Neurogenic Bladder

Background

 A term describing bladder problems related to a suspected neurologic cause, such as spinal cord injury, multiple sclerosis, stroke, Parkinson's disease, diabetes, etc.With such, the nerves to the bladder and/or urinary sphincter are not working properly, which results in either difficulty with bladder holding and/or emptying.

 

Causes

 As examples listed above, there are many possible causes. These probelms can be very complex and may require a multi-disciplinary approach.

 

Multiple Sclerosis

Patients with Multiple Sclerosis (MS) have a very high prevalence of lower urinary tract symptoms - as many as 90% of patients will experience voiding dysfunction and/or incontinence.

SYMPTOMS:

Patients with MS can have a variety of voiding symptoms. These include:

  • trouble with initiating the stream
  • urgency 
  • frequency - bladder (detrussor) overactivity
  • hesitancy - problems with co-ordinating relaxation of the muscles of the pelvic floor and contraction of the bladder (detrusor-external sphincter dyssynergia DESD)
  • difficulty emptying the bladder (high post void residual)
  • recurrent urinary tract infections
  • retention - acontractile bladder

These symptoms happen frequently. 50-80% of MS patients will experience urgency or frequency. Incontinence in 20-80%. Hesitancy for 28-58% of patients and up to 20% of patient experience urinery retention

 

EVALUATION OF PATIENTS WITH URINARY SYMPTOMS AND MS

Basic Evaluation Includes:

  • history and physical examination 
  • urinalyisis and culture
  • urodynamic studies

 

MANAGEMENT OF SYMPTOMS IN MS

Treatment options for patient with multiple sclerosis include conservative management of symptoms, medical management and surgical options. Usually, conservative management and medical therapy is tried and exhausted prior to moving to surgical solutions

 

 

Diagnosis & Evaulation

 Your urologist will consider possible causes, and evaluate with a history, examination, and possible ancilary tests including cystoscopy and urodynamic studies.

 

Treatment

 Treatment for neurogenic bladder depends on the patient's overall status, underlying diagnosis, and severity and complexity of the problem. Options may include medications to help the bladder either hold or empty better, catheterization (either a permanent indwelling catheter or preferrably intermittent catheterization either by the patient or family member), or even possibly surgery. Your urologist will assess you individual situation and provide options and a discussion of the relative pros and cons on each.

 

On the Web


General Urology Web Sites

Self Catheterization Products

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