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
There are two categories of Neurogenic Bladder problems:
1) overactive (hyper-reflexive or
spastic bladder) and
2) underactive (
hypotonic or flaccid bladder).
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
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
Neurogenic Bladder; 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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