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.
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