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Neurogenic Bladder Treatment

Neurogenic bladder refers to a malfunctioning bladder caused by a problem with the nervous system.

This condition can arise from various neurological disorders, leading to symptoms that can significantly impact an individual’s daily life.

Understanding its symptoms, diagnosis, and treatment options helps those affected and their caregivers.

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Symptoms of Neurogenic Bladder

Neurogenic bladder can manifest in various ways, depending on the underlying neurological condition and the type of dysfunction (overactive or underactive bladder). Here’s a more detailed look at the symptoms:

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    Urgency

    A sudden and strong need to urinate, even if the bladder isn't full. This can be challenging to control and may lead to episodes of incontinence.

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    Frequency

    The need to urinate more often than usual, sometimes as often as every 30 minutes to an hour.

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    Incontinence

    An involuntary loss of urine. This can range from occasional leakage when sneezing or coughing to complete loss of bladder control.

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    Incomplete Emptying

    A feeling that the bladder hasn't fully emptied after urination. This can lead to increased frequency as the individual feels the need to return to the bathroom shortly after urinating.

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    Dribbling

    A continuous or intermittent flow of urine, even after finishing urination.

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    Nocturia

    The need to wake up multiple times during the night to urinate.

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    Decreased Sensation

    Some individuals may not feel the usual sensation that signals the need to urinate, leading to unexpected episodes of incontinence.

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    Recurrent Urinary Tract Infections (UTIs)

    Due to incomplete emptying of the bladder or urine retention, there's an increased risk of bacterial growth, leading to frequent UTIs.

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    Pain or Discomfort

    Some individuals may experience pain or discomfort in the lower abdomen or during urination.

Diagnosis of Neurogenic Bladder

Diagnosing a neurogenic bladder involves a comprehensive approach to understand the underlying cause and the extent of bladder dysfunction. Here’s a more detailed examination of the diagnostic process:

Medical History: The first step in diagnosing a neurogenic bladder is a thorough review of the patient’s medical history. The doctor will ask about the onset and duration of symptoms, any known neurological conditions, previous surgeries, medications, and other relevant health issues.

Physical Examination: A physical examination, especially of the abdominal area, can provide clues about bladder function. The doctor may also perform a neurological examination to assess nerve function related to bladder control.

Urodynamic Testing:

  • Cystometry: This test measures how much urine the bladder can hold, how much pressure builds up inside the bladder as it stores urine, and how full the bladder is when the urge to urinate occurs.
  • Electromyography: Electrodes are placed on the skin near the urethra and rectum to measure the electrical activity of the muscles and nerves in and around the bladder.
  • Pressure Flow Study: This measures the bladder pressure required to urinate and the flow rate of the urine.
  • Cystoscopy: A cystoscope, a thin tube with a camera and light, is inserted into the urethra to examine the bladder’s lining. This procedure can identify abnormalities in the bladder and urethra.

Imaging Tests:

  • Ultrasound: This test uses sound waves to create images of the bladder and surrounding structures, helping to identify any abnormalities.
  • CT Scan: A CT scan provides detailed cross-sectional images of the bladder and can detect issues like stones, tumours, or other abnormalities.
  • MRI: An MRI can provide detailed images of the bladder and surrounding tissues, especially useful if there’s a suspected neurological cause.
  • Postvoid Residual Measurement: This test measures the amount of urine left in the bladder after urination. A significant amount of residual urine can indicate poor bladder function.

Urine Tests: A sample of urine may be taken to check for signs of infection, blood, or other abnormalities.

Voiding Diary: The patient may be asked to keep a diary of their urination habits, noting the times they urinate, the amount of urine, and any associated symptoms. This can provide valuable insights into bladder function over several days.

The combination of these tests and assessments allows for a comprehensive understanding of the nature and cause of neurogenic bladder in the patient. Based on the findings, the doctor can recommend appropriate treatment options.

Treatment Options for Neurogenic Bladder

The treatment of neurogenic bladder is tailored to the specific type of dysfunction (overactive or underactive) and its underlying cause. The primary goals are to protect the kidneys, ensure complete emptying of the bladder, and manage symptoms. Here’s a more in-depth look at the available treatment options:

Non-surgical Treatments

Behavioural Therapies

  • Bladder Training: This involves setting a urination schedule, gradually increasing the time between voiding to improve bladder capacity.
  • Pelvic Floor Muscle Exercises: Also known as Kegel exercises, these strengthen the muscles that help control urination.

Medications

  • Anticholinergics: Drugs like oxybutynin and tolterodine help relax the overactive bladder, reducing urgency and frequency.
  • Alpha-blockers: Medications like tamsulosin can help relax the bladder neck and prostate, improving urine flow.
  • Botulinum Toxin (Botox): Injected into the bladder muscle, Botox can help reduce overactivity and increase capacity.

Intermittent Catheterization
A catheter is periodically inserted into the bladder to drain urine. This method ensures complete emptying of the bladder and is especially useful for those who cannot void effectively on their own.

Surgical Treatments

  • Bladder Augmentation: This procedure enlarges the bladder using a piece of the intestine. It’s considered when the bladder cannot hold a normal amount of urine.
  • Urinary Diversion: In cases where the bladder isn’t functioning or needs to be removed, this procedure reroutes urine to an external bag or a reservoir created from a piece of the intestine.
  • Artificial Urinary Sphincter: This device is implanted around the neck of the bladder and can be manually controlled to open and close, helping those with incontinence.
  • Neuromodulation: Devices like sacral nerve stimulators can be implanted to modulate nerve signals, improving bladder function.
  • Vesicostomy: A surgical opening is created in the bladder, allowing urine to drain continuously into a collection bag. This is a temporary measure for severe cases.

Other Treatments

  • Clean Intermittent Self-Catheterization (CISC): This involves the patient or caregiver inserting a catheter several times a day to empty the bladder, reducing the risk of infections and ensuring complete emptying.
  • Continuous Catheter Drainage: In some cases, a catheter may be left in place continuously, with urine draining into a collection bag.

The choice of treatment depends on the severity of the symptoms, the type of neurogenic bladder, the patient’s overall health, and their preferences.

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Benefits of Treatment

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    Improved quality of life

    Effective treatment can alleviate symptoms, leading to increased comfort and confidence in daily activities.

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    Prevention of complications

    Timely and appropriate treatment can prevent issues like kidney damage and recurrent infections.

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    Enhanced bladder function

    Treatments aim to restore normal bladder function, allowing for better urine storage and release.

Conclusion

Neurogenic bladder, while challenging, is manageable with the right diagnosis and treatment. By understanding the condition and seeking timely medical intervention, individuals can lead a comfortable and fulfilling life.

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Dr Lee Fang Jann image

Dr Lee is a urologist and kidney transplant surgeon with a broad-based expertise of all urological disorders

He has subspecialty focus on men’s health and male infertility, and special interest in minimally invasive prostate enlargement therapy and kidney stone treatment. Dr Lee has received numerous awards for service excellence such as the Service With A Heart Award (2006-2008, 2011) and the Singapore Health Quality Service Award (2016).

  • Bachelor of Medicine and Bachelor of Surgery (Singapore)
  • Membership of The Royal College of Surgeons (Edin)
  • Master of Medicine (Surgery) (Singapore)
  • Fellowship of the Academy of Medicine (Urology)
  • Clinical fellowship at Oxford Transplant Centre in the UK

Prior to entering private practice, Dr Lee served in the public sector for 16 years at SGH, where he initiated dedicated clinics evaluating and treating patients with complex men’s health and fertility issues. He also led the Renal Transplant Program and laparoscopic donor nephrectomy service as Surgical Director.

Apart from clinical work, Dr Lee is active in academia and believes in the importance of grooming the next generation of doctor. He was Senior Clinical Lecturer at NUS’ Yong Loo Lin School of Medicine and currently, Adjunct Assistant Professor at the Duke-NUS Medical School. Dr Lee is also regularly invited to share his experiences locally and regionally through lectures, workshops and surgical demonstrations.

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    Frequently Asked Questions

    Are there any lifestyle changes that can help manage neurogenic bladder symptoms?
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    Yes, certain lifestyle changes can help manage symptoms. These include maintaining a healthy weight, avoiding bladder irritants like caffeine and alcohol, practising pelvic floor exercises, and staying hydrated while monitoring fluid intake, especially before bedtime.

    Can neurogenic bladder lead to kidney damage?
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    If left untreated, a neurogenic bladder can result in complications such as frequent urinary tract infections and urine retention. Over time, these issues can lead to kidney damage. Regular monitoring and appropriate treatment can prevent such complications.

    Is neurogenic bladder a permanent condition, or can it be cured?
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    The permanence of the neurogenic bladder depends on its cause. Some conditions, like nerve damage from certain surgeries or injuries, may be permanent. However, with appropriate treatment and management, many individuals can lead a normal life. In some cases, if the underlying cause is treatable, the neurogenic bladder can improve or resolve.

    Are there any risks associated with long-term catheter use for neurogenic bladder?
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    Long-term catheter use can increase the risk of urinary tract infections, bladder stones, and damage to the urethra. Follow proper catheter care guidelines and work closely with a urologist to monitor for potential complications.

    Can diet and nutrition play a role in managing neurogenic bladder?
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    Yes, a balanced diet can support overall bladder health. Avoiding irritants like spicy foods, citrus fruits, and caffeinated beverages can help reduce bladder symptoms. Additionally, consuming enough fiber can prevent constipation, which can exacerbate bladder issues.

    Are there any support groups or resources for individuals with neurogenic bladder?
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    Many organizations and support groups offer resources, counseling, and community support for individuals with neurogenic bladder and their families. It’s beneficial to seek out these resources for additional information, coping strategies, and emotional support.