The main functions of the bladder are the accumulation and controlled excretion of urine outwards. Regulation of this activity is entrusted to the nervous system of the body. In the event that there is a dysfunction of the site of the nervous system responsible for the functioning of the organ, a condition appears, designated in medicine by the term - a neurogenic bladder. With this pathology, hypotension occurs, that is, a decrease in the activity of the muscular walls of the organ, or vice versa, a hypertonic state characterized by increased work. All this leads to the impossibility of control over urination, respectively, a person experiences many unpleasant sensations.
Neurogenic bladder
The walls of the bladder consist of a mucous layer with the muscles entering into its structure and nerve endings. When the body is filled with urine, a signal is sent to the corresponding centers of the brain, in response to this, there is a desire to emptying the organ.
When urinating, a pulse arrives at the muscle fibers to ensure the reduction of the walls and the bladder is released from the accumulated fluid. Neurogenic bladder is characterized by impairment in the passage of impulses along necessary parts of the nervous system, a similar anomaly can be either congenital or acquired under the influence of trauma or some diseases.
According to the ICD 10, the disease is assigned number 31, which gives it a separate ailment. However, problems with urination are not the only signs of dysfunction of the neuromuscular structures of the bladder.
Almost half of the patients develop concomitant dystrophic and inflammatory changes in the urinary system, the most frequent include cystitis, pyelonephritis, nephrosclerosis, in severe cases - chronic renal failure.
Under the influence of these diseases arterial hypertension arises. A neurogenic hyperactive bladder provokes the emergence of psychoemotional problems - a patient with such a diagnosis does not adapt well in society, does not feel comfortable at home and at work.
Video will tell about the neurogenic hyperactive bladder:
Types of the disease
Muscular fibers of the walls of the bladder under the influence of incorrect nerve impulses decrease with increased or decreased activity, on the basis of this the classification of the disease is developed.
Neurogenic hyporeflective urinary bladder
A similar anomaly is observed when the nervous system is disturbed mainly in the sacral region. The muscle fibers of the organ work poorly, there is no reflex emptying of the cavity of the organ. Under the influence of this wall gradually stretch, the bubble increases in size.
On the other hand, urine can go up the ureters to the renal pelvis, where inflammation is formed under the influence of a caustic and concentrated liquid.
Neurogenic hyperreflexive bladder
This pathology is associated with a violation of the nervous system in the brain. With the development of this species, it is noted that urine retention is impossible. The liquid does not accumulate in the body, with a small accumulation immediately formed a urge to urinate.
A sharp urge to urinate may be triggered by irritation of the pelvic region. With a hyperactive bladder, cystitis is detected in severe form, leading to a gradual wrinkling of the organ.
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Neurogenic bladder dysfunction
People of any age are affected by the disease, depending on this and the provocative causes, the characteristic features are prominent.
In adults,
Bladder dysfunction in men or women can cause a variety of psychological and physical problems.
The disease can occur unexpectedly for the patient or develop gradually. Ill person notes the allocation of urine drop by drop, the impossibility of its retention in stressful situations.
Women experience symptoms of impaired functioning of the body after severe labor, gynecological surgeries, chronic pelvic organs.
In men, the disease is often formed under the influence of prostate adenoma, after prolonged physical work with lifting weights.
In children
In childhood, a violation of control of urination may be primary, that is, caused by congenital pathologies of the nervous system or secondary, formed under the influence of endogenous and exogenous provoking factors.
Causes of the disease
Normal functioning of the bladder is supported by a multilevel, complex regulation system, therefore, there are a lot of reasons for the development of the disease. It is accepted that the provoking factors are subdivided according to the age of the patient.
In mature people, bladder dysfunction is revealed in the following pathologies:
- Trauma and degenerative processes in the brain and spinal cord. This group includes strokes, vertebral fracture, tumor-like tumors, Alzheimer's, Parkinson's, multiple sclerosis, sequestered spinal hernia.
- Polyneuropathies of various kinds.
In children, dysfunction in the emptying of the bladder is observed when:
- Congenital malformations of the central nervous system, spine, urinary organs.
- As a result of an injury at the time of delivery.
Symptoms and signs
The signs and changes in the normal functioning of the bladder depend on the form of the disease.
In the hyperreflexive form of neurogenic bladder dysfunction, attention is drawn to the following symptoms:
- Frequent urges to emptying the body, with minimal amount of urine released.
- Incontinence - The fluid can drastically and uncontrollably stand out when an unexpected urge to visit the toilet.
- The number of visits to the toilet at night increases.
- The act of urination causes discomfort.
In the hypoactive form of the neurogenic bladder, patients complain of the following conditions:
- There is no desire to empty the bladder.
- After urination, there is no feeling of complete release from the urine of the body cavity.
- In the urethra, painful sensations are recorded.
Children develop day and night enuresis. A prolonged course of dysfunction leads to inflammatory processes in the organ itself, causing cystitis. Accumulation of urine in a hypoactive form creates conditions for pyelonephritis, the formation of stones in the bladder and ureters.
Diagnostic methods
The diagnosis is made after a thorough interview of the patient and after keeping a diary in which for several days he should fix the amount of liquid drunk, the amount allocated and the time of emptying the organ.
Since the symptoms of dysfunction are similar to many diseases of the genitourinary sphere, the following studies should be performed:
- Urinalysis by Nechiporenko, Zimnitsky.
- ultrasound and cystoscopy of the bladder.
- Radiography of the body with contrast agents.
If, as a result of the research, there is no data for inflammatory processes, then the head and spinal cord examinations are prescribed. For this, computer tomography, electroencephalography, x-ray pictures of the skull and all parts of the spine are used.
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Treatment of the disease
In many cases successful therapy of the disease depends on a complete diagnosis with the identification of the true cause of the disease.
Treatment of neurogenic dysfunction of the bladder should be carried out not only by the urologist, but also by the neurologist with the appointment of appropriate medications.
Therapy is started with medications, in the absence of effects and under certain indications, surgical intervention can help the patient, great importance is given to physiotherapy, special gymnastics and psychotherapeutic methods of influence.
- The medical treatment of is most effective in hyperreflex organ. It is necessary to achieve a decrease in muscle tone, for which purpose the course use of alpha-blockers( Dibenziran, Regitin), calcium antagonists( Nifedipine), anticholinergic drugs( Oxibutinin, Buscopan), antidepressants( Melipramine).The use of groups of drugs improving the blood supply of the body is shown. With hypertension, modern medicine uses Botulinum toxin, injected into the wall of the bladder.
In the case of a hypoactive form of the disease, a complete and rapid cure is much more difficult to achieve, with this kind of ailment it is necessary to control urination, forcing the emptying of the cavity. Antibacterial therapy is prescribed, since there is a possibility of inflammatory changes in the kidneys and ureters.
Hypotension of the walls of the organ is eliminated by M-cholinomimetics, which increase the motor function - Acekledin, Betanyol chloride is used. In all forms, the use of a course of vitamins and antioxidants is indicated.
- Surgical intervention of also depends on the form of the disease. Carry out the plastic of the muscular layer of the organ, the correction of the nerve fibers of the walls, with the hypotonic form, an expansion of the bladder cavity is possible.
- Physiotherapy in the disease is directed to stimulate the work of the muscle layer. Use ultrasound, laser, thermal action, electropulse therapy.
- Psychotherapy has a great positive effect in establishing the psychogenic cause of the ailment. Psychologist's help is also necessary for those patients with bladder dysfunction, in which self-esteem has fallen sharply, depressive conditions are observed.
- Homeopathy. From homeopathic preparations choose Urylan, Enuran, Petrozelinum. Homeopathic remedies can help only in the early stages of development and with not severe forms of dysfunction.
- Folk remedies in the treatment of a neurogenic bladder can reduce the bacterial activity of accumulated components of residual urine in the organ. It is also recommended phytopreparations with sedative effect.
Cowberry leaves have a diuretic and antiseptic effect, so this plant can be used in a hypoactive form. Urinary incontinence is treated with sage, fennel seeds, rosehip broth, a positive effect is the constant use of juice from fresh carrots.
Prognosis and prevention measures
A favorable prognosis is observed with the hyperactive form of the neurogenic bladder, the complete cure depends on the stage of the disease, the accompanying inflammations, the persistence of the patient in treatment.
Measures to prevent the onset of an illness is considered effective, timely treatment of spinal cord injuries and brain, prevention of inflammatory processes.
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