Neurogenic bladder is a group of diseases in which the process of urination is disturbed. Violation of control over urination at different levels: the brain, lumbar spinal cord or nerve ganglia, leads to various disorders of the urination process. Neurogenic bladder (NUB) can be diagnosed in people of any gender and age, but is most common in women and young children.

Already at the age of 2-3 years, the child learns to control the processes of urination, from 3-4 years this process should take place fully consciously and controlled. The bladder accumulates a certain amount of urine, holds it for a sufficient time and empties in a controlled manner, following signals from the brain. With the development of a neurogenic bladder, a violation of one or more functions of this organ may occur.

It is quite difficult to name the exact causes of the development of pathology in each case. Violation of the process of urination in childhood and in adults occurs for various reasons.

In adults, a neurogenic bladder most often develops due to:

In children, this pathology can develop due to:

• congenital pathologies of the brain and spinal cord;
• injuries of the brain and spinal cord;
• congenital malformations of the genitourinary system;
• infectious and endocrine diseases;
• strong fear, stress.

Whatever causes the development of urinary incontinence, patients quickly develop concomitant stress disorder or psychological problems. Both children and adults are embarrassed by the manifestations of their illness, often deny the presence of symptoms, "hide" and refuse to seek medical help. This greatly complicates treatment and often makes it less effective.

NMP in children

Neurogenic bladder in children is very common, according to Russian pediatricians, every tenth child aged 4 to 14 years suffers from this. Complete control over urination in children is established only by the age of 3-4 years, and only from this age can treatment begin.

This pathology can be suspected with a persistent, regular violation of the urination control process: nocturnal and daytime enuresis, too frequent or rare urination, involuntary release of small portions of urine during nervous and physical stress, or other symptoms.

When a disease is detected at an early age, it is very important to exclude congenital malformations and traumatic lesions of the brain, spinal cord and urinary organs, since the treatment of these pathologies often involves surgical intervention, and the sooner it is performed, the better.

NMP in women

In females, the development of a neurogenic bladder occurs several times more often than in men. This is due to the fact that the receptors responsible for emptying the bladder are more sensitive to female sex hormones. Also, a violation of the innervation of the bladder in women can be associated with injuries of the spinal cord and pelvic organs during childbirth and pregnancy.

Due to the peculiarity of the structure of the genitourinary system in women, stagnation of urine, and a violation of its separation, quickly leads to secondary infection of the higher organs: the ureters and kidneys.

NMP in men

In older men, problems with urinary control may occur as a result of treatment of the genital organs or as a complication after bladder catheterization. Often, males are reluctant to see a doctor, preferring alternative treatments, which in most cases are ineffective.

With a protracted or chronic course of the pathology, there is a high risk of the formation of sand and kidney stones, which can greatly complicate the course of the disease.

Symptoms

All manifestations of the neurogenic bladder are associated with a violation of its normal functioning.

Symptoms of pathology can be caused by:

Also, the symptoms are related to the level of control over urination, problems arose:

1. The cerebral cortex - the control centers for voluntary urination mature by 3-4 years, sometimes later. They can be damaged by trauma, neoplasms or diseases of the brain. The patient "forgets" that he must empty his bladder on time or loses his skills of neatness.
2. Subcortical formations - they control the functions of the autonomic nervous system, including the bladder. Violation at this level occurs with extensive damage, neoplasms, malformations, hemorrhage in the brain. In such severe cases, several functions are usually disturbed at once, including urination.
3. The spinal cord - the lumbar region of the spinal cord is directly responsible for controlling the organs of the small pelvis. Loss or disturbance of sensitivity at this level leads to the fact that urination occurs spontaneously, the patient does not feel the urge to urinate and cannot control this process in any way.
4. Intramural ganglia - the innervation of the bladder itself can be impaired as a result of endocrine or infectious diseases. In this case, a person cannot feel the urge to urinate in time when the bladder overflows, or the urge occurs too often.

The following forms of neurogenic bladder pathology are distinguished:

Hyperreflex bladder - an increase in the activity of the muscles of the urinary system leads to a number of problems with urination. Urine in the bladder does not accumulate in sufficient quantities, it is not always possible to control the process of urination, and the patient constantly feels the desire to urinate.

Typical symptoms of an overactive bladder include:

• frequent urge to urinate;
• excretion of urine in small portions;
• it is possible to release small portions of urine involuntarily;
• nocturnal enuresis or nocturia;
• pain when urinating.

A hyporeflex bladder develops when there is a decrease in the activity of the muscles of the bladder or a complete loss of control over urination. Even with the accumulation of a large amount of urine, the urge to urinate does not occur, the bladder is not completely emptied.

A flaccid bladder causes the following symptoms:

• lack or very weak urge to urinate;
• constant feeling of fullness of the bladder;
• weak stream of urine;
• there is no feeling of complete emptying of the bladder;
• overflow incontinence - urine "leaks" or is excreted in large quantities.

How does a doctor make such a diagnosis?

If you suspect the development of a neurogenic bladder in adults or a child, it is necessary to undergo a complete examination by a general practitioner / pediatrician, nephrologist and neuropathologist as soon as possible. This will help to identify or exclude organic pathologies of the nervous system or urinary organs, since it is useless to start treatment in the presence of an infectious or traumatic lesion, you must first get rid of the source of the pathology.

To make a diagnosis, an examination is carried out, including:

1. Collection of anamnesis. Careful questioning about concomitant symptoms, frequency of urination, time of onset of symptoms of the disease, and so on, helps to determine the form of the disease and prescribe a preliminary treatment.
2. Laboratory tests. A study of blood and urine helps to diagnose many infectious diseases, as well as to evaluate the contraction and excretory function of the bladder.
3. Additional research methods. Ultrasound of the urination organs, cystourethroscopy, fluoroscopy with a contrast agent, MRI of the brain.
4. Consultation with a neuropathologist, nephrologist, psychologist.

Treatment

Treatment of a neurogenic bladder begins with taking drugs that alleviate the patient's condition, lifestyle changes and treatment by a psychologist or psychotherapist. In severe cases, therapeutic treatment is supplemented by surgery.

Medical treatment

Depending on the condition of the muscles of the bladder, the following types of drugs are used:

All these drugs have many contraindications and side effects and should be used only according to the indications and prescription of a doctor, since many of them affect not only the bladder, but also other internal organs, such as the heart, kidneys, stomach, as well as vessels or brain.

In addition to drugs that affect the muscle layer of the bladder, the following are used to treat pathology:

• antibiotics - for infectious diseases and secondary infection;
• uroseptics - to exclude secondary infection;
• drugs that affect the patient's neuropsychic state - depending on the state of the nervous system, the patient's behavior, related problems, sedatives, herbal and synthetic origin, sleeping pills or antidepressants can be prescribed.

The intake of drugs from this group has an important therapeutic and prognostic value, since the neurogenic bladder is not only a somatic disease, but also a psychological and social one. The patient is shy because of this pathology, limits his contacts, he may develop depression or nervous strain.

It is recommended to start treatment of a neurogenic bladder with herbal sedatives, such as an infusion of valerian, motherwort root or hawthorn. With their ineffectiveness, barbiturates are used as sleeping pills or antidepressants: amitriptyline, fluoxetine and others. Antidepressants should be taken only under the supervision of a doctor, since long-term use and gradual withdrawal are necessary to achieve the effect.

Other treatments

In addition to drug therapy, physiotherapy and exercise therapy are of great importance in the treatment of neurogenic bladder.

The use of electrical stimulation, ultrasound, electrophoresis, therapeutic sleep and other physiotherapeutic methods can improve the permeability of the nerve impulse, strengthen or relax the muscles of the bladder, as well as its sphincters.

Therapeutic exercise also helps to strengthen the abdominal muscles and increase control over urination.

For a full recovery and improvement of the patient's condition in the presence of a neurogenic bladder, it is very important to change the mode of work, rest and lifestyle in general. Recommended:

• control the amount of fluid consumed - reduce the amount of fluid you drink;
• refuse spicy, salty foods, dishes that cause thirst;
• stop drinking alcohol and smoking;
• wear special absorbent underwear;
• sleep at least 7-8 hours a day;
• spend more time outdoors
• avoid stressful situations;
• Learn to control your emotions and relax.

Psychotherapy

The use of psychotherapy can become the most important element in the treatment of neurogenic bladder, since this is a pathology that is always accompanied by some disturbance in the patient's psycho-emotional sphere. Often, even the most timely and qualified treatment cannot help the patient, since he has already developed a neurosis and the pathology has secondarily "fixed" at the level of the psyche. Even after completely getting rid of the pathologies that caused the development of a neurogenic bladder, all symptoms remain, as the patient continues to experience severe stress.

Working with a psychotherapist helps patients to understand the causes of their problems, “work through” and let go of the emotions caused by the disease, as well as learn to control their body and mind and get rid of negative emotions.

Neurogenic bladder, which is abbreviated as LUT or organ dysfunction, is a pathological condition in which the process of accumulation and removal 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 with other acquired or chronic pathologies. The frequency of diagnosing the disorder is the same among the two sexes, so it is worth considering how the treatment is carried out. Neurogenic bladder in men and women is also accompanied by different symptoms, 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 when the process of urination takes place is taken into account, together with how full the bladder is at the present time.

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

Bladder dysfunction is:

1. Hyperreflex - a person feels the urge to defecate when a small amount of biological fluid has accumulated in a hollow organ (urine approaches the lower level, or slightly higher);
2. Hyporeflex - noted in patients who feel the desire 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 the norm.

The neurogenic bladder in women may or may not be adapted. These states 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, 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 a person is in a prone position, no problems arise while standing.

Causes

A neurogenic bladder, the treatment of which is within the competence of a urologist, develops as a result of the disruption of the relationship between nerve impulses and the brain, the department of which is responsible for the normal and full functioning of this organ.

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

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

• Encephalitis;
• Tumor formations;
• Post-vaccination neuritis;
• Neuritis diabetic;
• Tuberculosis;
• cholesteatoma;
• Multiple sclerosis;
• Vertebral hernias;
• Spinal injuries and bruises;
• Stroke;
• Severe labor activity with nerve injuries in the pelvic organs;
• Diseases and anomalies of the structure of the brain and spine of a congenital nature;
• obstructive uropathy;
• Megalocyst.

The mechanism of development of neurogenic bladder weakness is rather complicated. A bowel movement is a complex process that occurs at the reflex level, after the organ has been filled with biological fluid. If any pathology or disturbance in the functioning of the body system has a negative effect on it, then the chain of reflexes that previously performed normal urination breaks and various problems begin to arise with the accumulation, retention and excretion of urine.

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

Manifestation

The condition under consideration 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 should be understood that all the signs that will be described below can occur singly or in combination, and also have different degrees of severity.

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

Among the main symptoms, experts distinguish the following:

1. Sudden urge to have a bowel movement;
2. Feeling of pressure in the lower abdomen;
3. Lack of urge to urinate or it is excessively weak;
4. Inability to hold urine;
5. Delay 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 confident jet has become lethargic or weakened. Also, often people are 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 should make some effort to start the process of urination.

Along with this, other unpleasant concomitant symptoms appear:

1. The impossibility of committing an act of defecation;
2. Fecal incontinence;
3. Violation of the menstrual cycle;
4. Decreased level of sexual desire;
5. Development of erectile dysfunction;
6. Formation of trophic ulcers and bedsores;
7. Change in gait in a person;
8. Fluctuations in temperature and pain sensitivity of the legs.

In those situations where neuromuscular dysfunction of the bladder is not diagnosed in a timely manner, and the pathology progresses, the upper sections of this system may be involved in the process. This causes the described symptoms to be accompanied by conditions characteristic of kidney damage: fever, 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 non-specific symptoms and conditions that can occur with 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:

• blanching of the skin;
• Reduced body weight;
• The presence of the smell of urea from the oral cavity;
• Dry mucous membranes;
• Shaky "duck" gait;
• The presence of bedsores or scars after surgical treatment;
• Signs of spinal hernias;
• Paralysis or paresis of the lower extremities;
• Education in the lower abdomen in the form of a tumor;
• Complaints about problems with urination (wet laundry, unnatural smell of urine).

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

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

Among the 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. Plain radiography;
5. Urethrocystography;
6. Cystoscopy;
7. Ultrasound screening;
8. Radioisotope study of the kidneys;
9. Urofluometry.

The patient himself, or his relatives, must necessarily take an active part in the collection of anamnesis. The more detailed and truthful information they give about the state of health, 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 severity of bladder disorders, it is impossible to offer a single treatment regimen for everyone. In each case, individual therapy tactics are selected, and the approach must be comprehensive, otherwise it is difficult to achieve positive dynamics.

Medical

If there is such a condition as urinary retention in the body, then it is necessary to drink medicines, the action of which is aimed at relaxing the muscles of the organ. In this case, alpha-blockers are used, among which Tropafen or Phentolamine is preferred, which is determined by the leading specialist.

When physicians are faced with the task of contributing to the rapid removal of biological fluid from the body, it is necessary to create conditions of increased pressure in the organ, which will strengthen the tone of the detrusor muscles. Beta-blockers, for example, Inderal or Carbochol, do an excellent job with this task.

Inderal is used in complex drug therapy.

Neurogenic bladder syndrome is a condition of the bladder in which it cannot function due to failures in any structure of the nervous system responsible for its work. The pathology is not critical, but causes a lot of inconvenience to the patient.

Table of contents:

common data

note

Neurogenic bladder syndrome is a pathology that is quite common in urology, but it is treated together with neuropathologists.

The exact number of patients with this disease is unknown, since failures in the form of the development of a neurogenic bladder can be short-term, transient and unexpressed, after a while the bladder returns to normal without medical help (patients do not even have time to see a doctor) and continues to function as before. mode.

Urination disorders in neurogenic bladder have a bright social aspect - they significantly limit a person's freedom of action. As a result, two main problems arise:

• violation of social adaptation - a person is "tied" to the toilet, because of which his any daily plans collapse;
• depression that occurs for the same reason.

Causes

The regulation of urination is a complex multi-level system, its failures can occur at any level. Therefore, there are many reasons due to which neurogenic bladder syndrome occurs.

The causes of this disease can be divided into several large groups, namely:

• traumatic;
• inflammatory-degenerative;
• tumor;
• arising from a non-traumatic disorder of cerebral circulation;
• iatrogenic - resulting from medical intervention.

Injuries to the nerve roots, spinal cord and brain, in which neurogenic bladder syndrome often occurs, are of the following nature:

• traumatic tears and ruptures of brain tissue that occurred during accidents (falls from heights, gunshot wounds, traffic accidents, and so on);
• damage (in particular, squeezing) that can occur during natural disasters (earthquakes, tsunamis) and large-scale disasters that have arisen due to the influence of the human factor (collapses in mines).

Inflammatory-degenerative lesions leading to the development of the described condition are often:

The formation of a tumor can lead to the emergence of the neurogenic bladder syndrome - it, squeezing the nerve structures that regulate the functioning of the bladder, will cause a violation of their conductivity and, as a result, a disruption of the bladder.

A non-traumatic disorder of cerebral circulation, which can cause the described pathology, is:

• ischemic in nature (associated with difficulty or complete cessation of blood flow to the brain tissue);
• (develops due to hemorrhage in the brain tissue).

Iatrogenic damage to the central and peripheral nervous system, provoking the development of a neurogenic bladder, occurs as a result of medical manipulations:

• diagnostic;
• medical (damage during surgery, injections, and so on).

The causes of the development of a neurogenic bladder in children can be:

• congenital disorders of the development of the spine, central and peripheral nervous system;
• trauma during childbirth ().

Development of the disease

The pathophysiological essence of the syndrome is that there are failures in the accumulation of urine and its excretion from the urinary tract. Such disorders, in turn, can occur due to many disorders of the nerve centers and conduction pathways - bundles of nerve fibers that carry out complex regulation of the bladder. Such failures can be:

• organic - with a change in anatomy and morphology (structure at the tissue level);
• functional - consist in disruption of the work of nervous structures, while their structure remains unchanged.

There are two types of neurogenic bladder syndrome:

• hyperreflectory;
• hyporeflex.

Hyper reflex form develops due to increased activity of the detrusor (the muscle layer of the bladder, with the reduction of which urine is pushed out of the bladder). This activity occurs during the accumulation phase of urine. Normally, urine first accumulates, then it is excreted, and the person visits the restroom at a certain frequency. With the hyperreflex form of the described disease, urine does not have time to accumulate and is almost constantly excreted from the urinary system.

With a hyperreflex neurogenic bladder, there is a small amount of residual urine or its complete absence - in other words, after the act of urination, the bladder is almost empty.

Hyporeflex form occurs due to decreased detrusor activity during the urinary excretion phase. This leads to permanent urinary retention. Since the detrusor is not active, therefore, there is no increase in intravesical pressure - namely, this is necessary to overcome the resistance of the sphincter and push urine into the urethra.

With a hyporeflex neurogenic bladder, the volume of residual urine after urination can reach 400 ml.

Also, neurogenic bladder syndrome can lead to violations of the following nature. In addition to the detrusor, the release of urine from the bladder regulates its sphincter - circular muscle fibers. They are located in the neck of the bladder and, when contracted, narrow the exit from the bladder, preventing urine from entering the urethra.

The normal process of urination occurs in two simultaneously observed conditions:

• detrusor contraction:
• sphincter relaxation.

Conversely, to prevent urine from exiting the bladder, the detrusor must be relaxed and the sphincter must be contracted at the same time. If such mechanisms fail, namely the detrusor and sphincter contract or are in a relaxed state at the same time, then the so-called desynchronization of the activity of these muscle formations occurs.

There may also be an uncontrolled, very rapid release of a large volume of urine - such a bladder is called a cerebral uninhibited bladder.

If the neurogenic bladder syndrome has dragged on, it can provoke:

• development of significant trophic disturbances in its wall;
• its sclerosis (germination by connective tissue);
• shrinkage of the bladder.

Symptoms

Neurogenic bladder syndrome can manifest itself:

• constantly;
• periodically;
• episodically - with large hour intervals between the onset of symptoms.

The clinical picture of the pathology depends on the level at which the nervous system is affected, what the nature, severity and stage of the disorder are.

Signs of a hyperreflex type of pathology are:

• pollakiuria -;
• nocturia - a violation of urination, in which more urine is excreted at night than during the day;
• imperative urge - the feeling that the act of urination will begin immediately. They are characterized by a spastic state and emptying of the bladder with the accumulation of less than 250 ml of urine in it;
• and the very act of urination is difficult;
• urination can be triggered by mechanical or thermal irritation of the thigh and suprapubic region.

Such symptoms are due to the fact that in the hyperreflex type of the syndrome, intravesical pressure is increased even with a small amount of urine in the bladder. Imperative urges and pollakiuria occur if sphincter weakness is observed in parallel with increased detrusor tone.

In addition to signs that signal a disorder in the urinary system, there are so-called vegetative symptoms - these are:

• redness of the skin;
• increased blood pressure;

Signs of a hyporeflex type of pathology are:

• sluggish urination or its complete delay;
• straining when a person wants to urinate;
• feeling of fullness in the bladder after urination.

Such symptoms are explained by a decrease or complete absence of contractile activity of the bladder, and hence its emptying, although the bladder remains full or even full.

Signs that the sphincter tone prevails over the detrusor tone are:

• the ability to urinate occurs only with strong straining;
• often - complete retention of urine.

With a hyporeflex distended bladder, paradoxical ischuria can be observed. This is a condition when the patient cannot urinate normally, but at the same time, urine is involuntarily excreted from the urethra in drops or small portions. The phenomenon is explained by the fact that urine accumulates in the hypotonic bladder, under its pressure the sphincter opens slightly and passes some of it.

Diagnostics

The signs of a neurogenic bladder are varied and make it possible to suspect this disease even before an additional examination. Also important is the fact of violations of the nervous system. If a pathology is suspected in a child, then you should find out how the expectant mother went through pregnancy and childbirth. To make a definitive diagnosis, it is necessary to involve additional diagnostic methods.

Physical examination findings are non-specific and provide little information regarding the examination of the urinary system. But thanks to the physical examination, enough information can be obtained to determine the neurological nature of the disease. The survey data will be as follows:

• on examination - in case of overflow of the bladder, bulging in the suprapubic region is visually determined;
• on palpation (palpation) of the abdomen - with the hyporeflex type of the syndrome, an overflowing, tense bladder is palpated. Palpation in the case of a hyperreflex type of the disease can provoke urination;
• with percussion (tapping) of the abdomen - a dull sound is heard above the overflowing bladder, as if knocking on wood;
• auscultation of the abdomen (listening with a phonendoscope) - no changes are detected.

It is important to consult a neurologist to confirm the neurological nature of the pathology.

Instrumental and laboratory research methods are often used to exclude other diseases of the urinary system. Of the instrumental methods used:

To confirm the neurological nature of this pathology, a study of the central and peripheral nervous system is carried out using methods such as:

• – graphic recording of electrical potentials that are generated in the brain;
• skull and spine;
• CT scan;
• Magnetic resonance imaging.

Laboratory methods also help to identify or exclude diseases of the urinary system, similar in symptoms to neurogenic bladder syndrome, as well as to determine the nature of the neurological pathology that provoked the development of the syndrome. These are methods such as:

Differential Diagnosis

Due to the similarity of a number of symptoms, differential diagnosis of neurogenic bladder syndrome should be carried out with diseases such as:

• prostate hypertrophy in men;
• stress urinary incontinence;
• age-related urinary incontinence (in the elderly).

Complications

In most cases, complications develop in the form of inflammatory-dystrophic changes in the urinary system, which occur in a third of patients with the described syndrome. Most often, diseases such as:

Such pathologies, in turn, provoke the development of conditions that can lead to early disability of the patient. This:

• nephrosclerosis - germination of the renal parenchyma with connective tissue;
• - when her kidneys do not perform their functions.

Treatment of neurogenic bladder syndrome

Treatment of neurogenic bladder syndrome depends on the treatment of the neurological pathology that provoked its development. Therefore, appointments are carried out jointly by a neuropathologist and a urologist.

The hyperreflex type of the disease is easier to treat. The basis of prescriptions is the use of drugs that:

• reduce the muscle tone of the bladder;
• improve blood circulation;
• eliminate hypoxia.

The following medicines are used:

Botulinum toxin injections into the wall of the bladder or urethra are also practiced.

Non-drug methods of treating the disease are effective:

• physiotherapy exercises - strengthens the pelvic muscles, improves the blood supply to the bladder;
• physiotherapy;
• psychotherapy.

The most effective physiotherapeutic methods for treating the syndrome are:

• electrical stimulation of the bladder;
• laser therapy;
• hyperbaric oxygenation - blood saturation with oxygen due to the patient's stay in a special hyperbaric chamber;
• thermal applications;
• ultrasound treatment;
• mud treatment.

The hyporeflex form of the disease is less treatable. Due to congestion in the bladder, an infection can join.

The following appointments are important:

Surgical correction of the syndrome is also possible. It is resorted to if:

• conservative methods are ineffective;
• the syndrome progresses;
• there is a risk of complications.

Carry out operations such as:

• with bladder hypotension - transurethral funnel-shaped resection of the bladder neck. After the operation, urination occurs after a gentle pressure on the suprapubic region;
• with bladder hypertension - an incision in the external sphincter;
• bladder plastic surgery to increase its volume;
• bladder plastic to eliminate vesicoureteral reflux;
• the formation of cystostomy drainage - messages between the bladder and the anterior abdominal wall.

Prevention

Prevention of neurogenic bladder syndrome is very diverse - in fact, it is a huge set of measures aimed at preventing neurological diseases that provoke the onset of the syndrome. If such diseases have arisen, they must be treated without delay.

Activities that will help maintain the normal functioning of the bladder are also important. This:

• timely detection and treatment of any diseases (especially infectious ones);
• with the urge to urinate - going to the toilet without delay. If a person suffers, and the bladder remains full for some time, this leads to a violation of its wall and contributes to a more rapid onset of the syndrome.

Forecast

The prognosis for neurogenic bladder syndrome is very different and depends on the type, degree of development, severity of the neurological disease that provoked it, as well as on the degree of neglect of the syndrome.

The forecast becomes more complicated under such circumstances as:

Neurogenic bladder is a term used for a whole complex of urination disorders that are united by one cause, namely, a malfunction of the nervous system, that part of it that is responsible for the excretion of urine. As in the case of other diseases of the nervous system, it can occur in both adults and children.

Causes of neurogenic bladder

There can be many reasons for the development of a neurogenic bladder. Normal voluntary emptying of the bladder has a multilevel regulation, which involves a large number of nerves. Failure at any stage of complex regulation, ranging from experienced stress, brain diseases, and ending with a violation of the innervation of the sphincter of the bladder, can cause symptoms of a neurogenic bladder. The most common cause of the development of pathology in adults are injuries and diseases of the spinal cord. Neurogenic bladder in children, in addition to these causes, may be a manifestation of a malformation of the spinal cord or urinary tract, as well as a consequence of birth trauma.

Symptoms of a neurogenic bladder

Urination consists of two stages, the storage phase and the excretion phase. During the storage stage, urine from the ureters enters the bladder and accumulates there until about 150 ml is collected. After that, normally, a person feels the urge to urinate, a relaxing group of nerves of the bladder is triggered, and the excretion stage follows. Disorders manifesting as a neurogenic bladder can occur during both accumulation and excretion of urine. There are two types of neurogenic bladder, overactive and hypoactive (hypertonic and hypotonic).

An overactive bladder is characterized by:

• Frequent urge with a small amount of urine;
• Severe tension in the muscles of the bladder, sometimes even causing the backflow of urine from the bladder into the ureters (vesicoureteral reflux);
• Urgent imperative urge to urinate, when there is a sudden urge of such strength that the patient cannot bear to go to the toilet;
• Nocturia (frequent nocturnal urination).

An underactive bladder is manifested, on the contrary, by the absence of normal urination with a full and even overflowing (the amount of urine can exceed 1500 ml) bladder.

In addition, a symptom of a neurogenic bladder is a lack of control over urination. This may be the absence of "mature urination" in children at an age when this reflex should already be formed or the loss of controlled voluntary urination in adults.

The symptoms of a neurogenic bladder directly depend on which part of the nervous control has failed, this also affects the constancy (permanent, periodic, episodic) and the severity of the manifestations of the disease.

Diagnostics of the neurogenic bladder

Diagnosis of a neurogenic bladder begins with a thorough history taking. The patient is invited to keep a diary of urination for several days, while noting the time and amount of fluid drunk. When diagnosing a neurogenic bladder in children, it is suggested that parents keep a diary, in addition, it turns out if there are any hereditary prerequisites for the development of such a disease, as well as the history of childbirth.

Since the symptoms of a neurogenic bladder are similar to those of urination disorders in inflammatory diseases of the genitourinary system, a complete examination of the organs of this system for the presence of infection is carried out. This is a laboratory study of urine using various functional tests (according to Zimnitsky, according to Nechiporenko, etc.). The genitourinary system is also examined using medical imaging methods (ultrasound, MRI, cystoscopy, X-ray examination using radiopaque substances) to detect symptoms of inflammation or anomalies in the structure of the urinary tract. Only by completely eliminating the inflammatory process, one can speak of a neurogenic bladder.

If the absence of diseases of the urinary organs is established, a neurological examination is performed for the presence of pathologies of the spinal cord and brain. Various techniques are used for this, including CT and MRI.

In some cases, even after a complete and thorough medical examination, it is not possible to establish the cause of the neurogenic bladder, in this case they speak of a neurogenic bladder with an unclear etiology.

Treatment of neurogenic bladder

Treatment of neurogenic bladder consists of drug and non-drug therapy. Treatment is either by a urologist or a neurologist, depending on the established cause of the neurogenic bladder. An overactive bladder responds better to therapy. In this case, drugs that have a relaxing effect on the muscular apparatus of the bladder (anticholinergics, adrenergic blockers), as well as drugs that improve its blood supply, are prescribed as part of the drug therapy, since blood circulation is often disturbed as a result of spasm. Of the non-drug treatments for neurogenic bladder, physiotherapy exercises are used, including special training exercises for the pelvic floor muscles, physiotherapy methods, normalization of drinking and sleep patterns. If the psychogenic causes of the neurogenic bladder are established, a course of psychotherapy gives a good result.

The hypoactive type of neurogenic bladder is more difficult to treat. Due to congestion in the bladder, there is a high risk of developing secondary lesions of the urinary system and infection. The bladder overstretches, loses its elasticity, the accumulated urine irritates its walls and can be thrown into the ureters and from there to the kidneys, causing inflammation. For the treatment of neurogenic bladder with signs of hypotension, drugs are used to prevent the development of the inflammatory process, as well as physiotherapy, and methods for training the muscles of the pelvic floor and bladder. If treatment is ineffective, it is necessary to take measures to divert urine, for which bladder catheterization is used.

In the event that treatment with conservative methods has been unsuccessful, surgical treatment of a neurogenic bladder is sometimes indicated. Depending on the reasons, this may be a correction of the nervous apparatus of the bladder, or plastic surgery of the muscular-ligamentous apparatus.

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Neurogenic bladder (NMP), neurogenic bladder dysfunction (NDMP) - a complex of disorders of the reservoir (accumulative) and evacuation (excretory) functions of the bladder, resulting from a violation of their innervation and nervous regulation at any level - in the area of ​​​​cortical or spinal centers of urination , peripheral nerves. This is not an independent pathology, but a syndrome - a consequence of any congenital or acquired diseases that disrupt the functions of the bladder. In men and women, it occurs equally often and, as a rule, is accompanied not only by the phenomena of spontaneous urination, but also by constipation, disorders in the genital area, as well as others, which will be discussed below - in the appropriate section.

About why a neurogenic bladder occurs, about the symptoms, principles of diagnosis and treatment of this pathology, including the methods of physiotherapy used for it, you will learn from our article.

Kinds

There are 3 forms of NDMP, depending on the volume of this organ, in which urination is carried out. This:

• hyperreflex (the act of urination occurs with a small filling of the bladder - at the level of its lower border or slightly exceeding it);
• hyporeflex (urination is carried out only when the bladder is full, when its volume exceeds the upper limit of the norm);
• normo-reflex (urination occurs with an average - normal - filling of the bladder).

Also isolated adapted and non-adapted bladder. In the first case, the pressure in the bladder during the period of filling it with urine increases evenly, in the second case, when the bladder is filled, sharp fluctuations in pressure occur in it, which is manifested by a sudden urge to urinate and urinary incontinence.

Another variant of neurogenic dysfunction is the postural bladder. The symptomatology of this disease occurs only in the vertical position of the patient's body, and in the horizontal position there are no signs of pathology.

Causes and mechanism of development of pathology

So, NMP develops as a result of damage to the nerve centers or pathways that ensure its normal functioning. This can happen both at the highest level - in the region of the centers of urination in the cerebral cortex, and below - in the region of the spine and even in the peripheral nerves. Such violations can lead to:

• tumors of the brain, spinal cord, meninges;
• post-vaccination neuritis;
• neuritis of diabetic nature;
• tuberculoma;
• cholesteatoma;
• and other demyelinating diseases;
• spinal hernias;
• bruises of the spine;
• injury to the nerve structures near the bladder during difficult childbirth or surgical interventions on the pelvic organs;
• congenital pathology of the spinal cord and spine (agenesis, dysgenesis of the sacrum and coccyx, meningomyeloradiculocele and others);
• obstructive uropathy;
• megalocyst.

The mechanism of development of the NDMP is not simple. Urination is a complex reflex act that involves the accumulation of urine in the bladder and subsequent emptying of the organ. The impact of any of the above factors leads to a violation in the chain of reflexes that ensure the normal act of urination. A different level of damage entails clinical manifestations of a different nature - a violation of the adaptive function (urinary incontinence of varying degrees), bladder reflex (urinary retention), weakening or absence of the urge to urinate.

Simultaneously with the violation of the innervation of the bladder, as a rule, a violation of the innervation of other organs and parts of the body is determined - the kidneys, rectum, reproductive system, the lower half of the body as a whole. This is manifested by the corresponding clinical symptoms.

Symptoms

Patients with neurogenic bladder are concerned about various urination disorders.

The leading complaint of patients with NDMP is urination disorders. Their character is very wide. It can be:

• sudden urge to urinate;
• a feeling of pressure in the lower abdomen as a variant of the urge (a signal that the bladder is full);
• a sharp weakening of the urge or its complete cessation (this leads to spontaneous urination, because the patient does not feel the overflow of the bladder, does not realize that he needs to go to the toilet);
• urinary incontinence;
• urinary retention (patients often pay attention to the "swelling" in the lower abdomen) with its subsequent outcome - incontinence (usually, at night, urinary retention is resolved by spontaneous urination);
• difficult urination.

Patients note a sluggish stream of urine, a feeling of incomplete emptying of the bladder, "swelling", pressure in the lower abdomen, the need to make an effort to empty.

Often, when the upper urinary tract is involved in the pathological process, there are symptoms of kidney damage: fever, pain in the lumbar region, signs of chronic renal failure (lack of appetite, dry mouth, nausea and vomiting, thirst, weight loss, and others).

Concomitant complaints that occur when the organs located near the bladder are affected are as follows:

• constipation that does not respond to treatment;
• fecal incontinence;
• in women - decreased libido and other dysfunctions of the reproductive system;
• in men - erectile dysfunction ();
• paralysis or paresis of the legs;
• on the lower limbs;
• violation of temperature and pain sensitivity of the lower half of the body;
• change in gait.

Diagnostic principles

Since NUT can occur in a wide variety of diseases and disorders and is accompanied by a variety of non-specific symptoms, it is more than difficult to make a correct diagnosis. The specialist should carefully interview the patient about the nature of his complaints and the features of the development of the disease. To facilitate the work of the doctor, the patient and his family should be told in detail about the nature of urination disorders and other symptoms that accompany them, about the diseases that the patient suffered from earlier - injuries, pathologies of the nervous system and others, as well as the treatment methods used to eliminate them.

When examining a patient suffering from NUT, the doctor may pay attention to:

• pallor, emaciation, dry mucous membranes, smell of urea from the mouth;
• "duck" gait, her unsteadiness;
• the presence of bedsores, scars from operations on the sacrum and coccyx;
• the presence of paresis, paralysis of the legs, signs of violation of their innervation, decreased sensitivity, reflexes;
• the presence of spinal hernias, fistulas of the sacral canal, signs of underdevelopment of the coccyx and sacrum;
• tumor formation in the lower abdomen;
• wet underwear, smell of urine and other signs of urination disorders.

For the purpose of additional examination, the patient may be assigned:

• clinical blood test (increased ESR, signs of anemia);
• biochemical blood test (increased levels of creatinine, urea, azotemia, electrolyte imbalance);
• general urine analysis (low density, elevated levels of protein, bacteria, leukocytes);
• urinalysis according to Zimnitsky (decrease in the relative density of urine);
• survey radiography;
• urethrocystography;
• excretory urography;
• pyelography;
• radioisotope study of the kidneys;
• cystoscopy;
• study of kidney function (urofluometry, cystometry, sphincterometry, and others).

Principles of treatment

There is no single treatment regimen for all types of neurogenic bladder disorders, since the causes of this condition are many, and the nature of the disorders is quite diverse.

Treatment is predominantly symptomatic. Three directions can be distinguished:

• medication;
• physiotherapy;
• symptomatic surgery.

Medical treatment

The patient may be prescribed:

• alpha-blockers (phentolamine, tropafen and others) - reduce the tone of the internal sphincter; used for urinary retention;
• beta-blockers (inderal, carbachol and others) - increase the pressure inside the bladder and the tone of the detrusor, contributing to the expulsion of urine;
• alpha-agonists (izadrin, ephedrine, and so on) - increase the tone of the sphincter, are used for urinary incontinence.

As a rule, the effect of drug treatment is available only in mild forms of the disorder and is short-lived. That is why it is used simultaneously with physiotherapy methods that potentiate the action of drugs and provide a longer positive effect.

Physiotherapy

Paraffin applications may be used to reduce muscle spasm.

As a component of the complex treatment of NDMP in women, and can be used. The choice of technique depends on the form of the disease (hyper- or hyporeflex). Since the main role in this pathology belongs to changes in the relationship between the detrusor (the muscular apparatus of the bladder) and the sphincter, the impact is carried out mainly locally - it is on this area.

If there is a hyperreflex form of dysfunction, physiotherapy methods are used that have a sympathomimetic and antispasmodic effect. As a result of such treatment, the detrusor muscles relax, the sphincter contracts.

In the hyporeflex form of dysfunction, physiotherapy should be aimed at stimulating the detrusor. For this, the patient is prescribed myostimulating methods of physiotherapy.

Since the pathogenesis of NDMP is very complex, in order to influence its different links, physiotherapy methods are also used that have a vasodilating, corrective work of the autonomic nervous system and a sedative effect.

To reduce spasm of the detrusor will help:

• medicinal anticholinergics (atropine, platifillin, aminophylline) - affect the bladder area every day for 10-15 minutes; the course of treatment includes up to 12 sessions;
• medicinal electrophoresis of antispasmodics;
• ultrasound therapy (they affect the region of I-III lumbar vertebrae and the bladder zone; apply a labile technique; duration - up to 5 minutes per 1 zone; repeat daily in a course of 10-12 sessions);
• applications (warm the tissues in the area of ​​influence, which relaxes the muscles; act directly on the area of ​​the bladder or use a panty technique; use paraffin at a temperature of 40-45 ° C, the duration of the procedure is from half an hour to 45 minutes; sessions are carried out 1 time per day; course of treatment consists of 12-15 influences).

In order to stimulate the work of muscles, apply:

• therapy with sinusoidal modulated currents (performed every day in a course of 10 procedures);
• (they affect the area of ​​the bladder, which leads to an active contraction of many muscle fibers that form the sphincter; the procedure lasts up to 7 minutes, they are repeated every day, the treatment is carried out in a course of 10 sessions);
• drug electrophoresis of cholinomimetics (prozerin, galantamine) - act locally, 1 time per day, in a course of 10 sessions.

To normalize the functions of the autonomic nervous system, use:

• (they affect the lumbosacral region, the buttocks area and the lower abdomen; the initial dose is 4 DB, with each daily procedure the dose is increased by 1 DB; the course of treatment includes 4-5 sessions);
• (the orbital-occipital technique is used; as a result of such exposure, blood flow in the structures of the brain is activated, which leads to an improvement in the relationship between the sections of the autonomic nervous system; the procedure lasts up to half an hour, they are repeated 1 time in 2 days, the course of treatment consists of 10 sessions);
• (they act on segmental zones, the area of ​​the bladder and the perineum, combining local therapy with a general effect; duration - up to 2 minutes per 1 zone);
• (applications of peat or silt mud on the area of ​​panties; under the influence of peloids, the production of biologically active substances (catecholamines, corticosteroids) by the adrenal glands is activated; mud is used at a temperature of 37-40 ° C; the session lasts up to 20 minutes, they are repeated every day with a course of 12-15 procedures ).

As sedative (soothing) methods are prescribed:

• galvanic collar according to Shcherbak (normalizes the processes of excitation and inhibition in the cerebral cortex; the session lasts up to 15 minutes, they are repeated every day with a course of 10 exposures);
• (during the procedure, the "hormone of happiness" - serotonin accumulates in the subcortical structures of the brain; they act for up to half an hour, repeat sessions 1 time in 2 days or spend them 2 days in a row, taking a break on the third; the course of treatment includes up to 12 procedures ).

Also, with urinary incontinence, urethral and rectal stimulation of the bladder neck is used. Carrying it out is justified only if the innervation systems are preserved, and if they die, this method of treatment is ineffective.

Surgery

Surgical interventions are also predominantly symptomatic. There are many options for operations, they can be performed both with urinary retention and incontinence, with or without chronic renal failure.

A promising method is to restore the innervation of the bladder. This is more than difficult, but scientists and researchers have been actively working on this area of ​​treatment for the last 20 years.

After the operation, the patient is prescribed therapeutic exercises, drug treatment (drugs that increase muscle tone and general body tone), and physiotherapy.

Of course, the whole complex of therapeutic measures should be started as early as possible, when secondary complications of NDMT have not yet developed - in this case, the effectiveness of therapy is much higher.

Conclusion

Neurogenic bladder dysfunction can result from a number of different diseases and disorders. Its leading manifestations are incontinence or urinary retention, a decrease or complete absence of the urge to urinate, as well as signs of impaired innervation of other organs of the small pelvis. Treatment is predominantly symptomatic and may include medication, physical therapy, and surgery. Physiotherapy techniques help reduce bladder muscle spasm, increase their activity, balance the work of the sympathetic and parasympathetic divisions of the autonomic nervous system, and calm the patient.

Timely established correct diagnosis and persistent adequate treatment are the key to improving the condition of such severe patients.

Urologist N. A. Ermakova talks about neurogenic bladder: