like ADHD (Attention deficit hyperactivity disorder).
The bladder muscles can also be damaged due to the following reasons:
- Damage to nerves in the setting of chronic diabetes or long-term use of alcohol
- A history of pelvic surgery that may lead to nerves supplying bladder or associated tissues.
- Damage to spinal nerves as a result of tumor/ injury/ accident or growth.
The diagnosis of neurogenic bladder can be made via tests (such as strength of bladder muscles) or nerve function tests (for nervous system). Correct diagnosis can help your physician in prescribing appropriate treatment options.
Effects or Complications of Neurogenic Bladder
The long term effects of neurogenic bladder are devastating on the human body. For example, some notable complications include; loss of control on the urination, loss of urge to void or empty-out the bladder and negative changes in the control over the bladder. It also results in the stretching of bladder walls or loss of stretch reflex.
Some notable complications of neurogenic bladder include:
- Urinary retention (that increases the chances of developing recurrent urinary tract infection). According to a new study, the risk of recurrent UTI increases by 29-36% in patients with a history of neurogenic bladder (1). In poorly managed cases, renal tissue may also get affected.
- Obstructive uropathies (reported in more than 6 -11% cases)
- Renal failure
- Appearance of blood/ pus in the urine
Diagnosis of Neurogenic bladder
There are several tests and investigations that can be used to identify this condition. For example:
Physical examination and detailed history helps in making the preliminary diagnosis and allowing your physician to advise appropriate tests to confirm the etiology and diagnosis. Most vital investigations that are commonly used for the final diagnosis of neurogenic bladder are:
- Cystometrogram: A test that is conducted to assess the functioning and capacity of bladder.
- An electromyography: A test that is conducted to examine the tone and neural coordination of bladder muscles.
- Tests for imaging between spinal and brain.
- Imaging for bladder and kidneys.
The results clearly determine that helps the physician to diagnose whether the patient has neurogenic bladder or not.
How is Neurogenic Bladder Treated?
The treatment of neurogenic bladder is dependent on the exact diagnosis and comorbid medical conditions. Most frequently used treatment modalities include:
- Bladder re-training exercises: The patients are advised to practice bladder retraining exercises to restore functional strength and endurance.
- Void at intervals: it is advised to void at regular intervals (with or without any urge or desire to micturate).
- There are some therapies as well that help the patients to relieve from neurogenic bladder, these therapies include Kegel exercises and exercises to strengthen the muscles.
- Ruffion, A., Castro-Diaz, D., Patel, H., Khalaf, K., Onyenwenyi, A., Globe, D., … & Edwards, M. (2013). Systematic review of the epidemiology of urinary incontinence and detrusor overactivity among patients with neurogenic overactive bladder. Neuroepidemiology, 41(3-4), 146-155.
- Patel, D. P., Elliott, S. P., Stoffel, J. T., Brant, W. O., Hotaling, J. M., & Myers, J. B. (2015). Patient reported outcomes measures in neurogenic bladder and bowel: A systematic review of the current literature. Neurourology and urodynamics.
- Persu, C., Braschi, E., & Lavelle, J. (2014). A review of prospective Clinical Trials for neurogenic bladder: The place of surgery, experimental techniques and devices. Central European journal of urology, 67(3), 270.