Neurogenic bladder

Neurogenic bladder may also be called neuropathic bladder. The muscles and nerves of the urinary system work together to hold urine in the bladder and then release it at the appropriate time. Nerves carry messages from the bladder to the brain and from the brain to the muscles of the bladder telling them either to tighten or release. In a neurogenic bladder, the nerves that are supposed to carry these messages do not work properly, essentially paralyzing the bladder.

Causes

In children, a neurogenic bladder may be secondary to a birth defect or it may be acquired as the result of a different problem. The following are some of the most common causes of neurogenic bladder:

• Spina bifida - a defect that occurs during early fetal development. The defect consists of incomplete bony closure of the spinal cord through which the spinal cord may or may not protrude.
• Spinal cord trauma
• Central nervous system tumors

In many cases, neurogenic bladder is associated with the following:

• Urine leakage (this often occurs when the muscles holding urine in the bladder do not get the right message)
• Urine retention (this often happens if the muscles holding urine in the bladder do not get the message that it is time to let go)
• Damage to the tiny blood vessels in the kidney (this often happens if the bladder becomes too full and urine backs up into the kidneys, causing extra pressure)
• Infection of the bladder or ureters (this often results from urine that is held too long before being eliminated)

Symptoms

Each child may experience symptoms differently. Symptoms of neurogenic bladder may vary depending upon the cause and other associated conditions. Symptoms of neurogenic bladder may resemble other conditions and medical problems. Always consult your child's physician for a diagnosis.

Diagnosis

In addition to a complete medical history and physical examination, diagnostic procedures for neurogenic bladder may include:

• Urine tests
• Urodynamic study - during this study, your child's bladder will be filled with saline so that the bladder volume and pressure may be measured. The tone or amount of contraction of the bladder can also be determined.

Treatment:

Specific treatment for a neurogenic bladder will be determined by your child's physician based on:

• Your child's age, overall health, and medical history
• The extent of the disease
• Your child's tolerance for specific medications, procedures, or therapies
• Expectations for the course of the disease
• Your opinion or preference

Treatment may include:

• Insertion of a catheter or hollow tube (to empty the bladder at regular intervals)
• Prophylactic (preventive) antibiotic therapy (to reduce the incidence of infection)
• Placement of an artificial sphincter - a procedure that involves placing an artificial cuff around the neck of the bladder that can be inflated to prevent urinary incontinence and deflated when it is time to empty the bladder. These children will still require intermittent catheterization to completely empty the bladder.
• Surgery