Neurogenic Bladder: Causes, Symptoms, Treatment, and Cost

The term 'neurogenic bladder' describes urinary bladder dysfunction brought on by a neurological condition, trauma, or illness. This condition results in an inability to control bladder function and/or empty the bladder completely and can lead to urinary incontinence, urinary tract infection, and other complications.

Here are some common types of neurogenic bladder:

• Spastic Neurogenic Bladder: In this type, the bladder muscles are overactive, leading to frequent urination, urgency, and incontinence. It happens when the higher motor neuron pathways in the brain or spinal cord are damaged.
• Flaccid Neurogenic Bladder: In this type, the bladder muscles are weak and cannot contract adequately to empty the bladder. The lower motor neuron circuits that regulate the bladder muscles are damaged, which causes it to happen.
• Mixed Neurogenic Bladder: This type is a combination of spastic and flaccid neurogenic bladder. It happens when both the upper and lower motor neuron circuits are damaged.
• Reflex Neurogenic Bladder: In this type, the bladder contracts reflexively without the person's control. It occurs due to damage to the sensory nerve pathways that carry signals from the bladder to the brain.
• Atonic Neurogenic Bladder: In this type, the bladder muscles lose their tone and cannot contract to empty the bladder. It occurs due to damage to the autonomic nerve pathways that control the bladder's smooth muscles.
• Detrusor-Sphincter Dyssynergia: In this type, the bladder contracts while the external urethral sphincter muscle is still closed, leading to urinary retention. It occurs due to damage to the nerve pathways that control the bladder and the external urethral sphincter muscles.

Here are some common causes of neurogenic bladder:

• Spinal cord injury: Damage to the spinal cord, resulting from trauma, disease, or infection, can affect the nerve pathways that control the bladder, leading to a neurogenic bladder.
• Multiple Sclerosis: Multiple sclerosis is a disease that damages the myelin sheath around the nerves, leading to nerve damage and dysfunction, including the nerves that control the bladder.
• Parkinson's disease: Parkinson's disease is a neurodegenerative condition that impairs mobility and has the potential to harm nerves that control bladder function.
• Stroke: Neurogenic bladder may result from damage to the area of the brain that regulates the bladder after a stroke.
• Diabetes: Diabetes has the potential to harm the bladder's regulatory nerves, resulting in a neurogenic bladder.
• Pelvic surgery: The nerves that regulate the bladder may be damaged after pelvic surgery such as prostatectomy or hysterectomy, which can result in a neurogenic bladder.
• Birth defects: Birth defects affecting the spinal cord or brain can lead to neurogenic bladder.
• Infections: Certain infections, such as meningitis or spinal cord infections, can damage the nerves that control the bladder, leading to a neurogenic bladder.
• Medications: The neuronal circuits that regulate the bladder may be impacted by certain drugs, including those used to treat Parkinson's disease or overactive bladder, which can result in a neurogenic bladder.
• Aging: As we age, the nerve pathways that control the bladder may weaken, leading to a neurogenic bladder.

Depending on the underlying reason and the severity of the ailment, the symptoms of the neurogenic bladder might change. These are a few typical signs:

• Urinary incontinence: The inability to control urination.
• Urinary retention: the inability to empty the bladder.
• Frequency and urgency: The need to urinate frequently or urgently.
• Nocturia: the need to urinate a lot at night.
• Urinary tract infections: Recurrent infections brought on by incomplete bladder emptying.
• Overflow incontinence: Dribbling urine due to a constantly full bladder.
• Hematuria: Urine with blood in it.
• Discomfort or pain when urinating.
• Slow or weak urine stream: Difficulty initiating urination.
• Bladder spasms: Involuntary contractions of the bladder.

There are several methods to prevent neurogenic bladder or manage its symptoms:

• Exercise regularly to strengthen pelvic floor muscles.
• Practice good hygiene to avoid urinary tract infections (UTIs).
• To be well hydrated, drink plenty of water.
• Avoid foods that might irritate the bladder, such as spicy meals, alcohol, and caffeine.
• Use intermittent catheterization or other urinary management techniques as recommended by a healthcare provider.
• Take medications as prescribed to manage bladder function and prevent recurrent UTIs.
• Follow a healthy diet that includes fiber-rich foods to prevent constipation, which can exacerbate bladder problems.
• Seek prompt treatment for any underlying health conditions that may increase the risk of neurogenic bladders, such as diabetes or multiple sclerosis.
• Participate in bladder training programs to improve urinary control and reduce accidents.
• Consult with a healthcare provider or specialist on the proper management of neurogenic bladder.

Tests for Neurogenic Bladder are:

• Urinalysis: a laboratory test that looks for the presence of germs, blood, or other unusual materials in a urine sample.
• Cystoscopy: A procedure in which a thin, flexible tube with a camera attached (cystoscope) is inserted into the bladder to visually examine the bladder lining and urethra.
• Urodynamic testing: A series of tests that evaluate the bladder and urethra's ability to store and release urine.
• Magnetic resonance imaging (MRI): A non-invasive diagnostic instrument that creates precise pictures of the bladder and nearby structures using radio waves and a magnetic field.
• Electromyography (EMG): A procedure that records the electrical activity of the nerves and muscles that regulate bowel and bladder function.
• Blood tests: A set of laboratory tests that measure various substances in the blood to evaluate kidney function and rule out other medical conditions that may cause similar symptoms.

Here are some possible complications:

• Urinary tract infections (UTIs): The inability to empty the bladder can lead to recurrent UTIs.
• Kidney damage: The backflow of urine from the bladder into the kidneys can cause damage to the kidneys over time.
• Bladder stones: The formation of bladder stones due to the buildup of mineral deposits in the bladder.
• Urinary incontinence: The quality of life of a person may be greatly impacted by uncontrollable urinating.
• Hydronephrosis: The swelling of the kidneys due to urine backup caused by a blocked or damaged ureter.
• Renal failure: Renal failure brought on by chronic kidney disease may call for dialysis or a kidney transplant.
• Autonomic dysreflexia: A potentially life-threatening condition characterized by a sudden increase in blood pressure due to a reflex response triggered by a noxious stimulus.

Some common home remedies for the treatment of Neurogenic bladder are:

• Ashwagandha: This herb is known for its ability to reduce stress and anxiety, which can help in managing an overactive bladder caused by neurological disorders.
• Gokshuradi Guggulu: This Ayurvedic medicine is made from a combination of herbs like gokshura, Triphala, Guggulu, and Musta. It helps in strengthening the bladder muscles and reducing inflammation.
• Shilajit: This mineral-rich material is well-known for its ability to reduce inflammation and act as an antioxidant. It can help in reducing bladder inflammation and promote healing.
• Ayurvedic massage: Abhyanga, a full-body massage using warm herbal oils, can help in relaxing the mind and body. Moreover, it may enhance blood flow and lessen muscular tension, which both help with bladder control.
• Kegel exercises: By tightening and releasing the pelvic floor muscles during these exercises, the bladder muscles may be strengthened, leading to improved bladder control.
• Bladder training: To assist the bladder in becoming more acclimated to retaining pee, this entails progressively extending the amount of time between toilet breaks.
• Fluid management: Limiting fluid intake, especially before bedtime, can reduce the frequency of urination at night.
• Dietary changes: Avoiding bladder irritants like caffeine, alcohol, and spicy foods can help in reducing bladder irritation and improve bladder control.

Food that should be consumed when you are suffering from Neurogenic bladder are:

• Since they help control bowel movements, foods rich in fiber such as fruits, vegetables, and whole grains might be helpful for those with neurogenic bladder.
• Drinking plenty of fluids is important for individuals with neurogenic bladder to prevent dehydration and urinary tract infections.
• Foods rich in vitamin C such as citrus fruits, bell peppers, and strawberries can help prevent urinary tract infections.
• Probiotic-rich foods such as yogurt and kefir can help maintain a healthy balance of bacteria in the gut and reduce the risk of urinary tract infections.
• Berries, almonds, and dark chocolate are examples of foods strong in antioxidants that may help decrease inflammation and improve general health.

These foods shouldn't be consumed while suffering from Neurogenic Bladder:

• Spicy foods: Hot foods might aggravate the symptoms of the neurogenic bladder by irritating the bladder.
• Caffeine: Caffeine is known to increase bladder activity and can worsen urinary urgency and frequency in people with neurogenic bladder.
• Alcohol: Dehydration brought on by alcohol's diuretic effects, which increase urine output, might worsen the symptoms of neurogenic bladder.
• Carbonated beverages: Carbonated beverages, especially those that contain caffeine, can irritate the bladder and exacerbate symptoms.
• Artificial sweeteners: Artificial sweeteners that irritate the bladder, such as aspartame and saccharin, may make symptoms worse.
• Acidic foods: When a person with neurogenic bladder, acidic foods like tomatoes and citrus fruits may irritate the bladder and exacerbate symptoms.
• Dairy: Some people with neurogenic bladder may be intolerant to lactose or casein, which can worsen symptoms.
• High-fiber foods: High-fibre foods such as beans, lentils, and whole grains can increase bowel activity and put pressure on the bladder, worsening symptoms.

Neurogenic bladder, a disorder that impairs bladder function as a result of nerve injury or neurological problems, is treatable with several important therapies.

• Bladder augmentation: This surgical treatment involves the enlargement of the bladder by attaching a piece of intestine or stomach tissue to the bladder. This helps in increasing bladder capacity, reducing the frequency of urination, and improving bladder control.
• Urinary diversion: This surgical treatment involves redirecting the urine flow from the bladder to an external opening in the abdominal wall, which is connected to a drainage bag. This is usually done when the bladder is too damaged to function properly.
• Botulinum toxin injections: This treatment involves injecting botulinum toxin directly into the bladder muscle to relax the muscle and reduce contractions, thus improving bladder control.
• Sacral nerve stimulation: This is a minimally invasive surgical treatment that involves implanting a small device under the skin near the sacral nerves, which control the bladder and bowel function. The system controls bladder function by electrically stimulating the nerves.
• Mitrofanoff procedure: This surgical treatment involves creating a new pathway for urine to leave the body by using a section of the intestine to create a tube that connects the bladder to the outside of the body. Urinary tract infections are less likely as a result of regular urine drainage.

Several medical professionals may be contacted if you have a neurogenic bladder:

• Urologist: a medical professional with expertise in the male reproductive system and the urinary tract. A broad variety of urinary problems, including neurogenic bladder, may be diagnosed and treated by them.
• Neurologist: a medical professional with expertise in the identification and management of nervous system disorders. They can diagnose and manage Neurogenic bladders caused by neurological conditions such as multiple sclerosis, spinal cord injuries, and Parkinson's disease.
• Physical Medicine and Rehabilitation Specialist: a medical professional with expertise in the diagnosis and management of diseases that impair movement and function. They may aid in managing disorders that impair movement and function, such as neurogenic bladder brought on by spinal cord injury.
• Gynecologist: A doctor who specializes in women's reproductive health. They can help manage Neurogenic bladder in women, especially those related to pregnancy or childbirth.
• Primary Care Physician: A doctor who provides primary healthcare and can refer patients to specialists for further evaluation and treatment.

Here are some classes of medications that may be prescribed for the treatment of Neurogenic bladder:

• Antimuscarinic medications: These medications work by blocking the action of acetylcholine, a neurotransmitter that stimulates bladder contractions. Examples of antimuscarinic medications include oxybutynin (Ditropan), tolterodine (Detrol), and solifenacin (Vesicare).
• Beta-3 agonists: These medications work by relaxing the bladder muscles and increasing bladder capacity. Mirabegron (Myrbetriq) is an example of a beta-3 agonist medication.
• Alpha-adrenergic agonists: These medications work by increasing the tone of the bladder outlet and reducing incontinence. Examples of alpha-adrenergic agonists include pseudoephedrine (Sudafed) and phenylpropanolamine (Proin).
• Botox injections: Botulinum toxin A (Botox) injections can be used to treat overactive bladder symptoms in patients who have not responded to other treatments. Injections of Botox function by preventing the production of acetylcholine, which lessens bladder spasms.

The underlying reason and the degree of the ailment determine how long it takes for the neurogenic bladder to heal. Some patients may experience improvement within weeks, while others may require months or even years for complete recovery. In some cases, neurogenic bladder may be a chronic condition requiring ongoing management.

The outcome of surgery for a neurogenic bladder might vary according to the procedure and the patient.

• In certain circumstances, the effects could be long-lasting and provide long-term symptom alleviation.
• In other cases, additional treatment or surgery may be necessary to maintain or improve bladder function. Before deciding
• on surgery for a neurogenic bladder, it is crucial to go through the possible results and risks with a healthcare professional.

Here are some classes of medications that may be prescribed for the treatment of Neurogenic bladder:

• Antimuscarinic medications: These medications work by blocking the action of acetylcholine, a neurotransmitter that stimulates bladder contractions. Examples of antimuscarinic medications include oxybutynin (Ditropan), tolterodine (Detrol), and solifenacin (Vesicare).
• Beta-3 agonists: These medications work by relaxing the bladder muscles and increasing bladder capacity. Mirabegron (Myrbetriq) is an example of a beta-3 agonist medication.
• Alpha-adrenergic agonists: These medications work by increasing the tone of the bladder outlet and reducing incontinence. Examples of alpha-adrenergic agonists include pseudoephedrine (Sudafed) and phenylpropanolamine (Proin).
• Botox injections: Botulinum toxin A (Botox) injections can be used to treat overactive bladder symptoms in patients who have not responded to other treatments. Injections of Botox function by preventing the production of acetylcholine, which lessens bladder spasms.

Here are some estimated costs of Neurogenic bladder treatment in India:

• Medications: The cost of medications for Neurogenic bladder can range from a few hundred rupees to several thousand rupees per month, depending on the type of medication prescribed.
• Botox injections: The cost of Botox injections for Neurogenic bladder treatment can range from around Rs. 25,000 to Rs. 60,000 per injection, depending on the dosage and the hospital.
• Catheterization: Depending on the kind and frequency of catheterization, the cost of catheterization supplies might vary from a few hundred to several thousand rupees every month.
• Surgery: In some cases, surgery may be necessary to treat a Neurogenic bladder. The cost of surgery can vary widely depending on the type of surgery and the hospital, but it can range from around Rs. 1 lakh to Rs. 5 lacks or more.

Here are some possible side effects of common Neurogenic bladder treatments:

• Antimuscarinic medications: These medications can cause side effects such as dry mouth, constipation, blurred vision, dizziness, and cognitive impairment.
• Beta-3 agonists: Some drugs may have unwanted effects including headaches, nausea, vomiting, and raised blood pressure.
• Alpha-adrenergic agonists: These medications can cause side effects such as insomnia, restlessness, palpitations, and dry mouth.
• Botox injections: Botox injections can cause side effects such as urinary tract infection, urinary retention, hematuria (blood in the urine), and muscle weakness.
• Catheterization: Urinary tract infections, irritation of the bladder, and urethral damage are all risks that might rise after catheterization.