Neurogenic bladder - a term applied to a whole range of disorders of urination, which are united by one cause, namely, the violation of the nervous system, the part that is responsible for the excretion of urine. As in the case of other nervous system disorders may occur in both adults and children.
Reasons neurogenic bladder
The reasons for the development of neurogenic bladder can be set. Average arbitrary bladder emptying has multilevel regulation, which involved a large number of nerves. Failure at any stage of a complex regulation, ranging from experienced stress, diseases of the brain and nervous disorders ending urinary sphincter may cause symptoms of neurogenic bladder. The most common cause of disease in adults are injuries and diseases of the spinal cord. Neurogenic bladder in children, in addition to these reasons, it may be a manifestation of malformation of the spinal cord or the urinary tract, as well as the result of birth trauma.
The symptoms of neurogenic bladder
Urination consists of two stages, the accumulation phase and phase separation. At the stage of accumulation of urine ureters into the bladder, and accumulates there until gather about 150 ml. After that normal people feel the urge to urinate, a group of nerves is triggered relaxing the bladder, and the next stage of the selection. Violations, manifesting as neurogenic bladder, can occur both during storage and during urination. There are two types of neurogenic bladder, hyperactive and Hypoactive (hypertonic and hypotonic).
For overactive bladder characterized by:
- Frequent urging with a small amount of urine;
- Severe muscle strain of the bladder, sometimes even causing a reverse throw urine from the bladder into the ureters (vesicoureteral reflux);
- Urgent urgent need to urinate when the urge occurs suddenly with such force that the patient can not doterpet to the toilet;
- Nocturia (frequent nighttime urination).
Hypoactive bladder appears on the contrary, the absence of normal urination, and even when fully packed (the amount of urine may exceed 1500 ml) bladder.
In addition, symptomatic neurogenic bladder is the lack of control over urination. It may be the lack of "a mature voiding" in children at an age when this reflex has to be formed, or the loss of any controlled urination in adults.
Symptoms of neurogenic bladder directly depend on which part of the nerve in the management fails, it's impact on the permanence (permanent, periodic, episodic) and the severity of the disease.
Diagnosis of neurogenic bladder
Diagnosis of neurogenic bladder begins with a careful history. The patient is invited for several days voiding diary, noting the time and the amount of liquid you drink. In the diagnosis of neurogenic bladder in children blog invited to conduct the parents, in addition, it turns out that there are no prerequisites for the development of this hereditary disease, as well as the history of childbirth.
Because the symptoms of neurogenic bladder with symptoms similar to urinary disorders in inflammatory diseases of the genitourinary system, carried out a full examination of the system for the presence of infection. This laboratory examination of urine with different functional tests (for Zimnitsky by Nechiporenko et al.). Also a moment of examination of the genitourinary system using medical imaging techniques (ultrasound, MRI, cystoscopy, x-ray using radiopaque substance) for the detection of the symptoms of inflammation or abnormalities of the structure of the urinary tract. Only completely eliminating the inflammatory process, we can talk about neurogenic bladder.
If set to no diseases of the urinary organs, conduct a neurological examination for the presence of pathological brain and spinal cord. For this purpose various techniques including CT and MRI.
In some cases, even after a full and thorough medical examination to establish the cause of neurogenic bladder can not, in this case we speak of neurogenic bladder with an unclear etiology.
Treatment neurogenic bladder
Treatment of neurogenic bladder is made up of drug and non-drug therapies
. Treatment is carried out either by a urologist, a neurologist, depending on the established causes of neurogenic bladder
. Overactive bladder therapy lends itself better
. In this case, as part of the medical treatment appointed means has a relaxing effect on the muscular system of the bladder (anticholinergics, blockers), as well as the preparations improving its blood supply as a result of spasm of the blood circulation is often impaired
. From non-drug treatments for neurogenic bladder using exercise therapy, including special training exercises for the muscles of the pelvic floor physiotherapy techniques, normalization of sleep and drinking regime
. If installed psychogenic causes of neurogenic bladder, a good result gives psychotherapy
Hypoactive type of neurogenic bladder is more difficult to treat. Because of the stagnation in the bladder is a risk of developing secondary lesions and urinary tract infections joining. Bladder pererastyagivaetsya, loses its elasticity, the accumulated urine irritate its walls and can be thrown into the ureters and thence into the kidneys, causing inflammation. For the treatment of neurogenic bladder with symptoms of hypotension drugs used to prevent the development of inflammation, as well as physical therapy, and methods of pelvic floor muscle training and bladder. When treatment failure is necessary to take measures for diversion, which use the bladder catheterization.
In that case, if the treatment is conservative methods have not been successful, sometimes surgical treatment of neurogenic bladder. Depending on the reasons for this may be a correction of the nervous apparatus of the bladder, or plastic musculo-ligamentous apparatus.