Preventing Complications of Neurogenic Bladder

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Preventing Complications of Neurogenic Bladder
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For the urinary system to do its job, muscles and nerves must work together to hold urine in the bladder and then release it at the right time. Nerves carry messages from the bladder to the brain to let it know when the bladder is full. They also carry messages from the brain to the bladder, telling muscles either to tighten or release. A nerve problem might affect your bladder control if the nerves that are supposed to carry messages between the brain and the bladder do not work properly.

What bladder control problems does nerve damage cause?
Nerves that work poorly can lead to three different kinds of bladder control problems.

Bladder pic

Overactive bladder. Damaged nerves may send signals to the bladder at the wrong time, causing its muscles to squeeze without warning. (See Figure 1 above - Nerves carry signals from the brain to the bladder and sphincter.) The symptoms of overactive bladder include:

* urinary frequency—defined as urination eight or more times a day or two or more times at night
* urinary urgency—the sudden, strong need to urinate immediately
* urge incontinence—leakage of urine that follows a sudden, strong urge

Poor control of sphincter muscles.
Sphincter muscles surround the urethra and keep it closed to hold urine in the bladder. If the nerves to the sphincter muscles are damaged, the muscles may become loose and allow leakage or stay tight when you are trying to release urine.

Urine retention. For some people, nerve damage means that their bladder muscles do not get the message that it is time to release urine or are too weak to completely empty the bladder. If the bladder becomes too full, urine may back up and the increasing pressure may damage the kidneys. Or urine that stays too long may lead to an infection in the kidneys or bladder. Urine retention may also lead to overflow incontinence.

What causes nerve damage?
Many events or conditions can damage nerves and nerve pathways. Some of the most common causes are

* vaginal childbirth
* infections of the brain or spinal cord
* diabetes
* stroke
* accidents that injure the brain or spinal cord
* multiple sclerosis
* heavy metal poisoning

In addition, some children are born with nerve problems that can keep the bladder from releasing urine, leading to urinary infections or kidney damage.

How will the doctor test for nerve damage and bladder control problems?
Any evaluation for a health problem begins with a medical history and a general physical examination. Your doctor can use this information to narrow down the possible causes for your bladder problem.

If nerve damage is suspected, the doctor may need to test both the bladder itself and the nervous system (including the brain). Three different kinds of tests might be used:

Urodynamics. These tests involve measuring pressure in the bladder while it is being filled to see how much it can hold and then checking to see whether the bladder empties completely and efficiently.

Imaging. The doctor may use different types of equipment—x rays, magnetic resonance imaging (MRI), and computed tomography (CT)—to take pictures of the urinary tract and nervous system, including the brain.

EEG and EMG. An electroencephalograph (EEG) is a test in which wires are taped to the forehead to sense any dysfunction in the brain. The doctor may also use an electromyograph (EMG) to test the nerves and muscles of the bladder.

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