Existing in two forms - the flaccid form and the spastic form - the neurological bladder can cause problems such as urinary retention or urinary incontinence; moreover, if due to very serious causes or if not subjected to the right treatments, it can be harmful to the kidneys and give rise to complications, such as: kidney stones and hydronephrosis with vesico-ureteral reflux.
To diagnose the neurological bladder and identify its precise triggering cause, the following are essential: physical examination, medical history, neurological evaluation, urological studies, urodynamic studies and radiographic examinations.
The neurological bladder requires causal therapy, where possible, and symptomatic therapy.
Brief anatomical recall of the Bladder
Also known as the urinary bladder, the bladder is a hollow, muscular-membranous and unequal organ, which is used to collect the urine produced in the kidneys and ready to be expelled through the mechanism of urination.
The bladder is located in the anterior region of the pelvis, resting on the pelvic floor, behind the abdominal wall and the pubic symphysis, in front of the rectum and above the prostate in men, in front of the uterus and vagina in women.
The main consequences
Depending on what triggers it, the neurological bladder can impair the ability to empty the bladder (resulting in urinary retention) or alter the mechanisms that keep urine inside the bladder (triggering urinary incontinence).the impulses that serve to empty the latter.
Causes of the neurological bladder include all those conditions that alter, in some way, the afferent control (ie the control of the filling level) or efferent (ie the control of emptying) of the bladder.
The aforementioned conditions include:
- Diseases of the spinal cord;
- Injuries to the spine;
- Defects of the neural tube;
- Some brain tumors
- The state of pregnancy;
- Peripheral neuropathy.
Other causes of neurological bladder:
- Amyotrophic lateral sclerosis (ALS)
- Multiple sclerosis
- Parkinson's disease
Diseases of the Spinal Cord
The spinal cord is, together with the brain, one of the two main nerve structures, which make up the so-called central nervous system (CNS).
Located within the spinal canal (i.e. the empty space of the spinal column resulting from the vertical arrangement of the vertebrae), the spinal cord extends from the foramen magnum to the second lumbar vertebra, has two distinct areas of neurons called white matter and gray matter, and gives rise to 31 pairs of peripheral nerves called spinal nerves.
Among the various diseases of the spinal cord that can cause neurological bladder, syringomyelia deserves a special mention.
Syringomyelia is a pathological condition characterized by the formation, inside the spinal canal, of cysts filled with liquid, which - especially when they are large - are responsible for more or less profound damage to the spinal cord.
Syringomyelia recognizes various causes, including: a congenital malformation of the cerebellum known as Arnold-Chiari syndrome, spinal cord trauma, spinal cord tumors, some forms of meningitis, so-called rigid spine syndrome, and episodes of hematomyelia .
Syringomyelia is so called, because the liquid-filled cysts that characterize it are called syringes.
The backbone of the human body, the vertebral column (or rachis) is the skeletal structure resulting from the stacking of the vertebrae.
33-34 in number, the vertebrae are irregular bones separated from each other by a discoid element, called the intervertebral disc.
The intervertebral discs are substantially circular containers composed of fibrocartilage, within which there are a gelatinous substance, called nucleus pulposus, and the cartilage tissue that surrounds the aforementioned nucleus pulposus, that is the so-called fibrous ring.
The most common spinal injury linked to the neurological bladder is a herniated disc.
In medicine, the term "herniated disc" means the pulposus nucleus, contained within the intervertebral disc, coming out of its natural location.
The herniated disc is the result of an injury to an intervertebral disc, which can be caused by:
- L "aging;
- Trauma to the spine;
- Violent torso rotations;
- Repeated lifting of excessive weights;
- The habit of maintaining an incorrect posture;
- The presence of too weak back muscles.
Curiosity: what are the intervertebral discs for?
In addition to providing for the junction of the adjacent vertebrae, the intervertebral discs have the task of absorbing, by means of the nucleus pulposus, the shocks and loads that weigh on the vertebral column. In other words, with their particular content, the intervertebral discs perform the function of shock absorbing pads.
Defects of the Neural Tube
The neural tube is the structure of the human embryo, from which the central nervous system present at birth originates.
The neural tube defect most associated with the presence of the neurological bladder is the so-called spina bifida.
Spina bifida is a congenital malformation of the vertebral column, due to which the meninges and, sometimes, also the spinal cord come out of their natural location (corresponds to the spinal canal).
A brain tumor is the result of the abnormal proliferation of one of the cells making up the brain proper (or telencephalon).
Brain tumors affect the functionality of the brain area where the neoplasm is located, which explains why their symptoms vary from patient to patient, depending on the region of the brain affected.
A brain tumor is associated with the neurological bladder, when it arises in a "brain area responsible for afferent or efferent control of the bladder.
Today, it is known that the control of the urinary bladder by the brain belongs to: thalamus, prefrontal cortex, cerebral cortex (or insula), anterior cingulate cortex and periaqueductal gray matter.
Pregnancy can cause the neurological bladder, when the uterus, increasing by the effect of the growth of the fetus, pushes on those neighboring peripheral nerves responsible for afferent or efferent control of the urinary bladder.
Peripheral neuropathy is the morbid condition resulting from damage or malfunction of the peripheral nerves.
Peripheral neuropathy recognizes numerous causes, including first and foremost: diabetes mellitus, alcoholism, vitamin B deficiency, chronic kidney disease and chronic liver disease.
The neurological bladder is one of the possible consequences of a peripheral neuropathy, when the latter affects the peripheral nerves responsible for afferent or efferent control of the urinary bladder.it is very low and there is no bladder contraction.
In patients with this form of neurological bladder, the urine volume is normal or less than normal and there are constant bladder contractions.
The characteristics of the neurological bladder (ie the fact that it is flaccid or spastic) vary in relation to which nerve structures responsible for controlling the bladder have undergone the functional alteration..
Spastic Neurological Bladder: Symptoms
The neurological bladder is typically responsible for:
- Frequent urination;
- Nocturia (the repeated need to urinate throughout the night);
- Urgent need to urinate (overactive bladder), even when the bladder is not full
- Leaking urine.
In severe cases or in the absence of adequate treatments, a condition such as a neurological bladder can give rise to some complications; among the latter, the following are particularly noteworthy:
- The predisposition to the development of urinary tract infections;
- Kidney stones
- Hydronephrosis with vesicoureteral reflux.
As can be seen, therefore, the severe neurological bladder or not subjected to the right therapies is responsible for damage to the kidneys.
In the specific case where the neurological bladder depends on a spinal cord injury, patients can also experience a life-threatening complication, known as autonomic dysreflexia (or autonomic dysreflexia) and characterized by: malignant hypertension, bradycardia or tachycardia, headache, piloerection and excessive sweating., an "ultrasound of the" urinary tract and urine culture.
The list of urodynamic studies useful for deciphering the characteristics of the neurological bladder includes:
- The measurement of the post-voiding residue;
- The uroflowmetry;
- The urethral pressure profilometry.
Among the radiological studies that a doctor might prescribe in the presence of a neurological bladder (or suspected such), include: excretory urography, cystometrography and CT or magnetic resonance imaging of the central nervous system (brain and spinal cord).
Radiological investigations relating to the central nervous system are essential when there is a suspicion that the neurological bladder depends on a disease of the spinal cord (eg: syringomyelia) or of the brain (eg: brain tumor).
Generally, the aforementioned suspicion is the result of an objective examination, in which symptoms associated with the conditions listed above emerged.
Unfortunately, some causes of neurological bladder - including, for example, spina bifida or amyotrophic lateral sclerosis - are incurable.
When the neurological bladder is due to the state of pregnancy, the causal therapy is essentially childbirth; in fact, when the newborn leaves the uterus, there is less compression of the peripheral nerves that compromise the afferent or efferent control of the urinary bladder.
Symptomatic Therapy: the details
To counteract the symptoms of the neurological bladder and prevent complications, the therapist may resort to:
- Bladder catheterization.
It basically consists of inserting a catheter into the bladder in order to empty the bladder from the urine.
The insertion of the catheter into the bladder can take place either through the urethra (urethral bladder catheter) or through a hole made in the abdomen (suprapubic bladder catheter).
Depending on the causes of the neurologic bladder, the bladder catheter may be indwelling (i.e. permanent) or intermittently (i.e. removed after each bladder emptying).
- A specific drug therapy.
Depending on the type of neurological bladder present, either bladder emptying drugs or urinary incontinence drugs may be needed.
- The surgery.
It represents the solution to more serious clinical cases, which do not derive tangible benefits from any of the previous symptomatic treatments.
Neurological bladder surgery includes various treatments, including: bladder sphincterotomy, urinary shunt, artificial sphincter application, and enlargement cystoplasty.
OTHER USEFUL REMEDIES
Always remaining in the context of symptomatic therapy, patients with a spastic neurological bladder could benefit from so-called Kegel exercises (they are exercises to strengthen the pelvic floor muscles), while patients with a flaccid neurological bladder could benefit more fluid consumption throughout the day.