In a neurogenic bladder, the nerves that control the bladder malfunction, resulting in urinary incontinence, retention, or infection. It can be caused by a variety of factors, including spinal cord injury, brain injury, stroke, diabetes, or multiple sclerosis. There are many ways to diagnose neurogenic bladder, including physical exams, urine tests, blood tests, imaging tests, and nerve tests. By avoiding or managing the risk factors that can damage the nerves, neurogenic bladder can be treated with medications, catheters, surgery, or electrical stimulation.
Causes of Neurogenic Bladder
Damage or disruption of the nerves that transmit signals between the bladder and the brain can result in neurogenic bladder. There are two main causes of neurogenic bladder:
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The upper motor neuron (UMN) causes are conditions that affect the brain or spinal cord above the sacral level, where the bladder's nerves originate. The following causes can result in spastic or overactive bladders, in which the bladder contracts too frequently or too strongly, leading to urine leakage or urgency.
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Depending on the level and severity of the injury, the bladder may lose coordination with the brain and the sphincter muscles that control urine flow. Spinal cord injury can be caused by trauma, infection, tumors, or degeneration of the spinal cord.
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When a blood vessel in the brain is blocked or ruptured, the brain cells lose oxygen and nutrients, causing the bladder to lose its ability to sense and respond to brain signals.
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As a result of multiple sclerosis, the immune system attacks the protective covering of nerve fibers, called myelin, preventing nerve impulses from reaching the bladder.
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It can also affect bladder control and cause urinary problems due to the loss of dopamine-producing cells in the brain.
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These are conditions that affect the nerves connecting the spinal cord to the bladder and the sphincter muscles known as lower motor neuron (LMN). Some examples of LMN causes include: a flaccid or underactive bladder, which means that the bladder does not contract enough or at all, resulting in urine retention.
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When the spinal cord is injured due to trauma, infection, tumor, or degeneration, the bladder may lose connection with the spinal cord and the brain, leading to a loss of bladder sensation and reflex.
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In diabetics, high blood sugar levels damage the nerves throughout the body, affecting the bladder nerves and causing them to lose their function.
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Accidents, tumors, infections, or procedures that involve the pelvic organs or nerves can damage or sever bladder nerves, causing them to lose their ability to control the bladder.
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Symptoms of Neurogenic Bladder
Symptoms of neurogenic bladder vary depending on the type and cause of the nerve problem. Common symptoms of neurogenic bladder include:
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An involuntary loss of urine can be caused by bladder spasms, weak sphincter muscles, or overflow. Urinary incontinence can cause embarrassment, skin irritation, or infection.
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The inability to empty the bladder completely can be caused by bladder weakness, nerve damage, or obstruction. It can cause discomfort, pain, and infection.
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The need to urinate more frequently than usual can result from bladder irritation, infection, or overactivity. Urinary frequency can affect daily activities and sleep quality.
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A sudden and strong urge to urinate can occur as a result of bladder irritation, infection, or overactivity. It can cause anxiety, leakage, or accidents.
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Bacteria can enter the urinary tract through the urethra to cause urinary tract infections (UTI). UTI can cause fever, pain, burning, or blood in the urine.
Diagnosis of Neurogenic Bladder
Medical history, physical examination, and a variety of tests and procedures are used to diagnose neurogenic bladder. In addition to the symptoms, the doctor may ask about the onset and duration of the symptoms, the person's medical history, and her family history. A doctor may also examine the person to determine if nerve damage has occurred, such as reduced sensation, reflexes, or strength.
Neurogenic bladder can be diagnosed using the following tests and procedures:
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Tests of urine: To determine the amount and type of urine, as well as check for signs of infection, blood, or protein.
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The results of blood tests can help determine the cause or complications of neurogenic bladder, such as blood sugar levels, kidney function, and other substances.
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The purpose of imaging tests is to create pictures of the inside of the body, such as X-rays, ultrasounds, CT scans, or MRIs, in order to display the bladder, kidneys, and other organs' structure and function.
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Tests to determine the bladder function and the type of neurogenic bladder by measuring pressure, volume, and flow of urine in the bladder and urethra.
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By inserting a thin, flexible tube with a camera and a light through the urethra and into the bladder, a cystoscopy examines the inside of the bladder for any signs of tumor, infection, or obstruction.
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Testing the nerves that control the bladder and sphincter muscles can help identify the location and extent of nerve damage.
Treatment of Neurogenic Bladder
Treatment for neurogenic bladder depends on the cause, type, and severity of the condition, as well as the person's age, health, and preferences. The main goals are:
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The person's bladder function and quality of life will be improved or restored
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The prevention or treatment of neurogenic bladder complications, such as infection, kidney damage, or incontinence
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Identify the underlying cause or condition affecting the nerves
Neurogenic bladder can be treated with the following options:
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Medications may be given by mouth, injection, or infusion to relax, stimulate, or reduce bladder spasms.
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During catheterization, a thin, flexible tube is inserted through the urethra or abdomen and into the bladder, allowing urine to drain from the bladder. It may be done intermittently or continuously, depending on the person's needs.
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In surgery, bladder or sphincter muscles are repaired or rebuilt, obstructions are removed or bypassed, or devices are implanted that stimulate nerves or muscles. Other treatments, such as medications or catheterization, may be used in conjunction with surgery.
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A device delivers mild electrical pulses to the nerves or muscles that control the bladder and sphincter. Electrical stimulation may improve bladder function and reduce neurogenic bladder symptoms.
Prevention of Neurogenic Bladder
Neurogenic bladder cannot be completely prevented, as its cause is not always known or avoidable. However, there are possible ways to reduce the risk or severity of neurogenic bladder:
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Avoiding or managing risk factors that can damage nerves, such as trauma, infection, diabetes, or stroke
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Maintaining regular check-ups and screening tests to detect any signs or symptoms of nerve damage or bladder dysfunction
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If you notice any signs or symptoms of nerve damage or bladder dysfunction, seek medical attention right away
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Taking prescribed medications or treatments as directed by your doctor
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Taking care of the bladder and urinary tract by drinking enough fluids, emptying the bladder regularly, and preventing or treating infections
