Description
- 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 carry messages to the brain letting it know weather 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 bladder muscles to tighten in order to store urine again. Any interference in this mechanism leads to a condition known as Neurogenic Bladder. 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.
Symptoms
- Urinary leakage or dribbling
- Urinary retention
- Small urine volume during voiding
- Frequent urination
- Urinary urgency
- Pain and fullness lower abdomen/pelvic area due to a over distended bladder
- Loss of sensation of bladder fullness
- Urinary infection
- Back pain due to Kidney Stones
Cause
- 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)
How the diagnosis is made
- Urine cultures
- Post voiding residual measurements such as filling the bladder to see if it is how much urine it can hold and if leakage occurs.
- Voiding Cystourethrogram and Cystometrogram are other ways to assess bladder function.
Treatment
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 voiding.
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.