Neurogenic bladder (paralysis of the bladder)

Head | Neurology | Neurogenic bladder (paralysis of the bladder) (Disease)


Description

The normal function of the urinary bladder is to store and expel urine in a coordinated, controlled fashion. This coordinated activity is regulated by the central and peripheral nervous systems. Neurogenic bladder is a term applied to a malfunctioning urinary bladder due to neurologic dysfunction or insult emanating from internal or external trauma, disease, or injury.

Causes and Risk factors

Neurogenic bladder is a dysfunction of the urinary bladder caused by a problem of the nervous system. Types of neurogenic bladder are spastic bladder, reflex bladder, and flaccid bladder. It is also called neuropathic bladder. Neurogenic bladder is impaired bladder function resulting from damage to the nerves that govern the urinary tract. Various nerves converge in the area of the bladder and serve to control the muscles of the urinary tract, which includes the sphincter muscles that normally form a tight ring around the urethra to hold urine back until it is voluntarily released.

A variety of factors can damage these nerves and cause urinary incontinence. In some cases, spontaneous nerve impulses to the bladder trigger spastic unexpected bladder contractions, resulting in accidental voiding of sometimes large amounts of urine.

In other types of neurogenic bladder conditions, the bladder may become flaccid and distended and cease to contract fully, resulting in only partial emptying and continual dribbling of small amounts of urine. Rashes may erupt in areas of the skin irritated by urine.

Stagnant urine in the bladder also increases the risks of bladder stone formation and urinary tract infections. Such infections, when severe, can lead to life-threatening kidney failure. In some patients, there is a partial loss of anal sphincter control as well.

Diagnosis and Treatment

Symptoms of neurogenic bladder range from detrusor underactivity to overactivity, depending on the site of neurologic insult. The urinary sphincter also may be affected, resulting in sphincter underactivity or overactivity and loss of coordination with bladder function. The appropriate therapy and a successful outcome are predicated upon accurate diagnosis through a careful medical and voiding history together with a variety of clinical examinations, including urodynamics and selective radiographic imaging studies. ...