What is neurogenic bladder?
Neurogenic bladder refers to urinary bladder problems due to disease or injury of the central nervous system or peripheral nerves involved in urination control. There are many types of neurogenic bladder, depending on the underlying cause and symptoms.
What are the symptoms of neurogenic bladder?
Neurogenic bladder causes loss of control over the ability to urinate. It starts to cause great damage on the urinary system day by day with results such as too much urinary incontinence or not being able to empty the urine enough. If this situation is not taken under control, it can cause much more serious permanent damage.
Neurogenic bladder symptoms include:
- Drop by drop of urine while urinating
- Inability to completely empty the bladder
- Trying to urinate by squeezing your stomach (in the form of straining)
- Loss of bladder control
- Increased urinary tract infections
- Continuous leakage of urine
- Inability to feel if the bladder is full
- Urinating in small amounts more than usual
What is the cause of neurogenic bladder?
Neurogenic bladder is a condition caused by the nerves not working properly along the path between the bladder and the brain. Neurogenic bladder can occur mostly at birth. Birth defects that can cause neurogenic bladder include:
Spina bifida (myelomeningocele): This disorder occurs when the fetus' spine is not fully developed during the first month of pregnancy. Babies born with myelomeningocele often have problems with the functioning of the bladder.
Sacral agenesis: It refers to the absence of one or more sacral vertebrae.
Cerebral palsy: Cerebral palsy is a group of chronic (long-term) disorders that impair a person's ability to control body movement and posture. These disorders; caused by injuries in the motor areas of the brain. The problem that creates cerebral palsy can occur while the baby is still in the womb or after birth.
Anal atresia: Since some of this patient group without anus hole has congenital sacral nerve disorder, neurogenic bladder may accompany.
Neurogenic bladder can also be caused by a brain injury or bladder nerve damage later on.
Examples of brain injuries that can cause neurogenic bladder include:
- Alzheimer's disease
- Brain or spinal cord tumors
- multiple sclerosis
- Parkinson's disease
- spinal cord injury
- Birth defects involving the spinal cord, such as spina bifida
- Stroke
Conditions that affect the bladder muscles include:
- Diabetes, which can cause nerve damage
- Long-term alcohol use
- Pelvic surgery that can cause nerve damage
- Spinal nerve damage
If your doctor thinks you may have a neurogenic bladder, he or she will test your bladder muscles and nervous system. Treating the underlying condition can help reduce your symptoms.
What are the conditions that can develop due to neurogenic bladder?
Since the neurogenic bladder reduces the feeling of urination or causes loss, the bladder may leak urine in the form of leakage. Accordingly, it may cause less bladder capacity than the required bladder capacity.
The bladder may not empty completely even after urinating. This is called urinary retention. Remaining urine in the bladder increases the risk of urinary tract infection. Infection can occur when urine stays in the bladder or kidneys for too long.
Frequent urinary tract and kidney infections can cause greater damage over time. This can lead to kidney failure, which can be fatal in the long term.
What is neurogenic bladder treatment?
The main treatments for neurogenic bladder are:
Clean intermittent catheterization (CIC): Catheters are thin, flexible tubes that can be inserted through the urethra and into the bladder to drain urine. Patients who have urine remaining in their bladder after voiding and cannot empty their bladder at all should perform CIC at certain intervals. Otherwise, the urine remaining in the bladder will cause greater damage.
Medications: These are anticholinergic drugs (oxybutynin, tolterodine, and others). It can be given according to the patient's needs.
Botulinum A toxin injections: The doctor injects Botox into the bladder or urinary sphincters. It is done to prevent unnecessary contraction of the bladder. After a good evaluation, the decision should be made.
Bladder augmentation (augmentation cystoplasty): This is a surgery in which portions of the bowel (sigmoid colon) are removed and attached to the walls of the bladder. This reduces the internal pressure of the bladder and increases its ability to store urine.
Lifestyle changes: These are changes that involve avoiding certain foods or drinks that can irritate the bladder. These include beverages such as coffee, sodas, spicy foods, and citrus fruits. Losing weight can reduce stress on the bladder. Since the intestines are full will disturb the bladder, the intestines should also be under constant control. Intestines should be kept clean at all times. The child should never be constipated. It should consume enough water.
What happens if neurogenic bladder is not treated?
If neurogenic bladder is not treated and more importantly, if the patient is not followed up, recurrent urinary tract infections can cause greater damage to the bladder and kidney. Urine remaining in the bladder can back up to the kidneys. Urine leaking back into the kidneys can cause permanent damage to the kidneys. This damage can also lead to kidney failure over time.
How do we, the Center for Bladder-Bowel Disorders in Children, treat neurogenic bladder?
Since there is a nerve damage in the middle, there is no such thing as a complete return to normal. However, with certain daily lifestyle changes and pelvic floor rehabilitation, children can;
- Intestinal motility can be regulated.
- If there is poop incontinence, their incontinence may decrease or even disappear.
- The feeling of bladder fullness may increase.
- The amount of pee he pees out may increase.
- As the amount of urination increases, the number of TAKs can be reduced.
This treatment requires a process in children with neurogenic bladder. Very good results can be obtained with the efforts of the family, child, doctor and therapist.
Pelvic floor rehabilitation aims to regain the function of the pelvic floor muscles that control voiding and defecation. Rehabilitating the pelvic floor muscles is not just about focusing on the pelvic floor muscles. Our treatment is a comprehensive treatment that includes the rehabilitation of all the muscles associated with the pelvic floor muscles. In our treatment, there are many treatment types such as manual therapy, exercises, respiratory training, voiding techniques, electrical stimulation, neuromodulation, emg-biofeedback, pelvic floor exercises. It was determined whether all the patients we treated were exercising regularly, the amount of urine coming out of the CIC, the maximum amount of peeing, etc. We monitor all information regularly. As we follow up our patients regularly as a team, we prevent more serious problems that may occur.