Neurogenic bladder refers to any loss or impairment of bladder function caused by central nervous system injury or by damage to nerves supplying the bladder. Overactive bladder function may be manifested as either incontinence (loss of voluntary control of micturition) or loss of the autonomic reflex, producing the sensation that the bladder is full. This is also referred to as urinary incontinence.
Neurogenic bladder may present in one of the following two ways: (1) specific bladder dysfunction in which the neurological lesions are above sacral nerves S2 through S4 or (2) flaccid bladder dysfunction in which the lesions are below sacral nerves S2 through S4. Physical trauma to the spinal cord is a frequent cause of neurogenic bladder. Neurogenic bladder may arise as a consequence of multiple sclerosis, dementia, and Parkinson disease. Other causes can include nerve damage as a consequence of chronic alcoholism or heavy-metal poisoning. Metabolic disorders (e.g., diabetes mellitus or hypothyroidism) and collagen diseases (e.g., systemic lupus erythematosus) may cause overactive bladder. UTIs, cancer, kidney stones, and an enlarged prostate can cause overactive bladder, also.
Signs and Symptoms
An individual may complain of mild to severe urinary incontinence or the inability to control the passage of urine, inability to empty the bladder completely, difficulty in starting or stopping voiding, and bladder spasms.
A detailed history and a physical examination that includes a neurological evaluation are essential. Special tests that may be ordered include cystourethrography to evaluate bladder function, a urine flow study to assess urine flow, and sphincter electromyography to evaluate how well the bladder and urinary sphincter muscles work together.
Treatment goals include preventing complications from UTIs and controlling incontinence through learning special bladder evacuation techniques. The primary care provider may recommend one of two common methods of evacuation to clients who are unable to empty the bladder completely. In Crede method, the client presses on the lower abdomen while voiding. The second method, intermittent self-catheterization, requires the client to insert a catheter into his or her bladder through the urethra. Medications to relax the bladder may be prescribed to relieve episodes of incontinence. These drugs include tolterodine (Detrol), oxybutynin (Ditropan), trospium (Sanctura), solifenacin (Vesicare), and darifenacin (Enablex).
Any underlying diseases that are detected will be treated.
Biofeedback may be useful for teaching some aspects of bladder control.
Teach clients bladder evacuation techniques. Provide emotional support for both the client and family.
The prognosis depends on whether the damage to the nerves supplying the bladder is reversible. Such complications as UTIs and the formation of renal calculi worsen the prognosis. If the disorder is of the form in which sensation of a full bladder is lost, urine may back up, causing hydronephrosis and possible renal failure.
There is no specific prevention other than prompt treatment of diseases that may produce the nerve damage that leads to neurogenic bladder.