Neurogenic bladder - Causes, symptoms and treatment. MF.

Neurogenic bladder is a group of diseases, based on a violation of the nervous system responsible for the innervation of the bladder and urinary tract. The essence of the violation is that the bladder is controlled only by the spinal cord, that is, the process of urination completely loses its connection with the human consciousness. On the clinical course hypotonic and hypertonic forms of the neurogenic bladder are allocated.

Causes of

pathology The etiological factors of the neurogenic bladder can be organic or functional. Accordingly, they are divided into permanent and temporary.

As for functional impairment of innervation of the bladder, it can develop due to stress or a strong emotional shock. In this case, most often, the neurogenic bladder becomes the consequence of not a one-time, but a chronic chronic emotional disorder.

As for organic causes, then, as a rule, they include injuries of the brain and spinal cord. This breaks the connection between the cortical centers of the urethra and the bladder itself. This pathology is called the spinal bladder.

Also the cause of the development of a neurogenic bladder can be the pathology of the sphincter apparatus, which develops against the background of an inflammatory or destructive disease of the bladder or urethra. In addition, the cause of the sphincter disorder can also be trauma, only not of the nerve trunks, but of the bladder itself.

Some sources of medical literature describe another form of the disease - a congenital neurogenic bladder. The cause of its development are the defects of the spinal cord or birth trauma of the newborn.

Bladder innervation, reflex arc

Symptoms of the neurogenic bladder

As already mentioned, the neurogenic bladder has two variants of flow - hypertonic and hypotonic, which are characterized by completely different symptoms. With hypertensive bladder , the first frequent urge to urinate, which results in the release of a small amount of fluid, and sometimes, at all, the inability to urinate with a great desire. There is also a hypertonic organ, which is characterized by unpleasant painful sensations in the lower abdomen. Patients have a constant nighttime urge, which in most cases also does not end in success.

With , the hypotonic form of the neurogenic bladder has a completely different picture, which is characterized by a strong overflow of the organ and a complete inability to urinate. In such a situation it is necessary to resort to medical methods of evacuation of fluid from the bladder.

In any of the forms of the neurogenic bladder, mental disorders soon begin to develop. Such patients, because of a bad smell, can not adapt in their usual environment, which causes strong emotional upheavals, which only complicate the situation. There are even known cases when problems with urination caused suicide attempts among young people.

If any of the above symptoms occur, you should immediately seek help from a urologist who either prescribes the treatment yourself or redirects the patient to a neurologist.

Diagnosis of a neurogenic bladder

In recognition of the cause of this disease, not only the doctor, but the patient himself plays an important role. The latter requires active maintenance of the diary, in which there is a frequency of urination per day, and the amount of urine. This is necessary not only to diagnose the disease itself, but also to identify the shape of the latter.

In the case of small children suffering from illness, the diary is maintained by parents who also register the frequency of urination and the number of the latter.

When the diagnosis of a neurogenic bladder is already set, resort to the second stage of diagnosis - finding out the cause of the disease. For this purpose, a full range of laboratory and instrumental studies is conducted: a general blood test, a general urine test, a urine test for Zimnitskiy, Nechiporenko, excretory urography, and an ultrasound examination of the kidneys.

Neurogenic bladder for contrast radiography

When the diseases of the sphincter apparatus can be eliminated, one resorts to the study of the nervous system. After the MRI and CT of the brain, as well as neurosonography, often, it is possible to establish precisely the cause of the disease.

It is also often the case that after conducting the full range of clinical and laboratory studies, it is not possible to establish the cause of the pathology. In this situation, they speak of an idiopathic neurogenic bladder.

Treatment of a neurogenic bladder

Treatment of this disease, depending on its underlying cause, is performed in the urological or neurological department. If the cause of the disease are any neurological disorders of a functional nature, the patient needs psychotherapy sessions that are conducted in the therapist's office.

If a tumor or trauma of the brain or spinal cord results in a neurogenic bladder, then such a patient needs specialized neurosurgical care. Its volume may consist in the removal of a tumor or hematoma, which arose from the traumatic damage of blood vessels that feed the brain tissue.

With inflammatory or destructive diseases of the urinary system, urologists help. Specialized treatment of this or that disease of the genitourinary system is used.

In the hypotonic version of the neurogenic bladder, regardless of the causes of the latter, a medical evacuation of urine from the bladder is performed. It can be performed by placing the urethral catheter or, if it is impossible to do the latter, by applying an epicystostome. It involves the creation of an artificial hole in the anterior abdominal wall above the pubis, to set up a special conductor through which the urine outflow occurs. It should be noted that such a procedure can be permanent or temporary, if after the course of treatment the symptoms regress.

Nutritional features and lifestyle with a neurogenic bladder

Often the cause of a neurogenic bladder is some kind of inflammatory pathology of the genitourinary system. In this case, the course of its treatment must include dietary nutrition. Most often, this is the seventh table for Pevzner, which completely excludes from the diet salty, acidic, smoked, sharp and other extractives that can aggravate the inflammatory process or disrupt the function of the kidneys.

As for the lifestyle, most often it should be lying position. This is what the treatment plan requires for traumatic brain or spinal cord injuries. If the injury is not so significant or the cause of the neurogenic bladder was something else, then during the treatment it is better for the patient to avoid the usual group for him and undergo treatment in the hospital. This will help keep nervous stability at the same level and lead to a speedy recovery.

Rehabilitation after

The most common rehabilitation in patients needing a neurogenic bladder was caused by some other disease, most often of an inflammatory nature. They need to avoid hypothermia and adhere to normal hygiene of the external genitalia. Some diseases, for example, urolithic, which can also cause a neurogenic bladder, give a very good effect in sanatorium treatment. For them, the best resorts are mineral resorts, such as Polyana and Morshyn.

With a neurogenic bladder caused by psychological disorders, a long-term permanent rehabilitation is necessary for the psychologist. It consists of psychotherapy sessions that not only strengthen the nervous system, but also prevent recurrence of the disease.

Treatment with folk remedies

It should be noted that a neurogenic bladder is one of the few diseases that are susceptible to folk methods of treatment. True, to date, these methods are already firmly rooted in traditional medicine. All known "pumping out" is now successfully used by psychologists, only in a slightly modified form. There are in mind sessions of psychotherapy, which folk medicine men undergo in the guise of a procedure during which the usual chicken eggs are as if pumped from the body.

As for folk herbs and infusions, the effect should be expected unless only from broths of plants that have soothing effects. For example, a decoction of chamomile calms the nervous system and has a positive effect in the treatment of a neurogenic bladder.

Complications of the neurogenic bladder

Complications of this disease can be the most dangerous. First of all it is necessary to say about psychological disorders, which can be caused by a neurogenic bladder. As already mentioned, in medicine, several cases have been reported, when a neurogenic bladder led to suicide attempts.

Urinary incontinence is considered to be the most frequent complication of this pathology, since it does not officially belong to the signs of a neurogenic bladder. Most often it is observed in the hypertensive form of the disease.

As for the hypotonic variant, it is accompanied by stagnation of urine in the bladder, which eventually leads to urine reflux into the ureters. This is followed by a disruption of kidney function and uremia, that is, the infection of blood with urinary toxins.

Another outcome of a crowded bladder is the rupture of its wall. A consequence of this complication is peritonitis, which also leads to blood infection, but of a slightly different nature. In either case, such complications of the neurogenic bladder can be fatal, so it is extremely important to turn to a specialist in time.

Prevention of

The prophylaxis is not the neurogenic bladder itself, but the diseases that lead to it. To do this, you need to protect yourself from hypothermia and trauma of the pelvic organs and spine. First of all, this applies to people who are engaged in contact and traumatic sports.

If a person gives in to constant stress, then he needs to think about changing jobs or living. If the cause of a nervous breakdown is not that, then a qualified psychologist's help is needed.

Rev.doctor urologist Astashin Е.Е.