Neurological bladder * relevant anatomy * mechanism * types * neural pathway * management etc.

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Neurogenic Bladder

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Micturition, also known as urination, is the process
of expelling urine from the bladder. The purpose of
urination is to eliminate metabolic products and
toxic wastes from the body that have been filtered
from the blood by the kidneys.
INTRODUCTION

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The urinary tract comprises of two mutually dependent components:
the upper tract, which contains the kidneys and ureters, and the
lower tract consisting of the bladder and urethra. The lower tract is
involved in the micturition reflex.
Relevant Anatomy & Physiology
The bladder is a hollow organ that functions as reservoir for the storage and periodic
elimination of urine. The bladder’s walls are made up of three layers of smooth
muscle, known as the detrusor.
At the bottom of the bladder is an outlet into the urethra known as the bladder
neck, which is surrounded by a ring of smooth muscle known as the internal urethral
sphincter and is involuntarily controlled.
The urethra, the passage in which urine is excreted out of the body.

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The pelvic floor musculature encircles the urethra creating the external urethral
sphincter, which operates under conscious control.
During storage, both the internal and external sphincters are contracted to
prevent leakage.
Normally, the detrusor muscle is relaxed, which allows the bladder to expand as
it fills with urine.
When the bladder is full, the detrusor contracts to expel urine out of the body
through the urethra.
A normal healthy adult bladder can hold anywhere from 300-500mL of urine
for 2-5 hours.

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Mechanism
Micturition is a complex and highly distributed process, involving pathways at multiple
levels of the brain, spinal cord and PNS, in addition to being mediated by multiple
neurotransmitters.
o At the most basic level, the micturition reflex is triggered when the bladder fills with
urine.
o The detrusor muscle remains relaxed until the bladder fills to about 250 mL with
urine.
o As the bladder fills, the detrusor muscle contracts, which increases the pressure within
the bladder.
o Stimulates the stretch receptors within the detrusor and exciting parasympathetic
fibres to relay this information to the sacral nerves of the spine.

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Neurogenic Bladder, also known as Neurogenic
Lower Urinary Tract Dysfunction, is when a person
lacks bladder control due to brain, spinal cord or
nerve problems
What is Neurogenic Bladder?

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underactive (flaccid or
hypotonic) bladder
Types of neurogenic bladder
overactive (spastic or
hyper-reflexive)
bladder

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➢ A spastic or hyperreflexic bladder (UMN lesion) contracts and
reflexively empties in response to a certain level of filling
pressure. The reflex arc is intact with this type of injury.
The detrusor muscle is generally hyperreflexive. There can be
increased tone of the sphincter, contraction of the detrusor with
small urine volumes, and lack of coordination between detrusor
and sphincters (dyssynergia).
➢ A flaccid or areflexive bladder (LMN lesion) is essentially flaccid
because there is no reflex action of the detrusor muscle.

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Symptoms of Neurogenic bladder
The symptoms of neurogenic bladder vary depending on whether someone
has an overactive or underactive bladder.
The symptoms of an overactive bladder can include:
o frequently urinating in very small amounts
o feeling the urge to urinate a lot
o lack of bladder control
o urinary incontinence
The symptoms of an underactive bladder may include:
o having a bladder that is frequently full
o not being able to tell when the bladder is full
o difficulty urinating
o overflow leakage

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Causes of neurogenic bladder
Nerve dysfunction is what causes neurogenic bladder.
This means that any condition or trauma that affects the
nervous system may cause problems with bladder control.
o diabetes
o genetic conditions that affect the nerves
o trauma to the brain and spinal cord
o brain and spinal cord tumors
o Parkinson’s disease
o multiple sclerosis

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Neurogenic bladder treatment
Treatment can improve the symptoms and have a significant impact
on a person’s quality of life. It can also prevent certain complications,
such as UTIs or kidney damage.
Treatment will differ depending on whether the person has an
overactive or underactive bladder.
Depending on the severity of a person’s symptoms, treating an
underactive or overactive bladder usually begins with making lifestyle
changes.

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Lifestyle changes:
o Quick flicks: When a person gets the urge to urinate, they can try squeezing
and relaxing their pelvic floor muscles as quickly as they can. They should do
this until they no longer want to urinate.
o Dietary changes: Soda, caffeine, spicy foods, and alcohol can irritate the
bladder, so a person may want to reduce their consumption of these items to
ease the symptoms.
o Delayed voiding: This involves a person delaying urination for a few minutes to
begin with, then slowly building up the delay. Eventually, they may be able to
go a few hours without urination.
o Scheduled voiding: This involves a person using the bathroom according to a
daily schedule, such as every 2–4 hours, depending on how often they need to
urinate.

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Additional overactive bladder treatment
1. Drug treatment: botulinum toxin (Botox) injection into the bladder muscle to
stop it from contracting as much. Botox can wear off after a period of time, so
a person may need to have injections every 6–12 months.
2. Sacral neuromodulation: This treatment stimulates the nerves with electricity,
especially the sacral nerve, which relays signals from the spinal cord to the
bladder.
3. Percutaneous tibial nerve stimulation: During this treatment, a doctor inserts a
needle into the tibial nerve, which is in the leg. They then stimulate this nerve
with electrical impulses. These impulses travel to the sacral nerve. A person
usually needs to receive 12 sessions of this treatment.

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Additional underactive bladder treatment
If a person does not notice any improvements in their underactive bladder symptoms
after making the above lifestyle changes, a doctor may recommend medication or a
catheter.
There are two different types of catheterization that a person can try:
1. Clean intermittent catheterization (CIC)
2. Continuous catheterization.
CIC involves inserting a sterile catheter into the bladder through the urethra and
leaving the catheter in for only as long as it takes to drain the bladder. A person can
then remove the catheter and wait another 6–8 hours to do this again.
Continuous catheterization continuously drains urine. That said, these catheters do
need replacing every so often to prevent infection.

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THANKYOU
Presented by: Dinu Dixon
MPT (Neurology)