| For the urinary system to work right, the
muscles and nerves must work together to hold urine in the bladder and
then release it at the right time. Nerves carry messages from the bladder
to the brain, letting the brain know when the bladder is full. The nerves
carry messages 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.
Neurogenic bladder can lead to different kinds of problems. It may
result in urine leakage if the muscles holding urine in do not get the
right message. For other people, a neurogenic bladder means that their
muscles do not get the message that it is time to let go. If the bladder
becomes too full, urine may back up into the kidneys, and the extra
pressure causes damage to the tiny blood vessels in the kidney. Or urine
that stays too long may lead to an infection in the bladder or ureters,
which are the tubes that carry urine from the kidney to the bladder.
Accidents that cause trauma to the brain or spinal cord, heavy metal
poisoning, diabetes, and acute infections are among the ways nerves and
nerve pathways can be damaged. Some children are born with nerve problems,
which can keep a baby's bladder from releasing urine, leading to urinary
infections or kidney damage.
If neurogenic bladder is suspected, the doctor may need to test both
the nervous system (including the brain) and the bladder itself. The
doctor may take x-rays of the skull and spine. The doctor may do an EEG, a
test where wires are taped to the forehead to sense any dysfunction in the
brain.
The doctor will also test the nerves and muscles of the bladder. These
tests may include x-rays of the bladder and ureters. Tests may involve
filling the bladder to see how much it can hold and checking to see if the
bladder empties completely.
The treatment for neurogenic bladder depends on the cause of the nerve
damage and the type of voiding dysfunction that results. If the problem is
urinary retention (the bladder does not know when to let go), it may be
necessary to use a catheter to empty the bladder at regular times. A
catheter is a thin tube that can be slid through the urethra, up to the
bladder. Learning to use a catheter correctly helps to avoid infection and
stops the buildup of pressure that can damage the kidneys.
In the case of urine leakage (incontinence), the doctor will choose
from a range of treatments depending on the cause of leakage. If the
problem is that the muscle in the bladder itself squeezes out urine at the
wrong time, some drugs may help the bladder stay relaxed and store urine
longer. A different muscle, the sphincter muscle, is supposed to hold
urine in by squeezing the urethra shut at the opening of the bladder. If
urine leakage happens because the sphincter is not working, an artificial
sphincter may be necessary.
For more information, contact the following organizations:
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