Nervous bladder in adults treatment. Symptoms and treatment of neurogenic bladder in adults. Peripheral nerve disorders

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Neurogenic bladder dysfunction is a disease that often occurs in adults and children. Neurogenic bladder syndrome involves difficulty storing and emptying urine, impairing basic bladder functions. Malfunction of the bladder can lead to serious consequences, including psychological ones, and also indicate possible more serious diseases of the spinal cord and brain (age-related and pathological).

This disease can be either independent, caused by congenital disorders in the functioning of the brain and spinal cord, or acquired, provoked by the same disorders and injuries, but received during life. The neurological nature of the disease determines the complexity of its treatment and requires specialist intervention.

The Energo Medical Center is a clinic where many urological problems can be treated, including neurogenic bladder syndrome, its causes and symptoms. The use of modern drugs and treatment technologies, selected based on the psychological and physical characteristics of the patient, allows us to achieve effective results in a relatively short time.

Neurogenic bladder dysfunction: causes

The main reasons for the development of this disease are considered to be a violation of the neurological connection between the centers of the brain and the muscles and nerve endings of the walls of the bladder and sphincter, which causes a malfunction in their work.

Communication failure may be caused by:

• congenital pathologies of the spinal cord and brain;
• acquired pathologies of the spinal cord and brain caused by injuries, including birth injuries, as well as cancer;
• neurodegenerative diseases of the brain (Alzheimer's disease, Parkinson's disease, multiple sclerosis);
• inflammatory processes in the brain (encephalitis);
• injuries of the pelvic organs.

Among other things, this syndrome can also be caused by frequent stress or prolonged neurotic conditions.

Neurogenic bladder dysfunction: symptoms

In accordance with the nature of the bladder dysfunction, it is customary to distinguish two types of disease, each of which is characterized by its own symptoms:

• hyperreflex (overactive) bladder;
• hyporeflexive (hypoactive) bladder.

A hyperreflex bladder is characterized by high tone of the muscle wall, and consequently, a failure in the process of urine accumulation, which leads to the following signs of this type of bladder syndrome:

• frequent urge to urinate with little urine;
• imperative (suddenly occurring) urge to urinate, which provokes incontinence;
• discomfort when urinating;
• nocturia - frequent awakening at night due to the need to go to the toilet;
• pain when urinating.

The hyporeflex bladder is characterized by neurogenic weakness, which explains the following manifestations of the disease:

• weak urge to urinate even in the case of significant accumulation of urine;
• difficulties with urination;
• lack of feeling of complete emptying after going to the toilet;
• pain when urinating.

Consequences and complications

Due to the fact that neuromuscular dysfunction of the bladder is most often a symptom of more serious brain diseases (even degenerative and oncological), timely diagnosis of this disease makes it possible to identify the causes of its occurrence, which means that measures can be taken as quickly as possible and avoid serious consequences. consequences.

In addition, bladder disease (both overactive and hypoactive types) can lead to complications, since problems with the accumulation and excretion of urine lead to infection of both the bladder itself and other pelvic organs (if the excess urine goes higher up the ureters), which can cause:

• cystitis;
• urethritis (inflammation of the urethra);
• pyelonephritis (inflammation of the kidneys), as well as the formation of kidney stones.

In the case of an underactive bladder, excess urine also leads to stretching of the sphincter and bladder walls, which can also become a serious problem.

If the problems described above occur, as well as suspicion of bladder diseases, you need to contact someone who treats problems of the neurogenic bladder, as well as other diseases of the genitourinary system.

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Initial appointment

The initial appointment involves interviewing the patient, taking an anamnesis (recording the patient’s complaints and other information regarding the state of his health) and a thorough examination with the appointment of tests and a set of diagnostic procedures.

Diagnosis (examination) of neurogenic bladder

Diagnosis of a disease such as a neurogenic bladder is complicated by the fact that this deviation has similar symptoms to other diseases of the genitourinary system. As a result, the examination involves the use of diagnostic measures:

• blood tests and urine tests, which help exclude infectious diseases of the genitourinary system;
• Ultrasound: on ultrasound, the neurogenic bladder has its own characteristics (especially with the hypoactive type of the disease);
• urethrography and cystography;
• X-ray of the pelvic organs, which also allows us to identify concomitant diseases and complications.

If infectious or other non-neurological causes of the existing symptoms are not identified, the patient is prescribed studies of the spinal cord and brain:

• MRI (magnetic resonance imaging);
• EEG (electroencephalography);
• photographs of the skull and various parts of the spine.

Before the examination begins, the patient will need to keep a special diary for several days, where he will need to record the amount of liquid consumed and the frequency of going to the toilet, as well as features of the urination process (volume of urine, presence/absence of discomfort, etc.).

Further treatment regimen

If the results of tests and diagnostic studies confirm the diagnosis of “neurogenic bladder,” the specialist will prescribe treatment that is aimed at eliminating the symptoms and factors causing the disease in men.

Due to the nature of the disease, its treatment most often involves the involvement of not only a urologist, but also a neurologist and psychologist.

Treatment of the bladder, including neurogenic one, involves the use of a set of measures of various levels and scopes of action, which include:

• drug treatment: depending on the type of disease, either drugs are prescribed that reduce muscle tone, or, on the contrary, increase it. In addition, since one of the complications of this bladder syndrome is infectious diseases of the pelvic organs, anti-inflammatory drugs can also be prescribed, whose action is aimed at destroying the infection (in the bladder, ureters, urethra, kidneys, etc.). Medicines are also used to improve blood circulation in the walls of the bladder (both in the form of tablets and injections). Drug treatment is carried out only under the supervision of a doctor, which makes it possible to monitor the effectiveness of treatment and the body’s response to drugs (if necessary, the combination of drugs and doses can be adjusted).
• physiotherapy - physiotherapeutic methods are also aimed at stimulating the normal functioning of the walls of the bladder and sphincter, as well as the functioning of the nervous system itself (spinal cord and brain).
• psychotherapy - regardless of whether the disease was caused by psychological reasons (stress, neuroses) or not, consultations with a psychologist during the treatment process allow the patient to cope with the disease and its psychological impact on his daily life.
• a complex of exercise therapy (physical therapy), aimed at strengthening the muscles of the bladder and urinary system (involves conscious tension and relaxation of the corresponding muscles), as well as various parts of the spine and pelvis (especially in the case of previous injuries in this area). Exercise therapy is considered a very effective (and at the same time quite gentle) method of combating neurological bladder diseases.
• surgical intervention may be recommended in difficult cases. It is a plastic surgery of the bladder (musculo-ligamentous apparatus), as well as correction of the nervous apparatus of the urethra.

In addition, the patient is recommended to reduce the consumption of liquids, as well as salty foods, and, if possible, avoid consuming liquids 2-3 hours before bedtime in order to avoid cases of incontinence, as well as frequent trips to the toilet at night. However, this kind of restrictions should not affect the body’s water balance and lead to dehydration. In serious cases, if incontinence becomes a constant problem and causes constant discomfort to the patient, wearing special absorbent underwear may be recommended to avoid the unpleasant consequences of failure to empty the bladder.

The results and duration of treatment depend on the stage and type of the disease, as well as on the patient’s interest in recovery (with proper treatment, the unpleasant symptoms of the disease can either be reduced to zero or reduced to the minimum possible).

Due to the fact that this syndrome is caused by neurological problems, measures to prevent it include:

• preventive examinations by a neurologist, as well as an oncologist (especially if there have been cases of cancer and neurodegenerative diseases in the family);
• timely and correct treatment of spinal cord and brain injuries;
• healthy lifestyle: diet, moderate physical activity;
• reducing, if possible, the amount of stress and neurotic situations that can lead to various kinds of disorders, not only bladder disorders;
• a timely visit to the urologist for preventive purposes, as well as in the event of the above problems, since the neurogenic bladder and accompanying diseases can be cured the faster and more effectively the sooner the patient consults a doctor. At the same time, self-medication is strongly not recommended, because you can not only waste time, but also worsen your condition.

You can make an appointment with a specialist at the Energo clinic by using a special form on the clinic’s website or simply by calling. A timely visit to a doctor will solve all unpleasant problems and return comfort and peace to your life.

Neurogenic bladder, abbreviated as bladder dysfunction or organ dysfunction, is a pathological condition in which the process of accumulation and excretion of biological fluid from the body is disrupted. This occurs in situations where there are problems in the transmission of nerve impulses to the brain.

The presented condition is not an independent disease. It always occurs in patients who have other acquired or chronic pathologies. The frequency of diagnosis of the disorder is similar between both sexes, so it is worth considering how treatment is carried out. Neurogenic bladder in men and women is also accompanied by different symptoms and has several types.

Kinds

In urological practice, there are three types of NMP. The principle of classification is based on the distribution of pathologies depending on the volume of the organ. That is, the factor taken into account is when the process of urination occurs, together with how full the bladder is currently.

NMP can be of several varieties. Source: health-ua.com

Bladder dysfunction occurs:

1. Hyperreflex – a person feels the urge to defecate when a small amount of biological fluid has accumulated in the hollow organ (urine approaches the lower level or is slightly higher);
2. Hyporeflex – observed in patients who feel the urge to urinate when the organ is filled with urine above the upper limit;
3. Normoreflex - the urge begins at the moment when the biological fluid is at the middle level, which is considered normal.

The neurogenic bladder in women can be adapted or non-adapted. These conditions are distinguished depending on how evenly the organ is filled with urine. In the first case, the biological fluid is distributed equally, and in the second, it is distributed in jumps or periods, which provokes pain due to increased pressure. Against this background, patients often develop a state of urinary incontinence.

It is also worth noting that there is a neurogenic bladder in men and women of the postural type. It differs from the previously described varieties in that unpleasant symptoms can be traced only when the person is in a lying position; standing, no problems arise.

Causes

The neurogenic bladder, the treatment of which is the responsibility of a urologist, develops as a result of a disruption in the relationship between nerve impulses and the brain, the part of which is responsible for the normal and full functioning of this organ.

Causes of pathology development and provoking factors. Source: propochki.info

This condition may occur due to improper functioning of the urinary centers in the brain or spine. Experts identify several provoking pathologies:

• Encephalitis;
• Tumor formations;
• Post-vaccination neuritis;
• Diabetic neuritis;
• Tuberculosis;
• Cholesteatoma;
• Multiple sclerosis;
• Vertebral hernia;
• Spinal injuries and bruises;
• Stroke;
• Severe labor with nerve injuries in the pelvic organs;
• Diseases and abnormalities of the structure of the brain and spine of a congenital nature;
• Obstructive uropathy;
• Megalocyst.

The mechanism of development of neurogenic bladder weakness is quite complex. Defecation is a complex process that occurs at the reflex level after the organ is filled with biological fluid. If any pathology, or disruption in the functioning of the body system, has a negative impact on it, then the chain of reflexes that previously performed normal urination is broken and various problems begin to arise with the accumulation, retention and excretion of urine.

Neurogenic bladder dysfunction manifests itself differently in adults and children. The severity of the clinical picture is directly affected by the cause that led to the occurrence of this disorder. Once the innervation of the bladder is disrupted, the same can be observed in the kidneys, rectum, and reproductive organs.

Manifestation

The condition in question is a specific disorder in which all patients complain that they have problems with the process of removing biological fluid (urine) from the body. However, it is worth understanding that all the signs that will be described below can occur singly or in combination, and also have varying degrees of severity.

The pathological condition is accompanied by various unpleasant symptoms. Source: 1lustiness.ru

Among the main symptoms, experts identify the following:

1. Sudden urge to defecate;
2. Feeling of pressure in the lower abdomen;
3. Lack of urge to urinate or it is extremely weak;
4. Inability to hold urine;
5. Retention of biological fluid in the body;
6. Difficulty urinating.

Almost all patients, when talking with a urologist, pay attention to the fact that the previously reliable stream has become sluggish or weakened. Also, people are often tormented by the feeling that the organ has not completely defecated, which causes a feeling of increased pressure in the abdomen. Less often, people are faced with the fact that they have to make some effort to start the process of urination.

Along with this, other unpleasant accompanying symptoms appear:

1. Inability to perform an act of defecation;
2. Fecal incontinence;
3. Menstrual irregularities;
4. Decreased level of sexual desire;
5. Development of erectile dysfunction;
6. Formation of trophic ulcers and bedsores;
7. Changes in a person's gait;
8. Fluctuations in temperature and pain sensitivity of the legs.

In situations where neuromuscular dysfunction of the bladder is not diagnosed in a timely manner and the pathology progresses, the upper parts of this system may be involved in the process. This becomes the reason that the described symptoms are joined by conditions characteristic of kidney damage: increased body temperature, pain in the lumbar back, loss of appetite, dry mouth, nausea and vomiting (CRF).

Diagnostics

Neurogenic bladder (symptoms in women and men were discussed earlier) is accompanied by a complex of nonspecific symptoms and conditions that can occur in various pathologies. That is why doctors pay special attention to high-quality differential diagnosis.

During a standard visual examination of the patient, the presence or absence of the following indicators is taken into account:

• Pallor of the skin;
• Reduced body weight;
• The presence of urea odor from the oral cavity;
• Dry mucous membranes;
• Unsteady “duck” gait;
• The presence of bedsores or scars after surgical treatment;
• Signs of spina bifida;
• Paralysis or paresis of the lower extremities;
• Formation in the lower abdomen in the form of a tumor;
• Complaints about problems with urination (wet underwear, unnatural smell of urine).

This is the initial examination of the patient. If a person cannot answer the specialist’s questions on his own, or has diseases that do not allow him to do this, it is necessary that one of his relatives or close people be at the appointment. The information specified in the outpatient card is also taken into account.

The patient's uroflowmetry parameters are normal. Source: en.ppt-online.org.jpg

Among instrumental and laboratory diagnostic methods, preference is given to the following procedures:

1. Clinical and biochemical blood tests;
2. General urine analysis, according to Zimnitsky, according to Nicheporenko;
3. Excretory urography;
4. Survey radiography;
5. Urethrocystography;
6. Cystoscopy;
7. Ultrasound screening;
8. Radioisotope study of the kidneys;
9. Urofluometry.

The patient himself, or his relatives, must take an active part during the collection of anamnesis. The more detailed and truthful information they provide about your health condition, the greater the likelihood that the specialist will make the correct diagnosis the first time.

Treatment

Since each patient has a different clinical picture and the severity of bladder dysfunction, it is impossible to offer a single treatment regimen for everyone. In each case, individual treatment tactics are selected, and the approach must be comprehensive, otherwise it is difficult to achieve positive dynamics.

Medication

If there is a condition such as urine retention in the body, then it is necessary to take medications whose action is aimed at relaxing the muscles of the organ. In this case, alpha-blockers are used, among which preference is given to Tropaphen or Phentolamine, which is determined by the leading specialist.

When doctors are faced with the task of facilitating the rapid removal of biological fluid from the body, they need to create conditions of increased pressure in the organ, which will strengthen the tone of the detrusor muscles. Beta-blockers, for example, Inderal or Carbohol, do an excellent job of this task.

Inderal is used in complex drug therapy.

Neurogenic bladder - urinary disorders, united by one cause - damage to the part of the nervous system responsible for urine excretion.

The syndrome is characterized by a violation of the functions performed by the bladder: valve (continence of urine), evacuation (excretion of urine) and reservoir (accumulation of urine).

Neurogenic bladder is the most common type in women. Treatment of this pathology, as a rule, consists of several stages (use of medications, physiotherapy, exercise therapy, psychotherapy) and is long-term.

The functioning of the bladder is controlled by a huge number of nerves.

In this regard, any disturbance in the functioning of the nervous system can cause the development of neurogenic dysfunction.

In this case, urine that enters the bladder is immediately removed from it. As for the hypoactive type, it is provoked by disorders in the sacral region. In the hypoactive form, the bladder loses its ability to contract, causing urine to accumulate in the bladder and stretch it. Eventually, the sphincter stops holding urine and the problem of incontinence occurs.

Neurogenic dysfunction cannot be called an independent disease, because Within the framework of this syndrome, various pathologies in the functioning of the urinary system can be considered. Root causes of neurogenic bladder:

• damage to the peripheral nervous system;
• diseases of the spinal cord (intervertebral hernias, tumors, spinal diseases, injuries);
• diseases of the brain (tumors, hemorrhages, dementia, Parkinson's disease, trauma, strokes);
• HIV infection.

Also, the cause of urinary incontinence with neurogenic dysfunction may lie in cystitis and various neurological diseases.

Symptoms of the disease in women

Symptoms of neurogenic bladder depend on the form of the disease. The hyperactive type is characterized by the following symptoms:

• Frequent urge to empty the bladder, release of a minimal amount of urine during urination.
• Increased urge to urinate at night.
• Incontinence is a sudden and uncontrolled emptying of the bladder.
• Pain, discomfort during urination.

With a hypoactive form of dysfunction, it is customary to pay attention to other symptoms:

• No urge to empty the bladder.
• Painful sensations in the urethra.
• No relief after urination.

The listed symptoms directly indicate disturbances in the functioning of the urinary system.

Ignoring these signs creates favorable conditions for the development of pyelonephritis, urolithiasis, cystitis and other inflammatory processes.

Diagnostics

The first thing that needs to be done to diagnose pathology is to collect an anamnesis.

As a rule, the doctor suggests that the woman keep a “diary” for several days, i.e. record information about the frequency of urination, time and volume of fluid drunk.

Because Symptoms of neurogenic dysfunction are similar to those of other pathologies of the genitourinary system; a full examination of the organs may be required.

Often, during the examination, an infection is discovered that triggered the appearance of symptoms of the disease. In this case, a laboratory urine test is performed using a variety of functional tests.

To examine the organs of the genitourinary system, modern techniques are used (X-ray examination, cystoscopy, ultrasound). The listed methods make it possible to identify inflammatory processes, as well as abnormalities in the structure of the urinary tract. If during the examination the presence of diseases associated with the urinary organs is recorded, a neurological examination using MRI or CT is necessary. This examination is carried out to identify pathologies of the brain (spinal and brain).

Unfortunately, doctors are not always able to determine the exact cause of neurogenic dysfunction, and the etymology of the pathology remains unclear.

Bladder catheterization in men is used for difficulty urinating due to certain diseases. Here you will find a lot of useful information about the procedure.

Treatment of neurogenic bladder in women

If the diagnosis of “neurogenic dysfunction” is confirmed, the doctor prescribes a treatment program aimed at eliminating the symptoms and causes of this syndrome.

Due to the specifics of this disease, not only a urologist, but also a psychologist and a neurologist are involved in the treatment process.

As part of drug treatment, medications are prescribed that reduce muscle tone or increase it.

Due to the fact that neurogenic dysfunction is often accompanied by infectious processes in the pelvic organs, anti-inflammatory drugs may be additionally prescribed. The action of these drugs is aimed at eliminating the inflammatory process in the ureters, kidneys, urethra, etc.

Drugs (in the form of injections/tablets) are also used to improve blood circulation in the walls of the bladder. Drug treatment is carried out strictly under the supervision of the attending physician. This allows you to track the body’s response to medications and understand how effective the chosen treatment method is.

The second, no less important point in the treatment of neurogenic dysfunction is physiotherapy. Physiotherapeutic methods are aimed at normalizing the functioning of the nervous system, stimulating the sphincter and bladder walls. Along with physiotherapy, exercise therapy (physical therapy complex) is often used to strengthen the muscles of the bladder and various parts of the spine. A positive effect in this area is achieved by performing exercises involving conscious tension and relaxation of muscles.

Neurogenic bladder is a pathology that has a direct impact on a person’s life in society. The problems caused by this syndrome (for example, urinary incontinence) make a person feel inferior and lead to psychological problems. Only a course of psychotherapy can relieve the patient of these problems. An experienced psychologist will help a person cope with the disease and its impact on everyday life.

A woman suffering from neurogenic dysfunction is advised to avoid drinking too much (especially 2-3 hours before bedtime).

This will help avoid attacks of incontinence, as well as frequent urge to urinate. Such restrictions should not lead the body to dehydration.

In some cases, special absorbent underwear can be worn during treatment to avoid psychological problems associated with incontinence.

In difficult cases, surgical treatment methods can be used, during which plastic surgery of the bladder and correction of the nervous apparatus of the urethra are performed.

If you have been diagnosed with neurogenic dysfunction, do not try to self-medicate. Having no idea what causes the pathology, you risk worsening your condition and causing irreparable harm to your health.

Unfortunately, drug treatment and symptomatic surgeries do not provide lasting results. Therefore, work is currently underway to search for new algorithms for the treatment of neurogenic bladder dysfunction.

Video on the topic

Neurogenic bladder in women, treatment of this disease is carried out under the supervision of several specialists - a urologist and a neurologist, due to the fact that the disease can have varying degrees of severity and be aggravated by concomitant pathologies.

In this article we will talk about how neurogenic MP manifests itself, what treatment methods are used for this disease, and also consider methods for diagnosing this disorder.

Neurogenic bladder dysfunction in adults is a congenital or acquired disease of the nervous system. Bladder neuropathy is quite common in urology, characterized by a violation of the voluntary reflex accumulation and excretion of urine due to functional and organic damage to the nerve pathways and centers responsible for regulating this process.

Depending on the type it occurs:

1. Neurogenic dysfunction of the hyporeflex type - in this case, there is an increased volume of the bladder, absence of contractions and low pressure in it.
2. Neurogenic hyperreflex bladder - high tone of the muscle walls is observed, the size of the organ in most cases remains normal. There is a disruption in the process of urine accumulation, which causes various urination disorders to develop.

ICD 10 neurogenic bladder dysfunction can develop due to disruption of neurological connections between the centers of the brain and nerve endings, and the muscles of the bladder and its sphincter, which is why their functioning fails.

Communication disruption can be caused by the following factors:

• congenital or acquired pathologies of the brain and spinal cord;
• degenerative pathologies of the brain;
• injuries to organs in the pelvis;
• inflammatory diseases of the brain.

In addition, neurogenic disorders can be a consequence of frequent stress or prolonged neurotic conditions.

Depending on the type of disease, the clinical picture has certain differences.

Neurogenic bladder code according to ICD 10 leads to the formation of stones that disrupt the outflow of urine and provoke the development of infectious diseases. When the sphincter spasms, vesicoureteral reflux is observed, leading to an inflammatory process.

Treatment tactics

The symptoms and treatment of this pathology are closely related. It is based on the presence of clinical symptoms that the doctor selects the necessary treatment regimen. The disease has a favorable prognosis if treatment for neurogenic bladder dysfunction was started before kidney damage.

The main methods used are:

• increasing the volume of fluid consumed;
• catheterization;
• drug treatment;
• surgical intervention.

If neurogenic bladder dysfunction is confirmed, treatment is carried out as follows:

1. Drugs are used medicinally that reduce muscle tone (for hyperreactive MP, this is spasmex, smazmolit) or increase it (the hypoactive type is treated with M-cholinomimetics: aceclidine, galantamine). If concomitant infectious diseases are detected, a course of anti-inflammatory and antibacterial drugs (group of sulfonamides or nitrofurans) is prescribed.
   In addition, drugs are used that improve blood circulation in the walls of the bladder and eliminate hypoxia (propantheline, hyoscine). It is possible to individually prescribe alpha-blockers (phenoxybenzamine, diazepam) and alpha-sympto-mimetics (imipramine, midodrine) for patients with a hypoactive bladder.
2. Specific treatment of the neurogenic bladder and physiotherapy are aimed at restoring the normal functioning of the sphincter and organ walls, as well as the functioning of the NS. For these purposes, continuous or periodic catheterization is used; special techniques to induce urination, as well as electrical stimulation of the sacral nerve, thermal applications, laser therapy.
3. Neurological treatment and psychotherapy - when identifying the causes of the disease that provoked the disease, correction is carried out to cope with the impact of the disease on everyday life, as well as eliminate other consequences. Quite often the following medications are prescribed: pantogam in the treatment of neurogenic bladder. This is a psychostimulant and nootropic drug, often used to treat patients with urgency and urinary incontinence, enuresis, polakiuria, consequences of neuroinfection and psycho-emotional stress. The daily dose is selected by the doctor, it should not be more than 3 g. Phenibut is also a nootropic and psychostimulant drug, used in the treatment of asthenic and anxiety-neurological conditions, for the prevention of stressful conditions before medical interventions, for enuresis and other disorders. This drug relieves tension, anxiety, fear, enhances the effect of certain medications, has a psychostimulating and antiaggregatory effect, and also facilitates the transmission of impulses to the central nervous system. The price of the drug starts from 100 rubles.
4. Surgical treatment is used when drug treatment has not given the desired effect, or there is a risk of complications with acute or chronic infections. For men, sphincterotomy is used. The operation turns the bladder into an open channel with drainage. With the help of sacral radiotomy, it is possible to transform an overactive bladder into a hypoactive one, urine diversion will be carried out through a ureterostomy or intestinal canal.
   Surgical treatment of the neurogenic bladder in women and men can be performed by transecting the pudendal nerve due to spasticity of the external sphincter. Such an intervention is aimed at having an indirect effect on urinary dysfunction.

Treatment with folk remedies in the case of a neurogenic bladder is impossible, since such methods do not have the proper effect on the mechanisms of development of the pathology.

Diagnostic methods

It is extremely important to know how to treat a disease of this nature, but without timely and accurate diagnosis, choosing the right therapy is almost impossible.

In order to confirm neurogenic bladder dysfunction, the diagnosis should consist of:

1. Determination of residual urine volume - this method makes it possible to estimate the volume of fluid remaining in the bladder after emptying. The permissible value in adults should not exceed 50 ml. The assessment can be carried out through catheterization or ultrasound of the organ.
2. and MP-instruction implies conducting such a study with preliminary preparation (full bladder) for an accurate assessment of the condition of the urinary system. Ultrasound signs of a neurogenic bladder during the examination may be displayed in a large amount of residual urine or a change in the size of the bladder.
3. UBC and OAM, biochemical tests of blood and urine, urine tests according to Zimnitsky and Nechiporenko. The cost of such studies is insignificant, but their results are extremely important for the completeness of the clinical picture.
4. If necessary, urography, cystoscopy, cystography and cystometry with urodynamic tests are performed.

In elderly patients, it is recommended to carry out differential diagnosis with stress urinary incontinence and prostate hypertrophy. If it is impossible to establish the cause of the disease, they speak of idiopathic neurogenic bladder.

Frequently asked questions to the doctor

Important measures

Hello. Tell me, what preventive measures should be followed after I have treated neurogenic pathology of the bladder?

Greetings. Since this disease is associated with neurological problems, it is important to adhere to the following recommendations: undergo timely preventive examinations by specialists and treat brain injuries; do not forget about proper nutrition and feasible physical activity, avoid stressful situations; Visit a urologist in a timely manner for any disorders of the urinary system.

They call a group of urination disorders, manifested by impaired bladder emptying in individuals with a normal anatomical structure of the bladder and urethra. Otherwise, neurogenic bladder is also called neurogenic voiding disorder or neurogenic bladder dysfunction.

Neurogenic bladder is divided into two groups:

• caused by inorganic changes in the spinal cord or lower urinary tract,
• caused by organic damage to the terminal part of the spinal cord.

Seven clinical variants of nonorganic bladder dysfunction have been identified:

• subclinical (hidden) hyperreflex bladder - observed in 14-17% of patients with functional urination disorders; the disease is manifested by involuntary urination during sleep, urinary incontinence and a combination of similar symptoms;
• normoreflex bladder - observed in 4.5-5.5% of cases, combined with increased contractile activity of the urethral sphincter, manifested by involuntary urination during sleep, urinary incontinence, or a combination thereof;
• hyperreflexive non-adapted bladder - observed in 30-36% of patients with urination disorders of neurogenic origin; manifested by frequent (with an interval of 0-2.5 hours) urination in small portions of urine, urinary incontinence, and the presence of residual urine; characterized by intermittent intravesical hypertension during the entire period of bladder filling;
• hyperreflexive adapted bladder - observed in 29-31% of patients, characterized by the same symptoms as the non-adapted one, but less pronounced; the existing detrusor hyperreflexia is not accompanied by intermittent intravesical hypertension and the state of adaptation of the bladder to the filling phase is disturbed to a lesser extent;
• the fifth, sixth and seventh clinical variants of neurogenic dysfunction of the urinary tract are characterized by hyporeflexia of the muscles that push urine out; the differences lie in the fact that the presence of a hyperreflex bladder is combined with normal function (fifth clinical option), increased contractile activity (sixth option) and insufficiency (seventh option) of the urethral sphincter).

Clinically, all of these variants of the hyporeflex bladder are characterized by rare urination (2-3 times a day) and the release of large portions of urine (up to 500 ml or more), the presence of residual urine (up to 250 ml or more), as well as various types of urinary incontinence .

Neurogenic dysfunctions of the bladder of organic origin include all forms of neurogenic disorders of urination and urinary incontinence, united by a common etiological feature - separation of the bladder by the cortical centers of the brain, which ensure the controlled nature of urination. The most important and most common types of dysfunction of the bladder are those whose occurrence is caused by organic pathological changes in the spinal and peripheral conduction innervation. There are 4 main groups of spinal cord dysfunctions:

• I - with congenital malformations of the terminal part of the spinal cord and spinal column;
• II - with traumatic injuries of the spinal cord of extramedullary fibers of the cystic plexus;
• III - with inflammatory-degenerative diseases of the spinal cord and its membranes;
• IV - with damage to the intramural nervous system of the bladder.

TO causes of neurogenic bladder relate:

• congenital defects of the final part of the spinal column (spina bifida, agenesis and dysgenesis of the sacrum and coccyx);
• inflammatory and degenerative diseases of the spinal cord and its membranes, peripheral nerves and nerve plexuses, intravesical nerve endings (myelitis, poliomyelitis, meningitis, encephalomyelitis, syphilis, tuberculosis of the nervous system);
• damage to elements of the intravesical nervous system in obstructive uropathy in children;
• tumors and injuries of the spinal cord and spinal column, osteochondrosis;
• brain injury, cerebrovascular accident;
• damage to the nervous system by arsenic preparations, salts of heavy metals, endogenous and exogenous intoxication of the nervous system;
• long-term use of psychopharmacological and other drugs;
• denervation of the bladder due to massive surgical interventions in the pelvic organs.

The main role in the development of neurogenic urination disorders is played not so much by the nature of the cause as by the level of distribution and degree of damage to the nerve pathways and centers that provide the function of urination.

Depending on the level of damage to the innervation of the bladder and changes in the tone of its muscles, central, spinal and peripheral (inside and outside the organs) forms of urination disorders are distinguished, as well as hypo- and atonic neurogenic bladder.

There are also reflex, hypo-, hyper- and are-reflex, sclerotic neurogenic urination disorders.

Patients with neurogenic bladder dysfunction complain of:

• feeling of heaviness in the pubic area;
• urinary disturbance
• inability to completely empty the bladder,
• paradoxical urinary retention (ischuria) when the bladder is full, involuntary urination;
• with continued urination
• weak stream of urine even when pressing on a full bladder;
• in severe forms of the disease, the feeling of urge to urinate completely disappears.

How to treat a neurogenic bladder?

It is a complex set of procedures. Treatment consists of restoring urination, maintaining sufficient bladder capacity and addressing the inflammatory process. Treatment of neurogenic bladder of inorganic origin should be comprehensive, aimed at correcting all identified disorders, multi-stage. Its purpose is usually:

• maintaining normal kidney function,
• preventing (or treating) infection,
• ensuring urinary continence.

Treatment is based on periodic catheterizations under sterile conditions along with selective use of anticholinergic drugs. This helps reduce pressure in the bladder and prevents uninhibited bladder contractions.

The following areas of treatment for neurogenic bladder are distinguished:

• medicinal effects on the nervous system of the bladder with pharmacological drugs of directed mediator action + electrical stimulation;
• surgical palliative treatment;
• surgical palliative-symptomatic treatment.

Drug therapy is carried out in cases where lesions of the sympathetic or parasympathetic innervation predominate. The prescription of pharmacotherapeutic agents is combined with intraanal electrical stimulation. For its implementation, special devices “Tonus-1”, “Tonus-2”, “Bion-3” and the like are usually used. Direct electrical stimulation is carried out using a catheter-electrode, which is inserted into the bladder through the urethra. The electrode contacts the wall of the bladder through an electrolyte introduced into its cavity or directly. During neurotropic stimulation, platinum needle electrodes are inserted percutaneously into the area of ​​the nerve roots at the level of the third segment of the spinal cord. If electrical stimulation produces a positive effect with this technique, implantation of electrodes in the cauda equina area is carried out surgically.

All methods of this group of patients can be combined into 4 groups:

Influencing the effective parts of the autonomic nervous system at the segmental level or directly on the muscle that pushes urine out and the sphincter of the urethra. The goal is to restore the normal detrusor-sphincter ratio, reservoir function of the bladder and controlled urination by reducing or increasing the tone, contractile activity and reflex excitability of the muscle that pushes urine out, and to normalize the closing functions of the sphincter. They use - M-anticholinergics, M-cholinomimetics, anticholinesterase drugs and antiprostaglandin drugs, α-adrenolytics, α-adrenostimulants, calcium ion antagonists.

Influencing the efferent parts of the autonomic nervous system through the influence of pharmacological drugs against the background of preliminary activation of metabolic processes. Adrenomimetics and antagonists of potassium ions (ephedrine hydrochloride and isoptin), as well as coenzymes and cholinomimetics (cytochrome C for injection, riboflavin mononucleotides, aceclidine) are used simultaneously.

Causing activation of detrusor-stabilizing reflexes in their effective link and restoring the normal detrusor-sphincter ratio. Various forms of electrical stimulation of the anal sphincter, perineal muscles and bladder are used.

Influencing higher centers of autonomic regulation through the use of neurotropic antidepressants, tranquilizers, and metabolic therapy.

Treatment of neurogenic bladder of organic origin is ineffective. It is mainly aimed at prolonging the patient’s life. The cause of death of the patient may most likely be not so much dysfunction of the bladder as complications that occur in the upper urinary tract and kidneys, which leads to pyelonephritis, urosepsis and chronic kidney failure.

When conservative treatment is ineffective, there is a need to choose a method of surgical treatment.

In the final stage of the disease, therapy is aimed at saving the patient and prolonging his life. In such cases, a permanent catheter with a Monroe system is often installed.

For reflex bladder caused by transverse dissociation of the spinal cord above the lumbar region, tidal drainage of the bladder with Monroe has become widespread. The purpose of drainage is to develop and consolidate the reflex state of the bladder. With strict adherence to asepsis and an individual regimen, this method is safe and effective. The catheter must be changed after 3-4 days; to rest the urethra, it is necessary to periodically interrupt drainage for 2-3 days.

Pathogenetically based operations include:

• ileovesicopexy,
• ileorectovesicopexy,
• rectovesicopexy,
• reinnervation of the bladder by the rectus abdominis muscles

Intestinal plastic surgery for a neurogenic bladder is justified only in cases where the bladder is able to serve as a reservoir and provide outflow from the upper urinary tract. In practice, this is observed with an autonomous bladder due to damage to the spinal cord, with denervation of the bladder, which is observed after massive operations in the pelvic cavity.

After surgery, conservative treatment methods are used to strengthen the mechanisms of active urination, including active physiotherapy, physical therapy, and electrical stimulation of the bladder.

Contraindications to radical surgical treatment are:

• spinal cord injuries in the cervical and thoracic regions with bladder automaticity;
• severe bilateral ureterohydronephrosis, which developed as a result of vesicoureteral reflux in the presence of severe renal failure;
• massive narrowing of the urethra;
• dysfunction of the sphincters, accompanied by urinary and fecal incontinence.

The prognosis depends on the form and stage of the disease, the timeliness and correctness of the choice of a pathogenetically based method of treating neurogenic bladder dysfunction.

What diseases can it be associated with?

Bladder dysfunction is only the primary link in the pathogenesis of the disease; it gradually leads to a change in the anatomical structure of the organ, which significantly aggravates the functional disorders that already exist. Often the course of this pathology follows a “vicious circle” type. All this over time leads to profound changes in the ureter, upper urinary tract and kidneys, which are the main clinical features of neurogenic bladder dysfunction and ultimately determine its consequences.

In some cases, patients with a neurogenic bladder are found, etc.

The infection that occurs in such cases leads to the development of urosepsis. Often, in its symptoms, a neurogenic bladder is similar to acute cystitis or pyelonephritis, glomerulonephritis, urolithiasis, which makes diagnosis difficult.

Treatment of neurogenic bladder at home

Treatment of neurogenic bladder It can be carried out at home if the treatment method is conservative therapy, and the patient strictly follows all the doctor’s prescriptions. Worsening of symptoms, infection, development of complications and lack of effect from medications is a reason for hospitalization.

What medications are used to treat neurogenic bladder?

For treatment of neurogenic bladder A wide variety of pharmaceuticals are used:

• M-anticholinergics - beladonna,
• M-cholinomimetics - aceclidine, carbacholine,
• anticholinesterase drugs -
• antiprostaglandin drugs -
• a-adrenolytics - ,
• a-adrenergic stimulants - ,
• calcium ion antagonists - ,
• coenzymes and cholinomimetics - riboflavin mononucleotides,
• antidepressants -,
• tranquilizers - ,
• metabolic therapy - .

The dosage of medications, as well as the duration of the course, and the combination of the above drugs are determined by the attending physician, taking into account the origin of the dysfunction, the characteristics of its course and the results of individual diagnostics.

Treatment of neurogenic bladder with traditional methods

Neurogenic bladder cannot be treated with folk remedies. Such means do not affect the mechanisms of development of pathology.

Treatment of neurogenic bladder during pregnancy

Treatment of neurogenic bladder during pregnancy is a difficult problem. Her decision must be entrusted to specialized specialists who, depending on the stage of the disease and the patient’s well-being, will choose a treatment strategy that is acceptable in a particular case.

Which doctors should you contact if you have a neurogenic bladder?

Diagnosis of various clinical variants of the disease is always quite difficult. A preliminary idea of ​​the degree, form of neurogenic bladder dysfunction, and concomitant changes in other organs and systems is given by a carefully collected anamnesis and examination of the patient. A correctly collected anamnesis helps not only to establish a diagnosis, but also to trace the mechanism of transition from one form of neurogenic bladder dysfunction to another, determine its cause, and clarify the pathogenesis of the disease.

When examining a patient, pay attention to:

• pale skin,
• degree of weight loss,
• child's retardation in physical development,
• in the final stage of the disease - for dry mucous membranes, swelling, and the smell of urea from the mouth.

First of all, the doctor is faced with the task of establishing:

• when the patient or his relatives notice urinary disorders,
• find out their character and dynamics,
• obtain information about a previous injury to the spine or head (birth injury, fracture, bruise, fall on the sacrum, back, etc.),
• obtain information about diseases of the nervous system or infections, the presence of spina bifida,
• obtain information about the treatment of the conditions described above, if they were noted.

When urinary incontinence occurs:

• hypertrophy of the anterior skin,
• maceration of the skin of the thighs,
• strong smell of urine
• constant dripping of urine,
• upon palpation of the suprapubic area - urine discharge in a weak stream,
• sometimes an enlarged bladder is detected above the pubis.

A neurological examination allows you to determine the level and depth of damage to the central and peripheral innervation. After this, they resort to laboratory, x-ray, radionuclide and instrumental research methods.

Laboratory tests, excretory urography, renography, scanning and dynamic scintigraphy allow us to get an idea of ​​the function of the kidneys, survey urography - about the state of the skeletal system, the presence of stones in the kidneys and urinary tract, the contours of the kidneys and bladder.

Cystoscopy provides information about the condition of the mucous membrane and muscles of the bladder wall, its capacity, and the amount of residual urine. The functional state of the bladder is studied according to cysto-, sphinctero- and uroflowmetry.

To determine the condition of the urethra, bladder sphincters and muscles that push urine out, and to reduce the amount of instrumental interventions, urography is combined with sphincterometry, and ascending cystography is combined with cystometry. Cystography and ultrasound examination allow the slow introduction of a radiopaque substance into the cavity of the bladder to accurately determine its real capacity. Electrocystometry performed in parallel provides important information about the state of the contractility of the muscle that pushes urine out.

To assess the denervation mechanisms of the bladder, special electrophysiological research methods have been developed, the principle of which is that the development of a neurogenic bladder largely depends not on the nature of the disease, but on its topography and relationship to the spinal centers.