Neurogenic bladder dysfunction than to treat. Neurogenic bladder - features of the disease
Neurogenic bladder, which is abbreviated as LUT or organ dysfunction, is a pathological condition in which the process of accumulation and removal of biological fluid from the body is disrupted. This occurs in situations where there are problems in the transmission of nerve impulses to the brain.
The presented condition is not an independent disease. It always occurs in patients with other acquired or chronic pathologies. The frequency of diagnosing the disorder is the same among the two sexes, so it is worth considering how the treatment is carried out. Neurogenic bladder in men and women is also accompanied by different symptoms, has several types.
Kinds
In urological practice, there are three types of NMP. The principle of classification is based on the distribution of pathologies depending on the volume of the organ. That is, the factor when the process of urination takes place is taken into account, together with how full the bladder is at the present time.
NMP can be of several varieties. Source: health-ua.com
Bladder dysfunction is:
- Hyperreflex - a person feels the urge to defecate when a small amount of biological fluid has accumulated in a hollow organ (urine approaches the lower level, or slightly higher);
- Hyporeflex - noted in patients who feel the desire to urinate when the organ is filled with urine above the upper limit;
- Normoreflex - the urge begins at the moment when the biological fluid is at the middle level, which is considered the norm.
The neurogenic bladder in women may or may not be adapted. These states are distinguished depending on how evenly the organ is filled with urine. In the first case, the biological fluid is distributed equally, and in the second, in jumps or periods, which provokes pain due to increased pressure. Against this background, patients often develop a state of urinary incontinence.
It is also worth noting that there is a neurogenic bladder in men and women of the postural type. It differs from the previously described varieties in that unpleasant symptoms can be traced only when a person is in a prone position, no problems arise while standing.
Causes
A neurogenic bladder, the treatment of which is within the competence of a urologist, develops as a result of the disruption of the relationship between nerve impulses and the brain, the department of which is responsible for the normal and full functioning of this organ.
Causes of the development of pathology and provoking factors. Source: propochki.info
This condition can occur due to improper functioning of the centers of urination in the brain or spine. Experts identify several provoking pathologies:
- Encephalitis;
- Tumor formations;
- Post-vaccination neuritis;
- Neuritis diabetic;
- Tuberculosis;
- cholesteatoma;
- Multiple sclerosis;
- Vertebral hernias;
- Spinal injuries and bruises;
- Stroke;
- Severe labor activity with nerve injuries in the pelvic organs;
- Diseases and anomalies of the structure of the brain and spine of a congenital nature;
- obstructive uropathy;
- Megalocyst.
The mechanism of development of neurogenic bladder weakness is rather complicated. A bowel movement is a complex process that occurs at the reflex level, after the organ has been filled with biological fluid. If any pathology or disturbance in the functioning of the body system has a negative effect on it, then the chain of reflexes that previously performed normal urination breaks and various problems begin to arise with the accumulation, retention and excretion of urine.
Neurogenic bladder dysfunction in adults and children manifests itself in different ways. The severity of the clinical picture is directly affected by the cause that led to the occurrence of this disorder. After the innervation of the bladder is disturbed, the same can be traced in the kidneys, rectum, and reproductive organs.
Manifestation
The condition under consideration is a specific disorder in which all patients complain that they have problems with the process of removing biological fluid (urine) from the body. However, it should be understood that all the signs that will be described below can occur singly or in combination, and also have different degrees of severity.
The pathological condition is accompanied by various unpleasant symptoms. Source: 1lustiness.ru
Among the main symptoms, experts distinguish the following:
- Sudden urge to have a bowel movement;
- Feeling of pressure in the lower abdomen;
- Lack of urge to urinate or it is excessively weak;
- Inability to hold urine;
- Delay of biological fluid in the body;
- Difficulty urinating.
Almost all patients, when talking with a urologist, pay attention to the fact that the previously confident jet has become lethargic or weakened. Also, often people are tormented by the feeling that the organ has not completely defecated, which causes a feeling of increased pressure in the abdomen. Less often, people are faced with the fact that they should make some effort to start the process of urination.
Along with this, other unpleasant concomitant symptoms appear:
- The impossibility of committing an act of defecation;
- Fecal incontinence;
- Violation of the menstrual cycle;
- Decreased level of sexual desire;
- Development of erectile dysfunction;
- Formation of trophic ulcers and bedsores;
- Change in gait in a person;
- Fluctuations in temperature and pain sensitivity of the legs.
In those situations where neuromuscular dysfunction of the bladder is not diagnosed in a timely manner, and the pathology progresses, the upper sections of this system may be involved in the process. This causes the described symptoms to be accompanied by conditions characteristic of kidney damage: fever, pain in the lumbar back, loss of appetite, dry mouth, nausea and vomiting (CRF).
Diagnostics
Neurogenic bladder (symptoms in women and men were discussed earlier), is accompanied by a complex of non-specific symptoms and conditions that can occur with various pathologies. That is why doctors pay special attention to high-quality differential diagnosis.
During a standard visual examination of the patient, the presence or absence of the following indicators is taken into account:
- blanching of the skin;
- Reduced body weight;
- The presence of the smell of urea from the oral cavity;
- Dry mucous membranes;
- Shaky "duck" gait;
- The presence of bedsores or scars after surgical treatment;
- Signs of spinal hernias;
- Paralysis or paresis of the lower extremities;
- Education in the lower abdomen in the form of a tumor;
- Complaints about problems with urination (wet laundry, unnatural smell of urine).
This is the initial examination of the patient. If a person cannot answer the questions of a specialist on his own, or has such diseases that do not allow this, it is necessary that one of the relatives or close people be at the reception. The information specified in the outpatient card is also taken into account.
Patient's uroflowmetry parameters are normal. Source: en.ppt-online.org.jpg
Among the instrumental and laboratory diagnostic methods, preference is given to the following procedures:
- Clinical and biochemical blood tests;
- General urine analysis, according to Zimnitsky, according to Nicheporenko;
- excretory urography;
- Plain radiography;
- Urethrocystography;
- Cystoscopy;
- Ultrasound screening;
- Radioisotope study of the kidneys;
- Urofluometry.
The patient himself, or his relatives, must necessarily take an active part in the collection of anamnesis. The more detailed and truthful information they give about the state of health, the greater the likelihood that the specialist will make the correct diagnosis the first time.
Treatment
Since each patient has a different clinical picture and severity of bladder disorders, it is impossible to offer a single treatment regimen for everyone. In each case, individual therapy tactics are selected, and the approach must be comprehensive, otherwise it is difficult to achieve positive dynamics.
Medical
If there is such a condition as urinary retention in the body, then it is necessary to drink medicines, the action of which is aimed at relaxing the muscles of the organ. In this case, alpha-blockers are used, among which Tropafen or Phentolamine is preferred, which is determined by the leading specialist.
When physicians are faced with the task of contributing to the rapid removal of biological fluid from the body, it is necessary to create conditions of increased pressure in the organ, which will strengthen the tone of the detrusor muscles. Beta-blockers, for example, Inderal or Carbochol, do an excellent job with this task.
Inderal is used in complex drug therapy.
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Neurogenic bladder dysfunction is a common disease in adults and children. Neurogenic bladder syndrome involves difficulty storing and emptying urine, which means a violation of the basic functions of the bladder. Failure of the bladder can lead to serious consequences, including psychological ones, and also indicate possible more serious diseases of the spinal cord and brain (age-related and pathological).
This disease can be either independent, caused by congenital disorders in the functioning of the brain and spinal cord, or acquired, provoked by the same disorders and injuries, but received during life. The neurological nature of the disease determines the complexity of its treatment and requires the intervention of a specialist.
Energo Medical Center is a clinic where many urological problems can be treated, including neurogenic bladder syndrome, its causes and signs. The use of modern drugs and treatment technologies, selected based on the psychological and physical characteristics of the patient, allows you to achieve an effective result in a relatively short time.
Neurogenic bladder dysfunction: causes
The main reasons for the development of this disease are considered to be a violation of the neurological connection between the centers of the brain and the muscles and nerve endings of the walls of the bladder and sphincter, which causes a failure in their work.
Communication failure can be caused by:
- congenital pathologies of the spinal cord and brain;
- acquired pathologies of the spinal cord and brain caused by injuries, including birth, as well as oncological diseases;
- neurodegenerative diseases of the brain (Alzheimer's disease, Parkinson's disease, multiple sclerosis);
- inflammatory processes in the brain (encephalitis);
- injuries of the pelvic organs.
Among other things, this syndrome can also be caused by frequent stress or prolonged neurotic conditions.
Neurogenic bladder dysfunction: symptoms
In accordance with the nature of the violation of the bladder, it is customary to distinguish two types of the disease, each of which is characterized by its own symptoms:
- hyperreflex (hyperactive) bladder;
- hyporeflex (hypoactive) bladder.
A hyperreflex bladder is characterized by a high tone of the muscle wall, and therefore a failure in the process of urine accumulation, which leads to the following signs of this type of bladder syndrome:
- frequent urge to urinate with a small amount of urine;
- imperative (suddenly occurring) urge to urinate, which provoke incontinence;
- discomfort when urinating;
- nocturia - frequent awakening at night due to the need to go to the toilet;
- pain when urinating.
The hyporeflex bladder is characterized by neurogenic weakness, which explains the following manifestations of the disease:
- weak urge to urinate even in the case of a significant accumulation of urine;
- difficulties with the process of urination;
- lack of feeling of complete emptying after going to the toilet;
- pain when urinating.
Consequences and complications
Due to the fact that neuromuscular dysfunction of the bladder is most often a symptom of more serious diseases of the brain (up to degenerative and oncological), timely diagnosis of this disease makes it possible to identify the causes of its occurrence, which means that it is possible to quickly take measures and avoid serious consequences.
In addition, bladder disease (both hyperactive and hypoactive types) can lead to complications, since problems with the accumulation and excretion of urine lead to infection of both the bladder itself and other pelvic organs (if excess urine goes up the ureters), which can cause:
- cystitis;
- urethritis (inflammation of the urethra);
- pyelonephritis (inflammation of the kidneys), as well as the formation of kidney stones.
In the case of an underactive bladder, excess urine also leads to stretching of the sphincter and the walls of the bladder, which can also become a serious problem.
In the event of the problems described above, as well as suspicion of the presence of diseases of the bladder, it is necessary to contact someone who treats the problems of the neurogenic bladder, as well as other diseases of the genitourinary system.
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Primary appointment
The initial appointment involves questioning the patient, compiling an anamnesis (fixing the patient's complaints and other information regarding his state of health) and a thorough examination with the appointment of tests and a set of diagnostic procedures.
Diagnosis (examination) of neurogenic bladder
Diagnosis of a disease such as neurogenic bladder is complicated by the fact that this deviation has similar symptoms with other diseases of the genitourinary system. As a result, the survey involves the use as diagnostic measures:
- blood tests and urinalysis, which allow to exclude infectious diseases of the genitourinary system;
- Ultrasound: on ultrasound, the neurogenic bladder has its own characteristics (especially with a hypoactive type of disease);
- urethrography and cystography;
- X-ray of the pelvic organs, which also allows you to identify concomitant diseases and complications.
If no infectious or other causes of a non-neurological nature of the existing symptoms are detected, the patient is prescribed studies of the spinal cord and brain:
- MRI (magnetic resonance imaging);
- EEG (electroencephalography);
- pictures of the skull and various parts of the spine.
Before starting the examination, the patient will need to keep a special diary for several days, where it will be necessary to record the amount of fluid consumed and the frequency of going to the toilet, as well as the features of the urination process (urine volume, presence / absence of discomfort, etc.).
Further treatment regimen
If the results of tests and diagnostic studies confirm the diagnosis of "neurogenic bladder", the specialist will prescribe treatment that is aimed at eliminating the symptoms and factors of the disease in men.
Due to the nature of the disease, its treatment most often involves the involvement of not only a specialist urologist, but also a neurologist and a psychologist.
Treatment of the bladder, including neurogenic, involves the use of a set of measures of various levels and areas of action, which include:
- drug treatment: depending on the type of disease, either drugs are prescribed that reduce muscle tone, or, on the contrary, increase it. In addition, since one of the complications of this bladder syndrome is infectious diseases of the pelvic organs, anti-inflammatory drugs can also be prescribed, whose action is aimed at destroying the infection (in the bladder, ureters, urethra, kidneys, etc.). Medicines are also used to improve blood circulation in the walls of the bladder (both in the form of tablets and in the form of injections). Drug treatment is carried out only under the supervision of a doctor, which makes it possible to track the effectiveness of treatment and the body's response to drugs (if necessary, the complex of drugs and doses can be adjusted).
- physiotherapy - physiotherapeutic methods are also aimed at stimulating the normal functioning of the walls of the bladder and sphincter, as well as at the work of the nervous system itself (spinal cord and brain).
- psychotherapy - regardless of whether the disease was caused by psychological causes (stress, neurosis) or not, psychologist's consultations during the treatment process allow the patient to cope with the disease and its psychological impact on his daily life.
- a complex of exercise therapy (physiotherapy exercises) aimed at strengthening the muscles of the bladder and urinary system (involves conscious tension and relaxation of the corresponding muscles), as well as various parts of the spine and small pelvis (especially in case of injuries in this area). Exercise therapy is considered a very effective (and at the same time quite sparing) method of dealing with diseases of the bladder of a neurological nature.
- surgery - may be recommended in difficult cases. It is a plastic surgery of the bladder (muscle-ligamentous apparatus), as well as correction of the nervous apparatus of the urethra.
In addition, the patient is advised to reduce fluid intake, as well as salty foods, and, if possible, refuse to drink fluids 2-3 hours before bedtime to avoid cases of incontinence, as well as frequent trips to the toilet at night. At the same time, such restrictions should not affect the body's water balance and lead to dehydration. In serious cases, if incontinence becomes a constant problem and causes constant discomfort to the patient, wearing special absorbent underwear may be recommended to avoid the unpleasant consequences of a failure in the process of emptying the bladder.
The results and duration of treatment depend on the stage and type of the disease, as well as on the patient's interest in recovery (in the case of proper treatment, the unpleasant symptoms of the disease can either be reduced to zero or reduced to a possible minimum).
Due to the fact that this syndrome is caused by neurological problems, the measures for its prevention include:
- preventive examinations by a neurologist, as well as an oncologist (especially if there were cases of cancer and neurodegenerative diseases in the family);
- timely and correct treatment of injuries of the spinal cord and brain;
- healthy lifestyle: diet, moderate exercise;
- reducing, if possible, the number of stresses and neurotic situations that can lead to various kinds of disorders, not only disorders of the bladder;
- timely visits to the urologist for preventive purposes, as well as in the event of the above problems, since it is possible to cure a neurogenic bladder and its accompanying diseases the faster and more efficiently, the sooner the patient consults a doctor. At the same time, self-medication is strongly not recommended, because you can not only waste time in vain, but also worsen your condition.
You can make an appointment with a specialist at the Energo clinic using a special form on the clinic’s website or simply by calling. A timely visit to a doctor will allow you to solve all unpleasant problems and return comfort and peace to your life.
Neurogenic bladder (NMP) is not just a disease, it is a whole complex of painful deviations of the urinary process, the main cause of which is a violation of the part of the nervous system responsible for the innervation of the bladder.
The neurogenic bladder occurs both in adult women and men, and in children, since lesions of the nervous system can be both congenital and acquired.
Anatomical educational program
The bladder has three characteristic functions:
- reservoir(accumulation of fluid produced by the kidneys as a result of the removal of waste products of the body from the blood);
- evacuation(removal of urine);
- valve(retention of urine in the bladder).
Neurogenic dysfunction of the bladder is the starting point in the onset and development of the disease, which eventually causes 
change in the anatomical structure of the organ (bottom, four walls (anterior, posterior and two lateral) and the neck). Subsequently, such a change leads to an even greater aggravation of existing functional disorders and to profound changes in the ureter, upper urinary tract and kidneys.
Often, the symptoms of NUT are similar to those of acute cystitis (inflammation of the lining of the bladder), pyelonephritis (inflammatory kidney disease), glomerulonephritis (immunoinflammatory kidney disease), and urolithiasis (a disease that causes kidney stones).
Disease classification
The bladder has three phases:
- filling;
- accumulation;
- emptying.
According to the severity of neurogenic bladder dysfunction is divided into three types:
- light(pollakiuria, stress urinary incontinence, nocturnal enuresis);
- average(rare urination, stagnation of urine);
- heavy(urinary incontinence, constipation, urinary tract infections, upper urinary tract injuries).
Depending on the nature of the change, there are:
- hyporeflex bladder - neurological disorders are located in the sacrococcygeal region. Urine, getting into the organ of the excretory system, begins to accumulate. The bubble begins to stretch, but there is no urge to empty.
- hyperreflex- a pathological process is formed in the central nervous system. A person feels a frequent urge to urinate. This is due to the fact that the urine that is in the bladder is immediately excreted in small portions.
- Areflexory- Feeling the urge to urinate, it is consciously impossible to empty. Urine accumulates in the bladder to the maximum possible volume, after which spontaneous urination occurs.
Provocateurs of the disease
The reasons why a neurogenic bladder develops in adult women and men:
Causes of neurogenic bladder dysfunction in children:
- birth defects in the lower back;
- hypoplasia of the vertebral artery;
- congenital underdevelopment of the sacral part of the spinal cord;
- violation of physical and mental functions in a child due to brain damage;
- spinal hernia;
- agenesis and dysgenesis of the sacrum and coccyx;
- birth injury
- injuries, bruises, fractures;
- tumors;
- acute, chronic and degenerative pathologies.
Clinical picture
In medicine, two forms of the disease are distinguished - hyperactive and hypoactive.
Symptoms of the hyperactive form in adults:
The neurogenic hypoactive bladder in adults has the following symptoms:
- lack of urge to empty with an overflowing bladder;
- urination occurs with a delay;
- when urinating, there is a need for straining;
- due to the overfilled bladder, spontaneous emptying occurs.
Forms and symptoms of NMP in children are similar to adults. True, at a young age often occurs:
- postural disorder- in the daytime there are frequent urges to urinate, emptying occurs in an upright position;
- stress incontinence- occurs mainly in girls during physical exertion. Urine is involuntarily excreted in small volumes.
Establishing diagnosis
In order to make a diagnosis, the doctor collects an anamnesis and then proceeds to examine the patient, probing the abdomen and kidneys. Further, he gives direction for the delivery of tests and instrumental examination.
- general urine analysis;
- according to Nechiparenko;
- general blood analysis;
- blood biochemistry.
Instrumental Methods:
- x-ray of the urinary system and lower spine;
- urethrocystography;
- Ultrasound of the kidneys and bladder;
- cystoscopy.
In addition, a detailed diagnosis requires a number of additional examinations that will help to correctly assess the functioning of the urinary system. Among them:
- uroflowmetry;
- cystometry;
- sphincterometry.
Sometimes there are cases when it is impossible to establish the cause of the disease. In this case, the diagnosis is made - "neurogenic bladder of unknown etiology."
Therapy Methods
The treatment of a disease such as neurogenic bladder is a complex process, since it affects and disrupts all the main functions of the bladder.
That is why the treatment should take place with medication and non-pharmacological methods.
The essence of the drug method is that the doctor prescribes the following groups of drugs:
- anticholinergic drugs;
- blockers;
- beta-blockers;
- a-adrenergic stimulants;
- calcium channel blockers;
- prostenones E2;
- prostaglandins F2a;
- drugs with neurotoxic effects.
Non-drug treatments include:
Surgical intervention directly depends on the shape of the neurogenic bladder. For example, with hypotension of the LUT, laparoscopy is required. It is needed in order to insert a special surgical instrument into the urethra (TUR resection of the bladder neck). Thus, the patient has the opportunity to empty the bladder with a slight pressure from the outside.
With a hyperreflex bladder, an external sphincter is incised to reduce detrusor hyperreactivity and urinary pressure to increase bladder capacity.
In case of illness, specialists, using tissue plastic surgery, perform a surgical enlargement of the bladder, remove vesicoureteral reflux, or install a cystostomy drain to remove urine.
Pathogenetic treatment (blocking the mechanisms of the development of the disease) NMP not only reduces the risk of damage to the urinary and urinary organs, but also tries to prevent future operations.
You cannot self-medicate. Folk remedies do not have any effect on the mechanisms of NMP.
Therapy of the disease during pregnancy
Neurogenic bladder in women during pregnancy is common, but treatment is difficult. Therefore, it is worth contacting qualified specialists who, depending on the stage of the disease and the patient's well-being, will select the treatment.
Prognosis and complications
With appropriate therapy and behavior modification, LUTs have a favorable prognosis, according to which a complete recovery or a benign course of the disease is expected.
Growing up, most children completely get rid of it. If the disease arose already in mature years, then lifelong therapy and constant monitoring of the state of the urinary system will be required here.
If the NMP is not treated, then this will lead to the development of such pathologies as cystitis, pyelonephritis, ureterovesical reflux, etc.
How to prevent violation?
To minimize the risk of developing the disease, you must:
- eat fully and in a timely manner;
- do not abuse spicy and fatty foods;
- avoid smoking and alcohol;
- timely and to the end to treat all chronic and infectious diseases;
- do not overcool
- make sure that your feet do not get wet;
- at the first symptoms, contact a specialist, and not self-medicate.
This pathology is not uncommon and is most often the result of previous illnesses.
At the heart of the disease is a whole state group, which lead to damage to that part of the nervous system that controls the function of the bladder.
This condition occurs in neurological patients. In this article, we will consider the treatment of neurogenic bladder in women and men, as well as possible complications of the disease.
Neurogenic bladder dysfunction - what is it?
The human bladder is responsible for several processes in the body: accumulation of urine, retention and its removal. Already from the age of 4, a person is able to consciously control urination with the help of the nervous system.
Under the influence of pathogenic microorganisms or with congenital pathology there is a violation of any function of the bladder, nerve impulses that connect the brain and this organ. This is how neurogenic dysfunction of the bladder occurs.
In the International Classification of Diseases ( ICD-10) is code N31.2 Neurogenic bladder weakness, not elsewhere classified.
The disease progresses in three stages.: light, medium and heavy. There is another classification.
The neurogenic bladder is divided into three types:
- Hypoactive (hyporeflex). The fault in this case is a violation of the nervous system, which is fully localized in the coccyx zone. This is manifested by partial atrophy of the muscles responsible for the genitourinary system. Due to their insufficient contraction, the patient cannot urinate normally. As a result: the bladder is stretched, the person can no longer hold back urination;
- Hyperactive. As a result of changes in the brain, the bladder muscles become overactive. As a result, urine cannot stay in the body for at least some time;
- Arereflectory. There is also an accumulation of large amounts of urine, but the person cannot empty the bladder. This is a serious type of illness leading to chronic urinary incontinence and complications.
Neurogenic bladder dysfunction is a common cause of psychoemotional disorders in women and men.
Causes of pathology
Have a urinary disorder many reasons. Sometimes the disease is congenital in nature, sometimes it is a consequence of other ailments.
Often the culprit is a long-term psycho-emotional factor. It has been noticed that people who are anxious, suspicious, with a “mobile” nervous system are prone to neurogenic dysfunction of the bladder.
Main reasons leading to this disorder are:
With long-term bladder infections, changes in the sphincter can occur, leading to dysfunction.
Also, any chronic disease of the genitourinary system, whether it is cystitis or is a risk factor for getting a neurogenic bladder.
Symptoms and signs
Depending on the stage and the course of the disease, the patient can feel both mild discomfort and a lot of pain.
With a mild manifestation of the disease, a person will suffer only from, while with a severe disorder, complete atrophy of the muscles that ensure the functioning of the bladder can occur.
If diagnosed hyperactive form bladder, symptoms may include:
- Frequent urination with a small amount of excreted fluid;
- The severity of symptoms at night;
- Sudden attacks of urinary incontinence;
- Discomfort in the pelvic region
An underactive bladder is characterized by weak urination, the urge is present, but the person cannot completely empty.
With a strong filling of the bladder, there are frequent cases of spontaneous urination. An underactive bladder can lead to complete blockage of urination.
Diagnostics
Diagnosis and treatment of neurogenic bladder dysfunction is a urologist. In women, pathology can be suspected gynecologist. First, the doctor collects anamnesis, asks the patient in detail about the disturbing signs.
sick have to keep a diary the number of urinations so that the doctor can determine the form of the disease.
After that, a number of laboratory and functional studies are assigned:
- General blood analysis;
- Biochemical blood test for a number of indicators: urea, creatinine, uric acid, total protein, C-reactive protein;
- Urine analysis by;
- Urine analysis by;
- Ultrasound of the kidneys;
- Ultrasound of the bladder.
In diseases of the kidneys, such as hydronephrosis, cystography is prescribed, as well as cystometry.
With the help of these studies, the doctor can determine degree of bladder damage, what is the duration of urinary retention, evaluate the bladder itself, its volume and capacity.
In some cases, an MRI is needed– research, for example, in case of an obvious neurological disease and in lesions of the spinal cord or brain. Additional research methods include neurosonography, EEG. This helps to more accurately determine the cause of the disease.
And how to treat a neurogenic bladder in children - read the article on.
Treatment of pathology
Treatment of neurogenic bladder dysfunction in adults is always done complex. The main task of specialists is to normalize urination, to prevent the infection from lingering in the body.
Due to the variety of causes that lead to the disease, the treatment of neurogenic bladder often resort to the help of a psychologist and a neurologist.
Treatment of the disease includes:
Psychotherapy- a separate method of helping with neurogenic bladder dysfunction. Regardless of the cause of the pathology, this disease greatly interferes with the patient to communicate, work, just live. Therefore, the help of a psychologist is needed here.
Surgery- an extreme method of treating an ailment, it is rarely used and in very severe cases, for example, with a malignant tumor.
During treatment, the patient must comply with the drinking regime, limiting the intake of liquids, as well as salty foods. A special one may be prescribed, which must be agreed with the doctor.
Features of treatment during pregnancy
If a pregnant woman has bladder pathology, the doctor prescribes a treatment regimen only after examination future mother at the neurologist and psychotherapist.
Therapy is standard, although the drugs are selected taking into account the type of disease and the condition of the woman.
These can be antibiotics ("Metronidazole", "Trichopolum"), physiotherapy (selected individually) and a set of exercises from exercise therapy (also according to indications).
In addition, sedatives and vitamin complexes are prescribed.
Possible Complications
If neurogenic bladder dysfunction is left untreated, then it can lead to serious health problems.
Because this disease is most often a consequence of the underlying, chronic illness that exists in man. A neurogenic bladder can lead to neurosis, often severe, up to the onset of depression.
Such a disease threatens the patient with inflammation of the kidneys, renal failure.
However, if the pathology is treated correctly and on time, then the prognosis is most often favorable.
Prevention measures include timely treatment of the underlying disease, preventive examinations by a doctor, avoidance of stressful situations.
You can learn more about the disease from the video below:
The term neurogenic bladder is used to describe a group of functional disorders arising from damage to the organs of the central and peripheral nervous system. The disease is characterized by partial or complete loss of urination control, and the severity of symptoms depends on the location and etiology of the CNS lesion.
Numerous factors affecting bladder dysfunction make it difficult to verify the diagnosis, and to date, the medical community has not developed an unambiguous system for classifying the disease. However, it is reliably known that NMP (neurogenic bladder) is not an independent pathology, but is formed as a result of congenital or past diseases. In the etiology of neurogenic dysfunction of the bladder (bladder), the prevalence and degree of damage to the nervous system is of decisive importance, and the disease is based on desynchronization of the detrusor contraction with the opening of the urethra. Conventionally, the causes of neurogenic bladder are combined into several groups:
- Congenital dementia, oncological, infectious and inflammatory processes of the spinal cord and brain: encephalitis, neuritis of various etiologies, post-vaccination disorders, Parkinson's and Alzheimer's disease.
- Damage to the peripheral nerves and muscles of the storage organ due to intoxication and trauma, after surgical interventions and strokes.
- Congenital defects of the urinary tract and central nervous system.
- Degenerative changes in the cartilage of the spinal column - osteochondrosis and spinal hernia;
- The immunodeficiency virus is HIV.
In some cases, LUT syndrome is a consequence of chronic cystitis, urolithiasis and emotional shock. Neurogenic bladder in women occurs equally in relation to male patients. The occurrence of dysfunction in childhood is due to birth injuries, congenital pathologies of the central nervous system and urogenital area, as well as hormonal instability and metabolic disorders during puberty.
Clinical picture of different forms of the disease
Depending on the functional activity, hyperactive and hypoactive bladder are distinguished. The clinical picture and the nature of the development of pathological conditions have significant differences. Doctors distinguish 3 degrees of severity of violations of the neurogenic function of the bladder:
- Mild - accompanied by dysuria, incontinence with tension of the abdominal muscles, enuresis at night;
- The average is distinguished by rare urge to empty, stagnation of urine;
- The severe degree is characterized by constipation, incontinence, urolithiasis, chronic inflammation of the urogenital organs, neurotic conditions and general weakness.
Symptoms of a neurogenic bladder depend on the severity of the CNS lesion and can be both episodic and permanent.
Hypoactive bladder
Typical manifestations of dysfunction are a decrease in the contractile activity of the storage organ. Due to the hypotension of the detrusor and sphincter, it becomes impossible to create the necessary intravesical pressure parameters, which leads to a delay and sluggish process of fluid excretion, the formation of a large amount of residual urine and uncomfortable sensations of incomplete emptying. The result of hypotension is the formation of an overdistended bladder with hypertrophy of the walls and a decrease in the volume of the organ. Such a transformation leads to uncontrolled excretion of urine in small doses (drops), sclerosis and wrinkling of the storage organ.
overactive bladder
Urinary incontinence, irresistible (imperative) urge to empty the organ, and nocturnal dysuria characterize an overactive bladder. A spasmodic detrusor contributes to the formation of increased bladder pressure with a small volume of fluid, which causes imperative urges. Overactive bladder syndrome is usually accompanied by hypertension, sweating, and in severe neurological disorders, uncontrolled release of a large volume of urine may occur at the slightest tension of the abdominal walls.
Important! Neurogenic hyperactive bladder reduces the quality of life, significantly limits the circle of communication and physical activity. Against the background of the disease, serious complications arise: hypertension, inflammation of the kidneys, cystitis and dystrophic changes in the organs of the urogenital sphere.
It can be stated that neurogenic dysfunction of the bladder leads to atony of the organ walls and the development of severe urinary outflow disorders. A serious complication can be the reverse reflux of urine in an ascending type, which leads to the formation of stones and inflammation of the kidneys. In most cases, bladder dysfunction is accompanied by mental disorders and social exclusion.
Diagnosis of NMP
Establishing the cause and form of the pathology requires painstaking work not only from the attending physician, but also from the patient. An important aspect is keeping a diary, which indicates the time, number and amount of fluid removed, sensations after the act of urination. Diagnosis of neurogenic bladder consists of several stages, including the following types of examination:
- anamnestic survey with an analysis of objective complaints, hereditary factors, the establishment of chronic and past diseases;
- detection of neurological pathology and exclusion of organic lesions;
- urine tests according to Zimnitsky and Nechiporenko;
- sowing on the bacterial flora;
- Ultrasound of the urinary tract;
- clinical and biochemical blood tests;
- uroflowmetry - determines the muscle activity of the detrusor and the flow rate of the secreted fluid;
- cystometry of a filled bladder with an assessment of capacity and sensitivity, intravesical and intra-abdominal pressure;
- profilometry - urodynamic study of urethral pressure.
According to indications, additional, more informative types of diagnostics can be prescribed: suprapubic puncture, cystoscopy, rectromanoscopy, radiopaque methods, MRI. In most cases, it is advisable to consult narrow specialists: a neurologist, psychotherapist, proctologist, gynecologist, nephrologist. If it is impossible to establish an accurate diagnosis, they speak of an unclear etiology and the idiopathic nature of the pathology.
Treatment of neurogenic bladder
Therapy of the disease requires an integrated approach, especially important is the diagnosis of neurogenic bladder, aimed at identifying the cause and type of organ dysfunction. Typically, the therapeutic regimen includes:
- drug treatment;
- psychotherapy;
- periodic catheterization and the use of physiotherapy techniques;
- teaching patients to control urination with the help of special exercises;
- sacral electrical stimulation with electrode implantation;
- percutaneous drug blockade;
- minimally invasive surgical interventions.
To reduce bladder hypertonicity, anticholinergic agents that block nerve impulses are used: Oxybutynin, Darifenacin, Tolterodine. The drugs are not addictive with long-term use and have a pronounced effect with minimal negative consequences. Some categories of patients are prescribed calcium channel blockers Nifedipine and Pantogam. In case of accumulation of urine, catheterization and intravesical installations with solutions of anesthetic and antioxidant drugs are performed. In addition to drug treatment, patients with hyperfunction of the bladder may be prescribed physiotherapeutic procedures. Exercises aimed at training the abdominal muscles and pelvic floor are recommended, which in the future allows compensating for some of the lost functions of the urinary tract sphincter. In conditions accompanied by urinary retention and a decrease in detrusor tone, periodic catheterization and course electrical stimulation of the storage organ is performed. Reflex activity is restored by a course of cholinomimetics and drugs that enhance the work of smooth muscles: Cytochrome, Riboflavin, Bethanechol, Aceclidine. In many cases, in violation of the functions of the bladder, phytopreparations are included in the treatment regimen: Cyston, Cystenium, Kanefron, Monurel. In women during menopause, hormone replacement therapy is advisable. When an inflammatory process is detected, antibacterial, antiseptic and immunomodulatory drugs are prescribed. To eliminate detrusor-sphincter dyssenergy, promising methods are used for the introduction of botulinum toxin preparations into the wall or sphincter of the storage organ. Due to its high efficiency, neuromodulation is widely used, depending on the nature of the disorders, aimed at activating or inhibiting the functions of the storage organ. The event is considered successful when the signs of violations are reduced by more than 50%. Minimally invasive surgical techniques that improve bladder function have been developed and are actively used in medical practice.
The success of treatment is associated with the correction of behavioral habits and nutrition. During an illness, one should adhere to a salt-free diet and exclude spices, smoked meats, preservation, yeast pastries and alcohol from the diet. The treatment plan for patients with traumatic injuries of the brain and spinal cord requires bed rest, if the patient is able to move or the causes of the pathology are of a different etiology, then hospital treatment is recommended. Rehabilitation and prevention of the disease consists in daily exercises to strengthen the muscles of the pelvic floor, compliance with hygiene rules and medical recommendations. Frequent washing of the external genital organs with decoctions of herbs or warm water with special hygiene products prevent infection of the urinary tract. For the treatment of neurogenic bladder caused by psychological disorders, a necessary condition for recovery and prevention of relapses is long-term observation and rehabilitation by a psychotherapist. In all cases, spa treatment with the use of mineral water, mud therapy in the form of tampons and applications on the bladder area gives a good effect.
Prevention of the disease consists in the timely relief of inflammatory processes in the organs of the urinary system, the prevention of trauma, hypothermia and nervous stress.