Genito-Urinary Neuropathy: Upsetting Nerve Damage

Today's post from merckmanuals.com (see link below) talks about a form of autonomic neuropathy (where nerve damage affects involuntary functions of the body) which is common to both male and female patients living with neuropathy (especially if you're a little older). Genito-urinary neuropathy mainly affects bladder and sexual function and can be extremely distressing to all concerned. This short article concentrates on bladder and urination problems due to nerve damage (sexual dysfunction information can be found by using the search button to the right of this blog). You may also learn more by reading the 'professional' version of this article by clicking on the link just after the title. It's not a subject that's easily discussed with friends or family and even your doctor, so it's wise to arm yourself with as much information as possible. Please don't just put up with it, in the hope that it will go away. Talk to your doctor and try to find the best treatment possible in order to minimise the effects on your daily life.

Neurogenic Bladder By Patrick J. Shenot, MD 2016

NOTE: This is the Consumer Version. DOCTORS: Click here for the Professional Version

Disorders of Urination
Control of Urination
Interstitial Cystitis

Neurogenic Bladder
Urinary Incontinence in Adults
Urinary Retention

Neurogenic bladder is lack of bladder control because of a nerve problem such as a stroke, spinal cord injury, or tumor.

Uncontrollable loss of urine (urinary incontinence) is the primary symptom.

Bladder catheterization, imaging, and tests to measure urine flow are done.

Treatment is aimed at periodic emptying of the bladder (for example, by intermittent catheterization and/or drugs).

Several muscles and nerves must work together for the body to control urination.

Neurogenic bladder may be

Flaccid: A flaccid bladder does not contract and the bladder fills up until it overflows. Then urine dribbles out.

Spastic: The person has involuntary bladder contractions and feels the need to urinate even when there is little or no urine in the bladder. Bladder contractions are typically poorly coordinated with the muscle that closes the opening of the bladder (urinary sphincter).

Mixed: Some people have elements of both flaccid and spastic bladder.
 
Any condition that damages or interferes with nerves that control the bladder or the bladder outlet can cause neurogenic bladder. Causes include stroke, spinal cord damage or injury, amyotrophic lateral sclerosis (ALS), Parkinson disease, multiple sclerosis, diabetic neuropathy, and nerve damage caused by pelvic surgery.

Symptoms of Neurogenic Bladder

The primary symptom is urinary incontinence. People continually release small amounts of urine. Men tend to have erectile dysfunction. Some people with spastic neurogenic bladder also need to urinate frequently, often with an urgent need, and need to get up during the night to urinate. People with spastic neurogenic bladder may have damage to other nerves that causes weakness, muscle spasms, and/or loss of sensation in the legs.

People with neurogenic bladder are at risk for urinary tract infections and stones in the urinary tract. People are also at risk of hydronephrosis (see Figure: Hydronephrosis: A Distended Kidney) when urine retained in the bladder causes urine to back up in the kidneys.

Diagnosis of Neurogenic Bladder

Measurement of the amount of urine left in the bladder after urination

Ultrasonography of the urinary tract

Sometimes more detailed studies such as cystography

Doctors may suspect neurogenic bladder in people with nerve disorders who have incontinence. Usually, doctors measure the amount of urine remaining in the bladder after the person urinates (postvoid residual volume) by inserting a catheter into the bladder or using ultrasonography. Ultrasonography of the entire urinary tract is also done to detect abnormalities, and some blood tests are done to assess kidney function.

Further tests may be needed depending on the person's condition. More detailed studies of the urinary tract (for example, cystography, cystoscopy, and cystometrography) may be done to check bladder function or to help determine the duration and cause of neurogenic bladder. 

Treatment of Neurogenic Bladder

Catheterization

Maintenance of fluid intake

Surgery, rarely

Prompt treatment can help prevent permanent dysfunction and kidney damage. Catheterization or techniques to trigger urination can help prevent urine from remaining too long in the bladder. For example, some people with spastic bladder can trigger urination by pressing their lower abdomen or scratching their thighs. When urine remains in the bladder for too long, the person is at risk of urinary tract infections. Inserting a catheter into the bladder periodically is usually safer than leaving a catheter in continuously.

People are encouraged to drink sufficient fluids and to limit calcium in the diet to prevent stones from developing. Doctors also monitor kidney function regularly.

Sometimes drugs given to treat urge incontinence can be helpful (see Table: Some Drugs Used to Treat Urinary Incontinence). Rarely, people need surgery to create another way for urine to leave the body.

http://www.merckmanuals.com/home/kidney-and-urinary-tract-disorders/disorders-of-urination/neurogenic-bladder