Neurogenic bladder

Neurogenic bladder – the term which is applied to the whole complex of frustration of an urination which are combined by one reason namely, disturbance of work of a nervous system, that its part which is responsible for urine removal. As well as in case of other diseases of a nervous system, can occur both at adults, and at children.

Reasons of a neurogenic bladder

The reasons of development of a neurogenic bladder there can be a set. Normal any bladder emptying has multi-level regulation in which a large number of nerves is involved. Failure at any stage of difficult regulation, beginning from the endured stress, brain diseases, and finishing with disturbance of an innervation of a sphincter of a bladder, can cause emergence of symptoms of a neurogenic bladder. Injuries and diseases of a spinal cord are the most frequent reason of development of pathology in adults. The neurogenic bladder at children, in addition to these reasons, can be display of a malformation of a spinal cord or urinary tract, and also the investigation of a birth trauma.

Symptoms of a neurogenic bladder

The urination consists of two stages, a phase of accumulation and a phase of allocation. At an accumulation stage urine from ureters comes to a bladder, and collects there, about 150 ml will not gather yet. After that normal the person feels a desire on an urination, the weakening group of nerves of a bladder works, and the allocation stage follows. The disturbances which are shown as a neurogenic bladder can happen both during accumulation, and during release of urine. There are two types of a neurogenic bladder, hyperactive and hypoactive (hypertensive and hypotonic).

For a hyperactive bladder are inherent:

• Frequent desires at a small amount of the emitted urine;
• Strong muscle tension of a bladder, sometimes even causing the return throwing of urine from a bladder in ureters (a vesicoureteral reflux);
• Urgentny imperative desires on an urination when suddenly there is a desire of such force that the patient not in forces to wait to a toilet;
• Nocturia (frequent night urinations).

The hypoactive bladder is shown opposite, lack of a normal urination at full and even overflowed (the amount of urine can exceed 1500 ml) a bladder.

Besides, a symptom of a neurogenic bladder is lack of control over an urination. Children can have it lack of "a mature urination" at that age when this reflex has to be already created or loss of controlled any urination at adults.

Symptoms of a neurogenic bladder directly depend on on what site of nervous management there was a failure, same also weight of displays of a disease influences constancy (constant, periodic, incidental).

Diagnosis of a neurogenic bladder

Diagnosis of a neurogenic bladder begins with careful collecting the anamnesis. The patient is offered to keep the diary of urinations for several days, noting at the same time time and amount of the drunk liquid. At diagnosis of a neurogenic bladder at children the diary is offered to be kept to parents, besides, it becomes clear whether there are no hereditary premises of development of a similar disease, and also history of childbirth.

As symptoms of a neurogenic bladder are similar to symptoms of disturbances of an urination at inflammatory diseases of urinogenital system, full examination of bodies of this system on existence of an infection is conducted. This laboratory research of urine using various functional trials (across Zimnitsky, across Nechiporenko, etc.). Also inspection of bodies of urinogenital system by means of methods of medical visualization (ultrasonography, MRT, a tsistoskopiya, X-ray inspection using X-ray contrast substances) for detection of symptoms of an inflammation or anomalies of a structure of urinary tract will be moved. Only having completely excluded inflammatory process, it is possible to speak about a neurogenic bladder.

If absence of diseases of bodies of urination is established, conduct neurologic examination on existence of pathologies back and a brain. Various techniques, including KT and MPT are for this purpose applied.

In some case even after full and careful medical examination it is not possible to establish the reason of a neurogenic bladder, in this case speak about a neurogenic bladder with not clear etiology.

Treatment of a neurogenic bladder

Treatment of a neurogenic bladder consists of medicamentous and non-drug therapy. Treatment is carried out by either the urologist, or the neurologist, depending on the established reason of a neurogenic bladder. The hyperactive bladder gives in to therapy better. In this case as a medicamentous part of therapy the means having the weakening effect on the muscular device of a bladder (cholinolytics, adrenoblockers), and also the drugs improving its blood supply as as a result of a spasm blood circulation often happens broken are appointed. From non-drug remedies for a neurogenic bladder use the physiotherapy exercises including special training exercises for muscles of a pelvic bottom, physiotherapeutic methods, normalization of the mode of drink and dream. If the psychogenic reasons of a neurogenic bladder are established, the good result is yielded by a psychotherapy course.

The hypoactive type of a neurogenic bladder will more difficultly respond to treatment. Because of developments of stagnation in a bladder the risk of development of secondary damages of an urinary system and accession of an infection is high. The bladder pererastyagivatsya, loses elasticity, the accumulated urine irritates it walls and can be thrown in ureters and from there in kidneys, causing an inflammation. For treatment of a neurogenic bladder with symptoms of hypotonia use the drugs directed to prevention of development of inflammatory process, and also physical therapy, and methods of a training of muscles of a pelvic bottom and a bladder. At inefficiency of treatment it is necessary to take measures for removal of urine for what use bladder catheterization.

If treatment by conservative methods was unsuccessful, surgical treatment of a neurogenic bladder is sometimes shown. Depending on the reasons, it can be correction of the nervous device of a bladder, or plastic of the muscular and copular device.