Neurogenic bladder is a urination disorder, the cause of which lies in dysfunction of the central nervous system (central nervous system). Neurogenic dysfunction (NDMP) is not an independent disease. This is a set of symptoms that indicates damage neural connections leading to spontaneous or frequent urination.
When to suspect a neurogenic bladder
A characteristic symptom of NDMP is pollakiuria (constant urge) or incontinence when the bladder is full. A person is faced with urine retention and leakage. In men against the background of neurogenic dysfunction.
Signs of neurogenic pathology:
- night trips to the toilet;
- urinary spasm, paralysis, decreased sensitivity;
- uncontrolled contractions of the muscle layer of the bladder, causing leakage;
- frequent urge to go to the toilet.
The clinical picture depends on the level of damage to neural connections. Muscle spasm of the bladder provokes an increase in internal pressure, despite a small amount of urine. Weakness of the sphincter leads to an increased urge to visit the restroom.
Your child may have difficulty starting or urinating. Also, in adults and children, vegetative symptoms are added - increased sweating, horse racing blood pressure, spasms, pain. Neurological problems provoke spontaneous release of large amounts of urine. This syndrome is called cerebral uninhibited bladder.
With sluggish enlarged urinary tract, paradoxical ischuria is observed - leakage of urine with a full bladder and extreme stretching of the sphincter. Urine flows in droplets or in small portions.
Common causes of urinary neurosis
A disorder at any stage of urine excretion leads to neurogenic pathology. Neuromuscular dysfunction of the bladder occurs due to:
- injuries, lesions or operations on the brain or spinal cord ( acute disorder cerebral circulation, vertebral fractures, ruptures, compression);
- diseases of the central nervous system of an inflammatory, degenerative or oncological nature: encephalopathy, polyneuropathy, neuropathy (post-vaccination, alcoholic), tuberculoma, encephalomyelitis;
- congenital anomalies of the spine, brain or spinal cord, urinary system, birth trauma.
Classification of neurogenic bladder dysfunction
Neuromuscular dysfunction is divided depending on the specific clinical picture, the severity of symptoms, and the stage of the disease.
Hyperreflex and hyporeflex
Neurogenic bladder weakness is divided into two types:
- according to the hyperreflex type - increased tone of the urinary muscles;
- hyporeflex type – decreased muscle activity of the bladder.
Pathology can also manifest itself in the non-synchronous functioning of the muscles of the bladder and sphincter. This syndrome is called detrusus-sphincter dyssynergia. Adapted and unadapted
The ratio of detrusor tone to urine volume makes it possible to classify the disease into adapted and uninhibited (non-adapted) types. Neurogenic bladder dysfunction in adults is considered adapted if the pressure inside the bladder increases evenly with the accumulation of urine, and uninhibited - with uncontrolled spasms of the urinary muscles with a sharp increase in pressure by 16 cm of water column. or more. In this case, the patient complains of frequent urge to go to the toilet.
Other varieties
With neurogenic pathology, the bladder is of the following types:
- Flaccid - in this case, its volume increases, and the pressure is minimal, the detrusor tone is reduced. The cause of the disorder is damage to the peripheral nerves or spinal canal.
- Spastic - urinary volume is normal or slightly reduced, characterized by uncontrolled muscle contractions. Occurs due to damage to the spinal cord or brain.
A mixed type of neurogenic pathology is characterized by symptoms of a flaccid and spastic bladder. Its cause is tumors in the brain, sexually transmitted diseases (syphilis), hernias or protrusions of intervertebral discs, degenerative processes (multiple or amyotrophic sclerosis).
Possible complications
Due to disruption of innervation, cell nutrition deteriorates. This leads to and . A common complication of neurogenic pathology is interstitial cystitis, reduction and sclerosis of the bladder.
Due to the deterioration of urine outflow, stones form in the urinary tract or kidneys, and a bacterial infection occurs. Severe spasm of the sphincter provokes urine back into the ureters and kidneys, causing their inflammation. Methods for diagnosing the problem
To make a diagnosis of NDMP, you will need:
- pass ;
- pass the ;
- calculate the residual amount of urine;
- undergo cystography (x-ray), cystoscopy (examination inner shells urea), cystometry (intravesical pressure is examined);
- donate (blood serum) to assess kidney function.
Treatment of neurogenic bladder
Therapy for dysfunction is prescribed by a urologist and a neurologist. It is aimed at eliminating the root causes and symptoms, as well as treatment concomitant diseases. For this purpose, medications, physiotherapy, and in the most severe cases, surgery are used.
Drugs
The spastic form of neurogenic dysfunction is more amenable to correction. Prescribed drugs that relieve muscle tone, normalize blood flow, prevent oxygen starvation bladder tissue. This:
- calcium antagonists – Nifedipine;
- eliminating spasms - Propantheline, Hyoscine;
- antidepressants – Imipramine;
- adrenergic blockers – Phentolamine.
Injections of botulinum toxin into the ureter or bladder wall, as well as the administration of resiniferatoxin or capsaicin, are considered an effective innovation in the treatment of neurogenic bladder. Vitamins are indicated as maintenance therapy, as well as products containing succinic acid. These drugs have antispasmodic and anti-inflammatory effects.
The hyporeflex form is more difficult to correct. The treatment regimen includes:
- drugs to enhance motility, reduce the size of the bladder and the volume of residual urine: Galantamine, Bethanechol chloride;
- adrenergic blockers – Diazepam, Baclofen;
- medications that eliminate the leakage of urine during stress - Imipramine.
During treatment, it is necessary to monitor the volume of residual urine, as well as prescribe antibiotics (Streptocide) to prevent the addition of bacterial infection.
Physiotherapy
Non-pharmacological therapy for overactive bladder includes catheterization, as well as stimulation of urine output. In the hyporeflex form associated with damage to the spinal canal, catheterization is performed regularly.
To treat neurogenic dysfunction in women and men, thermal applications and psychotherapy are prescribed. Also shown:
- magnetic therapy;
- ultrasound;
- electrophoresis with calcium chloride;
- electrical stimulation of the urinary tract to eliminate spasms or activate muscle contractions.
Surgical intervention
A urologist surgeon knows how to treat a neurogenic bladder if medication and physical therapy are ineffective. Surgery is a last resort measure necessary to prevent severe complications, and also when inserting a catheter into the bladder is contraindicated.
An endoscopic operation is performed to expand the bladder neck, which guarantees free emptying with minimal effort. In spastic form, the doctor cuts the sphincter. The operation reduces the pressure of urine output and increases the volume of the bladder.
Tissue plastic surgery with the installation of a drainage system for urine removal allows you to increase the size of the bladder.
Timely drug therapy and physical therapy minimize the risk of complications and the need for surgical intervention in the future. Diet and lifestyle
The neurogenic bladder in men and women requires special care. From the menu you will have to exclude foods that irritate the organ or provoke the urge to urinate. Prohibited:
- pineapples, lemons, oranges, tangerines;
- citrus juices;
- caffeinated drinks (coffee, black tea, energy drinks);
- chocolate;
- sweets, including honey;
- tomatoes;
- milk, fermented milk products.
Other foods can also cause bladder irritation. Therefore, it is important to monitor symptoms and monitor your well-being.
Equally important for neurogenic dysfunction is compliance with the drinking regime. Trying to reduce fluid intake to reduce urgency will be unsuccessful. Insufficient water consumption makes the urine more concentrated, resulting in more irritation of the urine, and the urge to go to the toilet becomes more frequent.
The optimal solution is to drink at least 1.5-2 liters of clean still water. But coffee, sweet tea, alcohol, soda, and energy drinks will have to be excluded. Coffee and tea - alcohol provokes dehydration, and energy drinks and soda contain caffeine, which irritates the mucous membranes.
Physiotherapy
As symptomatic therapy At the same time as taking medications, special medications are prescribed. They strengthen muscles abdominal wall, restore the elasticity of the detrusor. An example is Kegel exercises, which are indicated during treatment or for the prevention of diseases genitourinary system. Most often recommended:
- slow alternating tension and relaxation of the pelvic muscles (within 2-3 seconds);
- accelerated execution of the previous exercise;
- “pushing” with the use of the peritoneal muscles.
The number of repetitions is increased slowly. It is recommended to start with 7-8 times, gradually increasing to 30-40. In order for the exercises to produce results, the exercises should be performed every day. Psychotherapy
Changing behavioral habits can help cure a hyper-reflexive bladder. People with NDMP exhibit specific behavioral patterns. They become dependent on the restroom, refuse to travel or engage in outdoor activities, and are required to visit the toilet before leaving their apartment or office.
Working with a clinical psychologist restores control over the bowel movements and reduces the frequency of urination. It is recommended to create a toileting schedule, which is reviewed weekly and the time between urinations is gradually increased.
Cognitive behavioral intervention – good workout bladder and restoration of lost control physiological processes body.
Treatment with folk remedies
It is impossible to cure neurogenic dysfunction solely with the recipes of traditional healers. But such therapy, in combination with medication and physiotherapy, relieves unpleasant symptoms and speeds up recovery.
Examples of folk remedies for NDMP:
- Rinse millet (100 g) under running water, add half a liter clean water, leave for 40 minutes. Drink a glass three times a day, shaking before drinking. The infusion relieves pain and improves urine output.
- 2 tbsp. dried corn silks are steamed with a liter of boiling water and boiled for half an hour. Allow to cool, drink on an empty stomach 3-4 times a day.
- 150 g of unpeeled pumpkin seeds are ground in a blender. Steam 1 liter of boiling water and leave for an hour. After cooling, the finished decoction should be drunk throughout the day.
Is NDMP completely curable?
The prognosis of therapy is positive if neurogenic dysfunction is identified before the addition of a bacterial infection or. With NDMP, a person takes a test once every 3 months and monitors the regularity of bladder emptying. You need to go through the kidneys 1-2 times a year.
Prices for treatment in Moscow
The cost of therapy for neurogenic pathology depends on the clinic and the qualifications of the urologist. Average:
- ultrasound examination will cost 250-400 rubles;
- visit to a neurologist – 500 rubles. and higher;
- initial appointment with a urologist – 200-350 rubles;
- Doctor visit general practice(therapist) – from 600 rubles;
- – from 3000 rub.;
- encephalography – 600-800 rubles;
- uroflowmetry – 350-500 rub.
Neurogenic pathology of the urinary tract is provoked by disturbances in the transmission of neural impulses from the brain or spinal cord. You can suspect the disease by frequent urge to go to the toilet, urine leakage or retention. The danger of the disease lies in its... Timely treatment can completely eliminate the pathology.
The term neurogenic bladder is used to describe a group of functional disorders that arise as a result of damage to the organs of the central and peripheral nervous system. The disease is characterized by partial or complete loss of urinary control, and the severity of symptoms depends on the location and etiology of the central nervous system lesion.
The numerous factors influencing bladder dysfunction make it difficult to verify the diagnosis, and to date the medical community has not developed an unambiguous classification system for the disease. However, it is reliably known that the urinary bladder (neurogenic bladder) is not an independent pathology, but is formed as a result of congenital or past diseases. In the etiology of neurogenic dysfunction of the bladder (bladder), the prevalence and degree of damage to the nervous system is of decisive importance, and the basis of the disease is desynchronization of detrusor contraction with opening urethra. Conventionally, the causes of neurogenic bladder are divided into several groups:
- Congenital dementia, oncological, infectious and inflammatory processes of the spinal cord and brain: encephalitis, neuritis of various etiologies, post-vaccination disorders, Parkinson's disease and Alzheimer's disease.
- Damage to peripheral nerves and muscles of the storage organ due to intoxication and trauma, after surgery and stroke.
- Congenital defects of the urinary tract and central nervous system.
- Degenerative changes in the cartilage of the spinal column - osteochondrosis and spina bifida;
- Immunodeficiency virus – HIV.
In some cases, urinary tract syndrome is a consequence of chronic cystitis, urolithiasis and emotional shock. Neurogenic bladder occurs equally in women compared to male patients. The occurrence of dysfunction in childhood due to birth injuries, congenital pathologies central nervous system and urogenital area, as well as hormonal instability and disruption metabolic processes during puberty.
Clinical picture of different forms of the disease
Depending on the functional activity, hyperactive and hypoactive bladders are distinguished. Clinical picture and nature of development pathological conditions has significant differences. Doctors distinguish 3 degrees of severity of disorders of neurogenic bladder function:
- Mild – accompanied by dysuria, incontinence when the abdominal muscles are tense, enuresis at night;
- The average is distinguished by a rare urge to empty, stagnation of urine;
- Severe degree is characterized by constipation, incontinence, urolithiasis, chronic inflammatory processes of the urogenital organs, neurotic conditions and general weakness.
Symptoms of a neurogenic bladder depend on the severity of the central nervous system damage and can be either episodic or permanent.
Underactive bladder
Typical manifestations of dysfunction are a decrease in the contractile activity of the storage organ. Due to hypotension of the detrusor and sphincter, it becomes impossible to create the necessary parameters of intravesical pressure, which leads to a delay and sluggish process of fluid excretion, the formation of a large amount of residual urine and discomfort incomplete emptying. The result of hypotension is the formation of an overstretched bladder with hypertrophy of the walls and a decrease in the volume of the organ. Such a transformation leads to uncontrolled excretion of urine in small doses (drops), sclerosis and wrinkling of the storage organ.
Overactive Bladder
Urinary incontinence, an irresistible (imperative) urge to empty the organ, and nocturnal dysuria characterize an overactive bladder. A spasmodic detrusor contributes to the formation of increased bladder pressure with a small volume of fluid, which causes an imperative urge. Overactive bladder syndrome is usually accompanied by hypertension, sweating, and in severe neurological disorders, uncontrolled release of a large volume of urine may occur at the slightest tension in the abdominal walls.
Important! Neurogenic hyperactive bladder reduces the quality of life, significantly limits the circle of friends and physical activity. The disease causes serious complications: hypertension, kidney inflammation, cystitis and degenerative changes in the urogenital organs.
It can be stated that neurogenic dysfunction of the bladder leads to atony of the walls of the organ and the development of severe disturbances in the outflow of urine. A serious complication can be the reverse reflux of urine in an ascending manner, which leads to the formation of stones and inflammation of the kidneys. In most cases, bladder dysfunction is accompanied by mental disorders and social maladjustment.
Diagnosis of NMP
Establishing the cause and form of the pathology requires painstaking work not only from the attending physician, but also from the patient. An important aspect is keeping a diary, which indicates the time, number and amount of fluid excreted, and the sensations after urination. Diagnosis of a neurogenic bladder consists of several stages, including the following types of examination:
- anamnestic survey with analysis of objective complaints, hereditary factors, identification of chronic and past diseases;
- identification of neurological pathology and exclusion of organic lesions;
- urine tests according to Zimnitsky and Nechiporenko;
- culture for bacterial flora;
- Ultrasound of the genitourinary tract;
- clinical and biochemical analysis blood;
- uroflowmetry – determines the muscle activity of the detrusor and the flow rate of the secreted fluid;
- cystometry of a full bladder with assessment of capacity and sensitivity, intravesical and intra-abdominal pressure;
- profilometry - urodynamic study of urethral pressure.
According to indications, additional, more informative types of diagnostics may be prescribed: suprapubic puncture, cystoscopy, sigmoidoscopy, X-ray contrast methods, MRI. In most cases, consultations with specialized specialists are advisable: neurologist, psychotherapist, proctologist, gynecologist, nephrologist. If it is impossible to establish an accurate diagnosis, they speak of an unclear etiology and the idiopathic nature of the pathology.
Treatment of neurogenic bladder
Therapy of the disease requires an integrated approach; diagnosis of the neurogenic bladder, aimed at identifying the cause and type of organ dysfunction, is especially important. Typically, the therapeutic regimen includes:
- drug treatment;
- psychotherapy;
- periodic catheterization and the use of physiotherapeutic techniques;
- teaching patients to control urination using special exercises;
- sacral electrical stimulation with implantation of electrodes;
- percutaneous drug blockades;
- minimally invasive surgical interventions.
To reduce bladder hypertonicity, anticholinergic drugs that block nerve impulses are used: Oxybutynin, Darifenacin, Tolterodine. The drugs are characterized by their lack of addiction with long-term use and have a pronounced effect with minimal negative consequences. Some categories of patients are prescribed calcium channel blockers Nifedipine and Pantogam. In case of urine accumulation, catheterization and intravesical installations with solutions of anesthetic and antioxidant drugs are performed. In addition to drug treatment Patients with bladder hyperfunction may be prescribed physiotherapeutic procedures. We recommend exercises aimed at training the abdominal and pelvic floor muscles, which in the long term allows you to compensate for some of the lost sphincter functions urinary tract. In conditions accompanied by urinary retention and decreased detrusor tone, periodic catheterization and course electrical stimulation of the storage organ are performed. Reflex activity is restored by a course of taking cholinomimetics and drugs that enhance smooth muscle function: Cytochrome, Riboflavin, Bethanechol, Aceclidine. In many cases, when bladder function is impaired, herbal remedies are included in the treatment regimen: Cyston, Cystenium, Canephron, Monurel. In women during menopause, hormone replacement therapy is advisable. When an inflammatory process is detected, antibacterial, antiseptic and immunomodulatory drugs are prescribed medicines. To eliminate detrusor-sphincter dyssenergy, promising methods are used to introduce botulinum toxin into the wall or sphincter of the storage organ. Due to its high efficiency, neuromodulation has become widely used, depending on the nature of the disorders, aimed at activating or inhibiting the functions of the storage organ. The event is considered successful if signs of violations are reduced by more than 50%. Developed and actively used in medical practice minimally invasive surgical techniques, improving bladder function.
The success of treatment is associated with the correction of behavioral habits and nutrition. During illness, you should adhere to a salt-free diet and exclude spices, smoked foods, preserves, yeast baked goods and alcohol from your diet. The treatment plan for patients with traumatic injuries of the brain and spinal cord requires bed rest; if the patient is able to move or the causes of the pathology are of a different etiology, then hospital treatment is recommended. Rehabilitation and prevention of the disease consists of daily exercises to strengthen the pelvic floor muscles, compliance with hygiene rules and treatment recommendations. Frequently washing the external genitalia with herbal decoctions or warm water with special hygiene products prevent infection urinary tract. For the treatment of neurogenic bladder caused by psychological disorders, a necessary condition recovery and prevention of relapses is long-term observation and rehabilitation by a psychotherapist. In all cases good effect gives Spa treatment with the use of mineral water, mud therapy in the form of tampons and applications to the bladder area.
Prevention of the disease consists of timely relief of inflammatory processes in the organs of the urinary system, prevention of trauma, hypothermia and nervous stress.
Neurogenic bladder is a disorder in the functioning of the bladder, which is caused by a malfunction of the nervous system. It should be noted that the same term can also refer to other ailments with a similar clinical picture. The disease can occur almost equally in both women and men.
Etiology
Clinicians point out that neurogenic bladder is not an independent disease. Usually, this syndrome formed after previously suffered chronic or viral diseases. Degree of development pathological process depends on the complexity of the nervous system injury.
A neurogenic bladder can form due to the following etiological factors:
- for spinal cord injuries, after severe operations;
- tumor diseases of the nervous system;
- compression of nerve endings on the spine during surgical intervention;
- as a consequence after ;
- complication after .
Neurogenic bladder develops due to the following reasons:
- congenital defects of the central nervous system;
- consequences of birth trauma;
- congenital defects of the genitourinary system;
- spinal injuries.
Also, neurogenic bladder syndrome in children can form as a result of stress, severe emotional shock (fear).
In some cases, dysfunction of the genitourinary system may be the result of chronic cystitis or various types of neurological diseases.
Symptoms
There are two types of neurogenic bladder: hypoactive and hyperactive. The clinical picture is somewhat different, as is the nature of the development of the pathology.
Symptoms of an overactive bladder may include:
- sudden urge to urinate (especially at night);
- complete absence or insufficient volume of residual fluid in the bladder;
- difficulty emptying;
- unstable blood pressure;
- increased sweating at night;
- urinary incontinence.
In more complex clinical cases, symptoms may be almost completely absent. In this case, the patient may complain of complete urinary retention and pain in the lower abdomen.
The hypoactive type of neurogenic bladder is characterized by the following symptoms:
- there are practically no contractions of the bladder;
- it is impossible to empty yourself completely, even with a full bladder;
- no signs of intravesical pressure;
- straining during miction;
- feeling of fullness of the bladder, even after emptying.
With such symptoms, uncontrolled release of urine in small quantities is almost always observed.
It should also be noted that such clinical picture can lead to the development of other ailments in the genitourinary system. A degenerative change in the bladder itself is also observed.
Possible complications
With bladder dysfunction, stones can form in the ureter, which also leads to complications when urinating. This, in turn, leads to fluid entering the cavity of the ureter and kidney, which is the reason for the development of the inflammatory process and other diseases.
A neurogenic bladder is especially dangerous for a child. IN early age The child’s genitourinary system is developing and if treatment is not started in a timely manner, this can lead to serious problems in the functioning of the kidneys and the genitourinary system as a whole. The psychological factor should not be overlooked. Involuntary loss of urine in a child can lead to the development of the complex in adulthood.
Diagnostics
If you have the above symptoms, you should immediately contact a urologist. If such a clinical picture is observed in a child, then you should initially contact a therapist or pediatrician.
Diagnosis of suspected neurogenic bladder begins with examination of the patient and clarification of personal and family history. Also, the doctor must familiarize himself with the medical history. After a personal examination and clarification of symptoms, instrumental and laboratory diagnostics are carried out.
To the standard program laboratory diagnostics includes the following:
- blood sampling for research;
- urine collection for research;
- donating urine for testing for infections;
- urine analysis according to Zimnitsky and Nechiporenko.
Concerning instrumental diagnostics, then this includes the following:
- and genitourinary system;
- X-ray of the urinary tract;
- profilometry;
- uroflowmetry.
If such diagnostic measures do not give an accurate answer, then additional examinations in the area of the brain and spinal cord. If bladder dysfunction is observed in a child, additional consultation with a psychologist may be necessary. This method differential diagnosis needed in order to exclude dysfunction due to nervous shock in the child.
If, as a result of diagnosis, it is not possible to establish the exact cause of the development of such a pathological process, then a diagnosis of an idiopathic form of neurogenic bladder is made.
Treatment
Treatment of a neurogenic bladder requires only an integrated approach. In most cases, the urologist carries out treatment measures together with a neurologist and even a psychologist.
The method of therapy and treatment program depend on the degree of development of the disease, the cause of progression of the pathological process and the individual characteristics of the patient.
Neurogenic bladder can be treated in three ways:
- medicinally;
- operable;
- non-drug method.
Drug therapy involves taking drugs with the following spectrum of action:
- tricyclic antidepressants;
- alpha blockers;
- oxybutynin;
- calcium antagonists.
The dosage and frequency of administration are prescribed only by a specialized medical specialist. Self-medication with the drugs described above can lead to complications.
In addition, additional injections into the bladder are used - the introduction of capsaicin and resinferatoxin.
Non-drug treatment includes the following activities:
- exercise therapy courses;
- procedures with a psychotherapist;
- maintaining proper nutrition and adequate sleep.
Physiotherapeutic procedures should be highlighted separately. The doctor may prescribe the following to the patient:
- thermal applications;
- laser therapy;
- electrical stimulation.
It is much more difficult to treat a hypoactive neurogenic bladder. This is due to the fact that this type of disease leads to the development of infections in the ureter and can affect the kidneys.
First of all, with the help of special medications and physiotherapeutic procedures, the bladder is completely emptied. If through such therapy one achieves positive result impossible, catheterization is performed. At the same time, the patient must take antibacterial drugs.
Surgical treatment includes the following procedures:
- a section is performed in the area of the bladder neck for complete emptying;
- surgically increases capacity;
- cystostomy drainage is installed.
The type of treatment depends on the cause of the pathological process. Self-medication or the use of folk remedies, if it improves the condition, will only be for a while. This does not fundamentally solve the problem.
Prevention
If the disease does not have a congenital etiology or is not a consequence of any injury or major surgery, then the risk of its development can be minimized. The following recommendations from urologists should be applied:
- food must be complete and timely;
- do not abuse spicy and fatty foods;
- smoking and excessive drinking should be avoided;
- all chronic and infectious diseases must be treated completely and in a timely manner;
- do not allow hypothermia or getting your feet wet;
- At the first symptoms, you need to contact a competent specialist and not self-medicate.
Compliance with these rules will help to avoid illnesses in the genitourinary and reproductive systems.
Is everything in the article correct from a medical point of view?
Answer only if you have proven medical knowledge
If a person experiences a malfunction of the nervous system, he begins to suffer from functional disorders. One of them is called neurogenic bladder. Already from the age of 2, a child can control the process of urination, that is, endure the need at the moment when the bladder is filled with liquid.
But if an adult or a child over 3 years old is unable to control the urge, this will indicate neurogenic dysfunction. The disease occurs approximately equally in men and women, with a slight bias towards the weaker sex due to the structural features of the genitourinary system.
When a patient begins to suffer from problems with bowel movements, it is called neurogenic bladder dysfunction. The most common manifestation of this pathology, both in older people and in children, is. The inside of the bladder consists of a special stratified mucous epithelium. Below it are the detrusor fibers, that is, smooth muscles, which are controlled by the cerebral cortex.
During the day, the organ begins to fill with fluid, stretching the mucous epithelium. As a result, signals are sent to the head through the nerve channels, after which the person feels an urge. If this process is disrupted and urination occurs involuntarily, it is necessary to begin investigating the problem with an ultrasound scan, this obvious signs neurogenic bladder.
Reasons for deviation
The manifestation of pathology is always associated with disruptions in the passage of nerve impulses to the organ. The progression of neurogenic bladder dysfunction in adults or children can occur against the background of other ailments or be congenital defect. If a deviation was diagnosed in a child, this could be due to the following reasons:
- Often the deviation is congenital or develops over time due to constant stress.
- Birth injury.
- Accompanying illnesses.
Note! Formation of urea and its nerve cells stops at 2-3 years of age, so it will not be possible to diagnose the problem earlier. It is during this period that parents need to pay attention to the baby’s urination pattern.
If neurogenic bladder is found in men or adult women, the causes may be:
- damage to the functions of the nervous system. These may include problems with the brain of the back, tumors or infections;
- constant stress at work and significant emotional distress;
- if we are talking about a neurogenic bladder in men, treatment should begin with eliminating problems with prostate adenoma, if any;
- spina bifida;
- polyneuropathy in various manifestations;
- a neurogenic bladder in women can develop due to prolonged labor;
- degenerative changes in the bladder due to frequent surgical interventions in the pelvic organs;
- long-term chronic infectious disease that affects any of the organs of the urinary system;
- the patient's ongoing use of psychopharmacological medications;
- cerebrovascular accident;
- congenital malformations of the spinal column (sacral dysgenesis and agenesis).
Types of pathology
Disorders related to urinary regulation can manifest themselves through overactive or weakened muscle tone. Before treating a neurogenic bladder, doctors determine its type, it can be as follows:
- Hyper-reflexive. This means that the pathology occurs due to disorders of the brain. In this case, the smooth muscles are constantly under tension, preventing the person from relieving himself when it occurs on time. As a result, incontinence develops, since fluid is unable to remain inside the organ. This can also lead to complications in the form of cystitis, reduction of the bladder and degradation of its cells.
- Neurogenic bladder dysfunction of the hyporeflex type always develops against the background of problems with the sacral part of the spinal cord. Here the muscle tissue, on the contrary, does not show activity and is constantly in a relaxed state. This provokes stretching of the fibers and enlargement of the organ as it fills with fluid. Then problems arise with the functioning of the sphincters and, due to strong pressure, the patient shows signs of incontinence. If the bladder is filled to capacity, it can also cause urine to flow back.
Symptoms accompanying the disease
Here the situation may be different, depending on the type of neurogenic bladder. In women, symptoms appear almost the same as in men, the only difference is the nature of the disease.
If the patient suffers from, the symptoms will be as follows:
- Difficulty trying to defecate.
- Incontinence.
- At night there is a strong urge.
- Constant changes in blood pressure readings.
- Insufficient volume or absence of the required amount of liquid in the bladder.
- Increased sweating.
If the patient has a particularly complicated form of the disease, it may not show any activity. In this case, you need to pay attention to pain in the lower abdomen and urinary retention. Another type of deviation is a hypoactive form of neurogenic bladder dysfunction. Treatment will be aimed at eliminating the following symptoms:
- lack of activity in the form of urea contractions;
- constant feeling that there is a large amount of fluid in the organ;
- inability to empty your bowel movements completely, even if the urge is strong;
- no signs of intravesical pressure;
- straining during micturition.
What complications can there be?
In some cases, the cause of kidney stones will be a neurogenic bladder. In this case, ultrasound is performed as a preventive measure in order to promptly diagnose the presence of stones. This will also provoke other inflammatory processes in the organs of the urinary system, since stagnant urine will return back through the ureters.
Important! Especially dangerous disease may be suitable for small children. At untimely treatment neurogenic bladder causes serious problems in the functioning of the kidneys and the entire genitourinary system. Over time, some diseases can become chronic.
It is very important to pay enough attention psychological factor. If y, there is a high probability that the deviation will not leave him even at a more mature age.
Methods for diagnosing the problem
To to the fullest To solve the problem, it is necessary to correctly diagnose the neurogenic bladder in women. Treatment is applied only after completing the entire complex of studies, which looks like this:
- Biochemistry and general blood check.
- Submission of urine to determine the type of infection.
- Analyzes according to Nechiporenko.
- General examination of urine.
Instrumental diagnostic methods include the following:
- X-ray;
- MRI and ultrasound;
- uroflowmetry;
- cystoscopy;
- profilometry.
If there is not enough data to precise definition neurogenic bladder, treatment is not carried out until additional examination of the brain of the back and head is carried out.
What treatment is used
Methodology and program therapeutic measures is always determined by several doctors, a psychologist, a neurologist and a urologist. Attention is also drawn to the individuality of the patient’s body and the causes of the deviation.
Typically therapy is carried out in the following ways:
- Operational.
- No medications.
- Medication.
The latter will mean that the patient is prescribed medications with such a spectrum of action as:
- antidepressants (tricyclics);
- oxybutynin;
- Kalimin for neurogenic bladder is used to improve neuromuscular transmission;
- calcium antagonists;
- alpha blockers.
If a patient is diagnosed with a hypoactive form of the disease, treatment will be much more difficult. Here additional inflammatory processes in the kidneys and ureters may be observed.
Conclusion
As preventive measures a person needs to adhere to proper nutrition, avoid excessive drinking and smoking. The development of pathology is also influenced by wet feet in rainy weather and untreated chronic diseases.
is bladder dysfunction caused by congenital or acquired pathology of the nervous system. Depending on the condition of the detrusor, hyper- and hypo-reflex types of pathology are differentiated. The disease may manifest itself as pollakiuria, urinary incontinence, or pathological retention. Diagnosis of the syndrome consists of a complete neurological and urological examination (tests, urography, ultrasound of the kidneys and bladder, urofluorometry, cystography and cystoscopy, sphincterometry, radiography and MRI of the spine, MRI of the brain, etc.). Treatment may include non-drug and drug therapy, bladder catheterization, surgery.
General information
Neurogenic bladder is a fairly common condition in clinical urology, associated with the inability to carry out voluntary reflex accumulation and excretion of urine due to organic and functional damage to the nerve centers and pathways that regulate this process. Urinary disorders have a social aspect, since they can limit a person’s physical and mental activity and create a problem for him. social adaptation in society.
The pathology is often accompanied by myofascial syndrome, pelvic venous congestion syndrome (venous stagnation). In more than 30% of cases, the development of secondary inflammatory-dystrophic changes in the urinary system is observed: vesicoureteral reflux, chronic cystitis, pyelonephritis and ureterohydronephrosis, leading to arterial hypertension, nephrosclerosis and chronic renal failure, which can threaten early disability.
Causes
A failure that occurs at any stage of the complex multi-level regulation of the urination process can lead to the development of one of the many clinical variants of a neurogenic bladder. In adults, the syndrome is associated with damage to the brain and spinal cord (stroke, compression, surgical intervention, spinal fracture), as well as with inflammatory-degenerative and tumor diseases of the nervous system - encephalitis, disseminated encephalomyelitis, polyneuropathy, polyradiculoneuritis, tuberculoma, cholesteatoma, etc.
Indirect and M-cholinomimetics (bethanechol chloride, distigmine bromide, aceclidine, galantamine) are used as drug therapy to enhance bladder motility, reduce its effective volume and the amount of residual urine. Alpha-adrenergic blockers (phenoxybenzamine - for internal detrusor-sphincter dyssynergia, diazepam and baclofen - for external detrusor-sphincteric dyssynergia), alpha-sympathomimetics (midodrine and imipramine - for stress urinary incontinence) are prescribed individually.
When drug therapy for a neurogenic bladder is used to prevent urinary infections, it is necessary to control the amount of residual urine and take antibacterial drugs(nitrofurans, sulfonamides), especially in patients with vesicoureteral reflux.
Surgical endoscopic intervention for hypotension of the organ consists of transurethral funnel-shaped resection of the bladder neck, which subsequently provides the possibility of emptying with gentle pressure from the outside. In the hyperreflex variant (with pelvic floor spasticity and detrusor-sphincter dyssynergia), an incision is made in the external sphincter, which reduces the pressure of urination, and subsequently the hyperreactivity of the detrusor, increasing the capacity of the bladder.
It is also possible to surgically enlarge the bladder (using tissue plastic surgery), eliminate vesicoureteral reflux, and install a cystostomy drainage to empty the bladder. Pathogenetic treatment of neurogenic bladder syndrome can reduce the risk of damage to the urinary organs and the need for surgical intervention in the future.
