Neurogenic bladder: symptoms, causes and treatment

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Definition

What is that neurogenic bladder?

Neurogenic bladder or neurogenic bladder is a condition of loss of bladder control due to disorders of the brain, spine, or nerves. Damage to the nerves can make the bladder become overactive or underactive.

The process of passing urine is controlled by the brain. When the bladder begins to fill, the brain sends signals to the bladder nerves so that the surrounding muscles contract. The contraction of the bladder muscles causes urine to pass.

In patients with one of these bladder diseases, there is a signal delivery problem so that the urine excretion process is also disturbed. If left untreated, this condition can lead to other problems such as bladder disease, urinary tract infections, and kidney damage.

There are a number of ways you can treat a neurogenic bladder. Several methods are aimed at training bladder function. If that doesn't work, the doctor may suggest bladder surgery to improve its function.

Symptoms

What are the symptoms neurogenic bladder?

The main symptom neurogenic bladder is the inability to control urination. Each person may experience different symptoms, depending on the type of nerve damage and the severity of the damage.

In general, here are the symptoms that often appear.

1. More frequent urination

Nervous disorders of the urinary system can cause the bladder to be overactive (overactive bladder). This condition makes the bladder muscles contract more often so that you constantly want to urinate (usually more than 10 times a day).

2. Unconscious urine excretion

An overactive bladder is usually accompanied by urinary incontinence, aka the unwanted passing of urine. In addition to driving you back and forth to the bathroom, these two conditions cause you to pass a few drops of urine without realizing it.

3. Inhibition of urine flow

Besides making you pee more often, neurogenic bladder can also have the opposite effect. Nervous disorders can make it difficult for your bladder to contract, so you rarely feel like peeing or can't pee completely.

4. Recurrent urinary tract infections

These are the first symptoms neurogenic bladder rarely realized. The urine that remains in the bladder can trigger the growth of bacteria, viruses, or fungi. The uncontrolled growth eventually leads to recurrent urinary tract infections.

5. Other symptoms

Apart from the various signs already mentioned, a neurogenic bladder can also cause other symptoms such as:

• Sudden urge to urinate.
• Drops of urine throughout the day.
• Urine is only dripping, not flowing when you urinate.
• Frequent urination at night (nocturia).
• Difficulty urinating so you have to push.
• Pain or heat when urinating.
• In men, erection problems may occur.

When do you need to see a doctor?

You should consult your doctor immediately as soon as you experience symptoms of a neurogenic bladder. The symptoms of this condition sometimes resemble other diseases of the urinary system, although the long-term effects may be more severe.

Untreated neurogenic bladder can result in repeated urinary tract infections and the formation of bladder stones. The accumulated urine can also put pressure on the bladder and cause inflammation of the kidneys.

In severe cases, excess pressure on the kidneys can result in damage to the small blood vessels of this vital organ. As a result, there is a decrease in kidney function and other disorders of the urinary system.

Cause

What causes neurogenic bladder?

Neurogenic bladder is a health disorder caused by problems with the nervous system. Under normal conditions, nerve signals must travel back and forth carrying commands from the brain to control contraction and relaxation of the bladder muscles.

When the amount of urine in the bladder is still small, the brain will command the bladder muscle to collect urine. Once the bladder is full, the brain sends a signal to empty the bladder. This signal is what makes you feel like urinating.

If nerve function is impaired, the bladder muscles cannot tighten (contract) and relax (relax) at the right time. As a result, the bladder will not fill or empty completely.

The bladder may become very active and contract more often even though it is not filled with urine. Or vice versa, the bladder does not contract, so you don't feel like urinating when the urine is full.

There are various health problems that can cause it neurogenic bladder, namely as follows.

1. Birth defects

A neurogenic bladder can be a congenital birth defect. The causes of disabilities include:

• Spina bifida: paralysis or muscle weakness due to incompletely formed spine during fetal development.
• Sacral agenesis:loss of a specific part of the lower spine.
• Cerebral palsy: various chronic (long-term) diseases that cause impaired mobility and body coordination.

2. Diseases that attack nerves

Generally, the main cause neurogenic bladder are diseases that affect the nerves such as:

• multiple sclerosis,
• Parkinson's disease,
• Alzheimer's disease,
• nerve damage due to diabetes (diabetic neuropathy), and
• amyotrophic lateral sclerosis (Lou Gehrig's disease).

3. Injuries and other conditions

Nervous disorders of the urinary system can also be caused by the following conditions:

• spinal cord injury,
• brain or spinal tumor,
• stroke,
• spinal cord damage,
• heavy metal poisoning,
• long-term excessive alcohol consumption, and
• pelvic surgery side effects.

Diagnosis

How to diagnose neurogenic bladder?

Neurogenic bladder is a condition involving the nervous and urinary systems. Handling must also be in accordance with the cause to be more optimal. Therefore, doctors need to carry out a series of tests to diagnose this condition.

Here are a number of checks that are often done.

1. View medical history

First of all, your doctor needs to know what symptoms you are experiencing, how often you experience them, and how they affect your daily activities. Doctors usually also ask for a history of disease, diet, and drinks that you usually consume.

2. Physical examination

The physical exam aims to detect anything on your body that might be causing a neurogenic bladder. This stage includes examining the abdomen, organs around the pelvis, rectum, and tests to detect benign prostate enlargement (BPH disease).

3. See a history of urinating

You may be asked to keep a urination journal. Its function is to record how often you urinate, how much urine comes out, and when you experience urine leakage without realizing it.

4. Pad test

This examination aims to detect urinary incontinence, you will be asked to use pad or special diapers that have dyes in them. The diaper will change color when urine comes out.

5. Other examinations

Apart from looking at your medical history and performing a physical exam, doctors sometimes need to order other tests to confirm a diagnosis. Another examination to diagnose neurogenic bladder is as follows.

• Urine culture test. Your urine sample is examined in a laboratory for signs of infection.
• Cytoscopy. The doctor inserts a long tube with a small camera at the end to see firsthand the condition of the urethra (urethra).
• Urodynamic test. The skin near your urethra will be fitted with a special sensor. This sensor can measure urine flow as well as the capacity and function of the bladder.
• Scan bladder. Scanning generally uses the ultrasound method. If necessary, doctors can also use CT scan, MRI, or X-rays.

Medicine and Medicine

How to solve neurogenic bladder?

Neurogenic bladder is a serious condition with a wide variety of causes. The method of treatment will be determined by the doctor taking into account:

• age, general health condition, and medical history,
• causes of nerve damage,
• symptoms and their severity, as well
• the body's reaction to certain drugs, procedures, or therapies.

Referring to the Urology Care Foundation, below are the methods that can be done.

1. Lifestyle changes

If the nerve damage is still relatively mild, the first treatment is usually through lifestyle improvements. During a certain period of time, you will need to make lifestyle changes which consist of:

• Urinate according to a schedule until you get used to it every 2-4 hours.
• Practice holding back urination if your bladder is overactive.
• Doing pelvic muscle exercises or Kegel exercises.
• Maintain a healthy body weight and be more active.
• Avoid coffee, tea, soda, sour fruits, and spicy foods.
• Keep a urination journal.

2. Take drugs

Medication cannot cure the neurogenic bladder or control urination. However, there are medications that help prevent bladder contractions, thereby reducing the urge to urinate.

3. Use of a catheter

The use of a catheter is so that you can empty the bladder. You do this by inserting a small tube into the bladder to remove urine. However, you may need to take antibiotics while using the catheter because this procedure carries a risk of causing urinary tract infections.

4. Electrical stimulation therapy

This is one of the treatments neurogenic bladder which is quite common. There are two types of electrical stimulation therapy, namely:

• Neuromodulation of the sacral nerves. A thin wire is placed near the sacral nerves to prevent nerve signals from making the bladder overactive.
• Tibial nerve stimulation. The doctor inserts a needle into the tibial nerve in the leg. This needle sends signals from a special instrument to the tibial nerve, then the sacral nerve.

Electrical stimulation therapy uses low-voltage electrical currents that are safe for the body. The second principle of therapy is basically similar, namely improving the signal between the brain and bladder so that you can urinate normally again.

5. Botox injection

Botox injections use toxins from bacteria C. botulinum. When used in small doses, Botox toxins can prevent contraction of the bladder muscles, thereby reducing the urge to urinate. While effective, this method needs to be repeated every six months.

6. Operations

The operation is selected when other methods have produced no results. There is a surgical insertion of a ring on the urethra that can be removed and attached to prevent leakage of urine. There is also bladder reshaping surgery to restore its function.

Home Care

How to live a healthy life if you have neurogenic bladder?

Even if you have a neurogenic bladder, you can still live a normal life. The steps you can take include:

• Urinate on schedule.
• Hold back urination when it's not time.
• Train the bladder with Kegel exercises.
• Lose weight if excess.
• Avoiding foods that irritate the bladder.
• Avoiding drinks that trigger a urge to urinate.
• Consult a doctor if you routinely take high blood medications.
• Monitor your health condition every day.

Neurogenic bladder is a health disorder that has a major impact. Even so, you can manage it by regularly undergoing medication, maintaining a healthy bladder, and implementing lifestyle improvements as recommended by your doctor.