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Pediatric – Neurogenic Bladder

Normally, the bladder is responsible for storing and expelling the urine in a controlled and voluntary manner. The central nervous system and the peripheral nervous system control the urination process.

A malfunction or disorder in the bladder can cause neurogenic bladder.

In normal conditions, the spherical bladder is lined inside with a soft tissue lining and covered with a muscle sheet on the outer side. Apart from this, the bladder neck – opening similar to a funnel which connects the bladder with the urethra – the urethra – tube connecting the bladder to the urethral opening – and the external urethral sphincter muscle – muscle group surrounding the urinary passage – make the entire urinary tract.

The muscles and nerves in the urinary system must function normally and in coordination for normal urination and storing the urine and emptying in the bladder and removing it effectively. Nerve messages control the functions of the muscles and sphincters that manage the flow of urine normally.

What is Neurogenic Bladder?

Loss of normal functioning of the bladder is known as neurogenic bladder. It can be caused due to an injury or damage to the part of the nervous system controlling it. This affects the normal storage and expulsion of the urine from the affected bladder.

What are the risk factors that cause Neurogenic Bladder?

These are some of the known risk factors that develop neurogenic bladder in a person:

• Congenital defects – Birth defects that affect the spinal cord severely (spina bifida or other spinal disorders)

• Tumors – Tumor in the spinal cord or pelvis affects normal nerve functions

• Severe spinal cord injury – Severe trauma to the spinal cord also disrupts the normal functioning of the bladder muscle and nerves

What are the signs and symptoms of Neurogenic Bladder?

Urinary incontinence – inability to control urine – is the most commonly seen symptom of neurogenic bladder. There are several causes for this condition.

A dribbling and abnormally slow stream of urine usually signifies the development of urinary incontinence. It may also cause the patient to strain or have inability to urinate sufficiently. Loss of control over the bladder muscles may prevent them from contracting completely and result in significant amount of urine being constantly stored in the bladder, leading to urinary retention.

There are several irritating symptoms as well, such as urinary urgency and frequency which may indicate towards development of bladder hyperactivity. Other similar symptoms include, dysuria (painful urination) resulting in UTI (urinary tract infection), pyelonephritis (severe kidney infection), etc. Constant storing of urine with insufficient draining may also result in VUR (vesicoureteral reflux) which also leads to UTI in most cases.

Kidney stones may also form in the urinary tract due to blocked flow of urine or infection.

How is the diagnosis for Neurogenic Bladder done?

In case neurogenic bladder is suspected, the doctor will advise testing the nervous system along with the bladder.
These are some of the diagnostic tests required to determine the development of neurogenic bladder in a person:

• X-ray – Spinal and thoracic

• EEG (electroencephalogram) – Helps to identify malfunction in the brain/nervous system

• Imaging tests – Bladder and ureters

• Functional test – To check the storing capacity of the bladder

How is Neurogenic Bladder treated?

Medicinal approach is helpful in treating overactive bladder, as well as for improving irritating syndromes and incontinence. Antibiotics are needed for treating or preventing UTI, especially when the patient also shows symptoms of VUR. Other medications are also helpful to controlling bladder movement.

CIC (clean intermittent catheterization) is also useful for emptying the affected bladder.

Surgical treatment may involve using minimally invasive surgical method to remove the external urethral sphincter to allow free flow of urine. This is often combined with a CIC procedure for more effectiveness. A temporary treatment also includes injecting paralytic agents into the outer muscle wall of the bladder.

Another surgical repair includes implanting permanent stents in the affected bladder neck for efficient flow of urine.

In case the damage to the bladder is severe and results in loss of functioning completely, then the doctor may advise bladder augmentation through surgical methods.

What is the prognosis after treatment of Neurogenic Bladder?

The doctor will schedule extensive follow-up visits to check the success of the treatment and the pace of improvement in the condition. This will involve testing the functioning of the kidney and the bladder.

Proactive management of patients helps to lessen the risk of damage to the bladder and kidney.

Frequently asked questions:

What is the likelihood that a child affected with spina bifida will develop Neurogenic Bladder?

There is significant risk in a child affected with spina bifida to develop neurogenic bladder condition also. Frequent evaluation of the condition is required to detect and treat neurogenic bladder is seen to develop.

Are there any limitations for a patient with Neurogenic Bladder?

The affected functioning of the bladder are the only type of limitation that the patient suffers from when affected with neurogenic bladder.

Can the symptoms of neurogenic bladder be prevented?

Certain symptoms and effects of neurogenic bladder are easily prevented with effective management and regular medication. At times, proper surgical treatment can also help to avoid greater complications from the condition.