Neurogenic Bladder 

Neurogenic bladder is a condition which can develop in men and women where the nerves used to signal when urine should be held or released from the bladder do not function properly, and patients lose bladder control. or retains too much urine.

People with a neurogenic bladder have experienced some form of trauma like a spinal cord injury or nerve damage.

Different traumas like: acute urinary tract infections, diabetes, heavy metal poisoning, carcinogens, stroke can affect the nervous system and cause urine to leak uncontrollably or urine to be retained. So in over active instances the bladder can require the individual to empty his/her bladder too frequently.

The bladder as a result can often reduce in its voulme capacity because of increased frequency to empty  the bladder fails resulting in an increase in urinary tract infections

An underactive bladder,on the otherhand, can be caused by :diabetes, pelvic surgery, MS ( multiple sclerosis) ,venereal disease and polio to name a few so when it’s time for the bladder to empty the message from bladder to the brain is dysfunctional so the bladder keeps filling-much like a tap not turned off,but with the plug in the sink.

The urine in the bladder then pushes down on the sphincter muscle and it is unable to withhold the increasing pressure from the weight of urine and as result urine leaks out.

What are the symptoms of Neurogenic Bladder?

· No sensation the bladder is full

· UTI urinary tract infections

· Kidney stones

· Urinary incontinence

· Small amounts of urine

· Increase in urinary frequency

· Urgency with wanting to urinate 

Diagnosis of Neuronic Bladder

To determine if someone has NB a series of tests are run and because it involves both bladder and brain they may test both organs.

Those tests on the bladder may include:

  • The use of an instrument called a cystoscope (a tiny camera) is inserted into the urethra to rule check for any damage to the bladder or for the presence of kidney stones.
  • Tests to measure bladder pressure
  • Urine retention, capacity or flow.
  • Ability to empty (void) the bladder and how completely.

The tests on the brain may include:

  • An MRI(Magnetic resonance imaging)
  • Computed Tomography (CT scan)
  • Computed axial tomography (CAT scan), a medical imaging procedure that utilises computer-processed X-rays to produce slices of specific areas of the body.

Treatments for Neurongenic Bladder

Patients with an overactive bladder can be trained and conditioned to empty on a routine basis which is the most non-invasive method to retrain these muscles and help patients hold urine better.

Kegel exercises or the strengthening of the pelvic floor muscles are also a great way to control urges to urinate. The muscles  training (once correctly performed) can progress quickly in strength and stamina to postpone and control urges to urinate at inappropriate times.

Kegel exercises works best with a biofeedback system (i.e. “The Kegel Exerciser”) to hasten progress and strength.

 A combination of behavioural measures and medication works well than either alone. There are not specific medications for patients with an underactive bladder resulting from nerve damage.

A therapy called Interstim is typically reserved for patients who are not helped by behavioural therapy and medications. Interstim is a small pacemaker that sends impulses to the sacral nerve, which controls the bladder. The success rates for this procedure are very good.

Catheterisation is another way for patients with underactive bladder to drain their bladder. Catheterisation can be used as a diversion of the urine or enlarge the bladder to help protect the kidneys and keep patients continent.

BoTox can also be used to help decrease involuntary bladder contractions. Botox helps to relax the detrusor muscle surrounding the bladder and there is anecdotal evidence to show it has a longer lasting effect than other drugs.

For patients whose bladder and sphincter muscle do not work cooperatively, surgeons can open the sphincter and remove a portion of the muscle using a procedure called sphincter resection.

Artificial sphincters are mechanical devices for patients with severe incontinence related to activities such as coughing, running, sneezing, and lifting. These devices have a cuff that fits around the urethra, which is normally full and prevents urine from coming out. The fluid in the cuff can be emptied into another part of the device, allowing the sphincter muscle to relax and urine to pass. 

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