Neurogenic Bladder  

This is an overview of Neuro-urological disorders

Kindly refer to other sections for details regarding the diagnostic and management options for Neurogenic bladder.

Q 1. What is a neuro-urological disorder?

A. The nervous system connects the brain and spinal cord to all parts of the body through a network of nerves. A disturbance in that network can cause problems storing and passing urine.

Urinary problems caused by the nervous system are called neuro-urological disorders.

Q 2. What is Lower urinary Tract?

A. The lower urinary tract consists of the bladder and urethra and includes the prostate in men.

The bladder stores the urine produced by the kidneys. It is a hollow stretchy bag made of muscle tissue that sits on the pelvic floor muscles.

Normally the bladder is able to store urine without building up high pressure. Below the bladder, the urinary sphincter helps store the urine and prevent leakage. It is composed of different parts and muscle layers.

The urethra is the tube through which urine passes from the bladder out of the body.

The main functions of the lower urinary tract are storing and passing urine. Both functions are regulated by the nervous system, which coordinates interaction of the bladder and the sphincter.

Q 3. What is neurogenic lower urinary tract dysfunction?

A. For normal storage, the bladder muscle should be relaxed and the sphincter muscles tense. For urination, the bladder muscle should contract to build up pressure and to press the urine out, and the sphincter should relax to allow for easy and complete emptying without resistance.

These functions involve many parts of the nervous system, including the brain, the spinal cord, and the peripheral nerves.

Any disturbance of these parts can lead to malfunction of normal storage and voiding and cause many symptoms.

This disturbance is called neurogenic lower urinary tract dysfunction.

It may be associated with:

• A neurologic disease such as dementia, stroke, or multiple sclerosis
• Previous surgery or injury to the spine or pelvis
• Previous radiation
• Deformity of the spine
• A slipped disc
• A brain tumour or abnormal cell growth that affects the nervous system
• Diabetes
• Numbness or pain in the hands or feet (called peripheral neuropathy)

Q 4. What are the Symptoms and complications of Neurogenic Lower Urinary Tract Dysfunction?

A. Symptoms and complications of neurogenic lower urinary tract dysfunction depend on where the problem is in the nervous system. Normal storage and passing of urine is disrupted. Sometimes a problem doesn’t cause any discomfort.

Symptoms include:

• Slow or incomplete emptying of the bladder
• No sensation of the bladder
• Feeling abdominal fullness
• Not knowing when or if you will urinate (bladder spasticity)
• A frequent and compelling urge to empty the bladder, day or night, that is difficult to defer
• Incontinence
• Pain in the bladder or genital region

The location of the neurological problem usually influences the type of symptoms the patient may experience, for example: storage symptoms, such urinary urgency or voiding symptoms, such as a weak urinary stream.

Urological problems that occur after sudden changes like spinal injury tend to be more severe than those caused by chronic conditions.

Neurogenic lower urinary tract dysfunction can cause a variety of short- or long-term complications:

• Damaged kidney function caused by high pressure in the bladder is the most significant complication.
• The bladder can deteriorate and lose the ability to empty if high pressure builds up during storage or urination.
• Incomplete emptying of the bladder or backflow of urine to the kidneys might cause recurrent urinary tract infections, which can lead to dangerous effects on organs or even the whole body.

Delay of treatment might lead to worsening of all lower urinary tract function. This results in the need for more drastic therapy. Generally, treatment and follow-up examinations are based on the type of neuro-urological disorder and the underlying cause.

Q 5. What else should I know?

A. Many characteristics, symptoms, and hazards of neuro-urological disorders depend on the underlying cause. It is possible that you are not bothered by symptoms but have a risk of developing complications. A timely and thorough diagnostic evaluation helps prevent worsening of the situation.

Many treatment options enable individualised therapy. Safety and quality of life are the main goals of therapy, with kidney function being the main aspect of safety.

Q 6. How do I protect my kidneys?

A. Depending on the characteristics, a neuro-urological disorder can lead to kidney problems. This is serious and might lead to intensive, time-consuming treatment, reduced quality of life and early death.

The primary aim of treating neuro-urological disorders is the conservation of kidney function. Therapeutic measures like catheterisation may substantially reduce your quality of life but prevent even more serious problems.

Depending on the characteristic of your neuro-urological disorder, your doctor might want to check your kidney function regularly.

Q 7. How do manage my symptoms?

A. Neuro-urological disorders are often unstable. The symptoms may vary widely, even within a relatively short time period.

Regular follow-up with your doctor is necessary. How often depends on the underlying cause.

Urinary incontinence may significantly affect your social life. Many treatment options exist. You shouldn’t be embarrassed to discuss your situation with your doctor.

A lot of tools exist, like different catheters, pads, or condom catheters. Some can help in your daily life. Some might be better suited to your lifestyle than others.

If you try to explain the details of your problem, your doctor can help you select the right tools.