The bladder is a balloon-like muscular sac where urine is stored.
When this sac becomes full, it is excreted. A pathway of nerves from
the bladder carries messages to the brain letting it know whether the bladder
is full or empty. The brain, then using another set of nerves, sends
messages to the muscles of the bladder telling them to relax and allow the
bladder to empty. Once empty, the brain signals the muscles at
the bladder outlet to tighten in order to store urine again. Any
interference in this mechanism leads to a condition known as
There are two categories of Neurogenic Bladder problems: 1)
overactive (hyper-reflexive or
and 2) underactive
With an overactive (spastic) bladder there is uncontrolled,
frequent expulsion of urine from the bladder, reduced bladder
capacity and incomplete emptying of urine thus failure to properly
store the urine.
An underactive (flaccid) bladder has a large capacity
(up to 2000 ml). Because there is a loss of sensation of
the bladder filling, it does not contract as forcefully as
it normally should, and thus small amounts of urine dribble
out. In other words the bladder fails to empty completely
and the urine dribbles out the urethra.
Dysnergic Bladder describes a bladder with both problems.
- Urinary leakage or dribbling
- Urinary retention
- Small urine volume during voiding
- Frequent urination
- Urinary urgency
- Pain and fullness of the lower abdomen/pelvic area due to an over-distended bladder
- Loss of sensation of bladder fullness
- Urinary infection
- Back pain due to Kidney Stones
- Spinal cord injury or brain damage after accidents
- Tumors and other masses pressing on the spinal cord or the brain
- Diseases affecting the nerves and nervous system (diabetes, Syphilis, Multiple Sclerosis, Parkinson's, ALS etc.)
- Ruptured disks
- Acute infections
- Congenital or birth defects (myelomeningocele) poisoning (heavy metal poisoning)
- Urine cultures
- Post-voiding residual measurements such as filling the bladder to see how much urine it can hold and if leakage occurs.
- Voiding Cystourethrogram and Cystometrogram are other ways to assess bladder function.
- To determine the most appropriate treatment method, it is first
necessary to distinguish between the overactive or underactive types
of Neurogenic Bladder. This can be done by recording the frequency
and the amount of urination voided over a 48-hour period, followed
by determination of how much urine remains in the bladder after
A small residual amount of urine would indicate a normal or small
spastic bladder while a large amount of urine remaining would
indicate a flaccid or a hypotonic bladder.
Depending on the cause, treatment may include a need for frequent
urinary catheterization (a catheter is inserted through the urethra
and into the bladder whenever it is full). Use of medications such
as Ditropan, Tofranil, Pro-Banthine, Levsin, Ornade Cystospaz,
Urispas only in mild cases of
and Hytrin in
cases of Flaccid bladder. Depending on the nature and type of
the problem, surgery (replacing the sphincter with a ring-like
muscle at the neck of the bladder that normally stops urine from
leaking out) may be an option.
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