- Main symptoms
- 1. Overactive bladder
- 2. Hypoactive bladder
- Possible causes
- How to confirm the diagnosis
- How the treatment is done
- Is neurogenic bladder curable?
The neurogenic bladder is the inability to control the act of urination due to a dysfunction in the bladder or urinary sphincter, which can have several causes, ranging from changes in the nerves, which prevent the muscles of the region to function properly, as well as situations that irritate the region, such as hormonal changes, inflammation of the bladder or infections, for example.
The neurogenic bladder may or may not be cured, which is defined after evaluation by the urologist, who determines its causes and defines whether it is of the type:
- Hypoactive: when muscles are unable to contract at the appropriate time; Hyperactive: when there is excessive muscle contraction and involuntary loss of urine.
Based on the type of bladder, the doctor will be able to define among the treatment options, which include the use of medicines, such as oxybutynin, tolterodine or application of botulinum toxin, for example, in addition to physical therapy, use of bladder catheter or surgery.
Main symptoms
In the neurogenic bladder, there is a change in the nerves that control the muscles surrounding the bladder or urinary sphincter, which are unable to relax or contract at the appropriate time.
Thus, the person with this alteration loses the ability to urinate in a coordinated manner, according to his will. Depending on the type of change, the neurogenic bladder can be:
1. Overactive bladder
It is also known as spastic bladder or nervous bladder, as the bladder contracts involuntarily, thus causing urine to leak unexpectedly and at inappropriate times.
- Symptoms: urinary incontinence, urge to urinate frequently and in small quantities, pain or burning in the bladder region, loss of control of the ability to urinate.
The overactive bladder is more common in women and can be stimulated by hormonal changes in menopause, or by an enlarged uterus during pregnancy. Learn more details on how to identify the overactive bladder.
2. Hypoactive bladder
It is also known as a flaccid bladder, because the bladder is not able to contract voluntarily, or the sphincter is not able to relax, which causes the storage of urine, without the ability to eliminate it properly.
- Symptoms: feeling that the bladder has not emptied completely after urinating, dripping after urinating or involuntary urine loss. This increases the chances of urinary tract infection and impaired kidney function, so treatment should be started as soon as possible.
Possible causes
The causes of neurogenic bladder can be:
- Bladder irritation, by urinary infection or hormonal changes, as in menopause; Genetic changes, as in myelomeningocele; Reversible neurological diseases such as neurocysticercosis or neuroschistosomiasis; Compression of nerves of the lumbar region by herniated disc; Accident that injures the spine, causing paraplegia or quadriplegia; Degenerative neurological diseases such as multiple sclerosis or Parkinson's; Post-stroke neurological impairment; Peripheral neurological changes due to diabetes; Loss of bladder elasticity, caused by inflammation, infections or neurological changes in general.
In men, the enlarged prostate can simulate many symptoms of neurogenic bladder, being an important reversible cause of altered function of the urinary muscles.
How to confirm the diagnosis
In order to diagnose the neurogenic bladder, the urologist will evaluate the person's clinical history, detailing the symptoms, and the physical examination, in addition to requesting tests that can observe the functioning of the urinary tract, such as ultrasound, contrast radiography, urethrocystography and urodynamic examination., to assess the contraction of urinary muscles at the time of urination.
How the treatment is done
Treatment for neurogenic bladder is complex and may involve:
- Use of parasympathetic agonist drugs, such as bethanechol chloride, antimuscarinics, such as oxybutynin (Retemic) or tolterodine, in addition to other agents that act on neurotransmitters, such as glutamate, serotonin, norepinephrine, dopamine and gamma-aminobutyric acid (GABA), used according to each case; Botulinum toxin (botox), which can be used to decrease the spasticity of some muscles; Intermittent sounding, which is the passage of a bladder tube, which can be used periodically by the patient himself (4 to 6 times a day) and removed after emptying the bladder; Surgery, which can be to improve the functionality of the bladder or divert the urine to an external opening (ostomy) created in the abdominal wall; Physiotherapy, with exercises to strengthen the pelvic floor. See how physical therapy is performed for urinary incontinence.
The type of treatment will depend on the cause of the disease, aiming at its solution. However, when this is not possible, the doctor may recommend a combination of treatments to improve the person's quality of life, in addition to avoiding recurrent infections and renal impairment.
See in this video how to do the exercises to strengthen the pelvic floor and avoid the neurogenic bladder:
Is neurogenic bladder curable?
The neurogenic bladder can be cured when it is caused by reversible causes, such as urinary tract infection or brain infection by neurocysticercosis, for example, showing improvement after treatment.
However, in many cases, the neurogenic bladder has no cure, but treatment can help improve muscle tone, relieve symptoms and improve a person's quality of life. For this, it is important to have a follow-up with a urologist and, in some cases, a neurologist.
