Neurologic bladder dysfunction, neuropathic bladder

What is this condition?

Neurogenic bladder refers to all types of bladder problems caused by disruption of normal nerve impulses to the bladder. The complications that follow neurogenic bladder include lack of bladder control, failure to completely empty, urinary infection, stone formation, and kidney failure. A neurogenic bladder can be spastic or flaccid.

What causes it?

At one time, experts thought neurogenic bladder was caused by spinal cord injury. Now it appears to be linked to such conditions as acute infectious diseases, dementia, heavy metal toxicity, certain types of cancer, and many additional disorders.

What are its symptoms?

Neurogenic bladder produces a wide range of effects, depending on the underlying cause and its effect on the structural integrity of the bladder. Usually, the person with this disorder has some degree of mcontmence.

If the person has a spinal cord lesion, a spastic neurogenic bladder may produce involuntary or frequent scanty urination without a feeling of bladder fullness and, possibly, spontaneous spasms of the arms and legs, hypertension, and headaches. Flaccid neurogenic bladder may be linked to overflow incontinence, diminished anal sphincter tone, and a greatly distended bladder that the doctor can feel. The person may feel no bladder fullness because the senses are impaired.

How is it diagnosed?

The doctor will ask about the person's health history to determine if he or she has a condition or disorder that can cause neurogenic bladder. The doctor will also ask if the person has experienced incontinence or disruption in urination patterns.

Tests to evaluate the person's bladder function may include cystography (a picture of the voiding process) to check bladder neck function, urine backup, and continence; and studies of how urine is stored in the bladder and how well the bladder empties.

How is it treated?

The doctor will work to maintain the integrity of the upper urinary tract, control infection, and prevent urinary incontinence through evacuation of the bladder, drug therapy, surgery or, less commonly, neural blocks and electrical stimulation.

The person may be taught to empty his or her bladder by applying manual pressure over the lower abdomen. He or she may be taught how to insert and remove a catheter. Generally, a man can perform this procedure more easily, but a woman can learn self-catheterization with the help of a mirror. Intermittent self-catheterization, in conjunction with a bladder-retraining program, is especially useful for people with flaccid neurogenic bladder.

If conservative treatment fails, the doctor may use surgery to correct structural problems by modifYing the bladder neck, widening the urethra, removing part of the sphincter muscle, or building a new route for urine. Implantation of an artificial urinary sphincter may be necessary if permanent incontinence follows surgery for neurogenic bladder.