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