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The bladder is a balloon like muscular sac where urine is stored.
When this sac becomes full, it is excreted. A pathway of nerves from
the bladder carry messages to the brain letting it know weather the bladder
is full or empty. The brain, then using another set of nerves, sends
messages to the muscles of the bladder telling them to relax and allow the
bladder to empty. Once empty, the brain signals the bladder muscles to
tighten in order to store urine again. Any interference in this
mechanism leads to a condition known as
Neurogenic Bladder.
There are two categories of Neurogenic Bladder problems: 1)
overactive (hyper-reflexive or
spastic bladder)
and 2) underactive
(hypotonic or
flaccid bladder).
With an overactive (spastic) bladder there is uncontrolled,
frequent expulsion of urine from the bladder, reduced bladder
capacity and incomplete emptying of urine thus failure to properly
store the urine.
An underactive (flaccid) bladder has a large capacity
(up to 2000 ml). Because there is a loss of sensation of the
bladder filling, it does not contract as forcefully as it
normally should, and thus small amounts of urine dribble out.
In other words the bladder fails to empty completely and the
urine dribbles out the urethra.
Dysnergic Bladder describes a bladder with both problems.
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- Urinary leakage or dribbling
- Urinary retention
- Small urine volume during voiding
- Frequent urination
- Urinary urgency
- Pain and fullness lower abdomen/pelvic area due to a over distended bladder
- Loss of sensation of bladder fullness
- Urinary infection
- Back pain due to Kidney Stones
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- Spinal cord injury or brain damage after accidents
- Tumors and other masses pressing on the spinal cord or the brain
- Diseases affecting the nerves and nervous system (diabetes, Syphilis, Multiple Sclerosis, Parkinson's, ALS etc.)
- Ruptured disks
- Acute infections
- Congenital or birth defects (myelomeningocele) poisoning (heavy metal poisoning)
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- Urine cultures
- Post voiding residual measurements such as filling the bladder to see if it is how much urine it can hold and if leakage occurs.
- Voiding Cystourethrogram and Cystometrogram are other ways to assess bladder function.
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- To determine the most appropriate treatment method, it is
first necessary to distinguish between the overactive or
underactive types of Neurogenic Bladder. This can be done by
recording the frequency and the amount of urination voided over
a 48-hour period, followed by determination of how much urine
remains in the bladder after voiding.
A small residual amount of urine would indicate a normal or small
spastic bladder while a large amount of urine remaining
would indicate a flaccid or a hypotonic bladder.
Depending on the cause, treatment may include a need for frequent
urinary catheterization (a catheter is inserted through the urethra
and into the bladder whenever it is full). Use of medications
such as Ditropan, Tofranil, Pro-Banthine, Levsin, Ornade Cystospaz,
Urispas only in mild cases of
Neurogenic Bladder; and Hytrin in
cases of Flaccid bladder. Depending on the nature and type of the
problem, surgery (replacing the sphincter with a ring-like muscle
at the neck of the bladder that normally stops urine from leaking
out) may be an option.
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