Neurogenic bladder can occur due to illness, injury or congenital malformations of the brain, spinal cord or nerves leading into the bladder, its opening (part of which opens into the urethra), or both.Neurogenic bladder may be too active, when it is unable to constrict (nekontraktilan) and completely empty, or it may be overly active (spastičan), emptying the uncontrolled nerve reflexes.
Causes
• Too little active bladder is usually caused by interruption of local nerves supplying the bladder. The most common cause in children is a congenital disorder such as spina bifida (split spine of bone, usually in the lower part or area of the cross) or mijelomeningokele (condition in which the cleavage of the spine followed by a bag and the protrusion of the spinal cord).
• overactive bladder usually occurs when the spinal cord and brain do not have normal control over the work of the bladder. Common causes of injuries or disorders such as multiple sclerosis, affecting the spinal cord, which can also lead to paralysis of legs (paraplagije) or both arms and legs (quadriplegia). Such damage often causes flabbiness bladder for days, weeks or months (period of shock). Later on, and overactive bladder empties will be no impact.
Symptoms
Symptoms vary, depending on whether the bladder is too small or too active.
Being too active bladder usually are released, it expands until it becomes very large. This increase is usually not painful because the bladder is stretched slowly and has little or no innervation. In some cases, the bladder remains increased, but it constantly running out of small amounts of urine (overflow). In people with too little active bladder urinary bladder are common, because the amount of residual (residual) urine creates conditions that encourage bacterial growth. Within the bladder stones can be created, especially if the person has a chronic infection of the urinary bladder with which she needs a permanent catheter. Symptoms of bladder infection can vary, depending on the degree of innervation, which is still operating.
Overactive bladder can be filled and discharged without control and with the expressed differently warning signs, because it fills and empties reflexively (without the influence of the will).
With too little active bladder pressure and back flow of urine from the bladder to the ureters, can damage the kidneys. In people with spinal cord injury, bladder contraction and relaxation of the bladder outlet may not be aligned so that the pressure remains in the bladder prevents the kidneys and increased discharge.
Diagnosis
The doctor can often detect increased bladder examination of the lower abdomen. X-ray pictures using contrast material injected into a vein (intravenous urography) or via a catheter introduced into the bladder (cystography) and urethra (uretrografija) provide abundant information.
X-ray images show the size of the ureter and bladder, and possibly gallstones and kidney damage, revealing the doctor how your kidneys are working. Search UZ-om provides similar information.
istoskopija the process by which a doctor examines the inside of the bladder directly through a flexible tube that is introduced, usually a painless procedure, through the urethra.
The amount of urine that remains in the bladder after urination (residual or residual urine) can be measured by introducing a catheter through the urethra to the bladder emptied. The pressure inside the bladder and urethra can be measured by connecting the catheter with a measuring device (cistometrografija).
Treatment
When neurological injury caused by too little active bladder, urethra through a catheter can be introduced to the bladder permanently or periodically emptied. Katater be introduced as soon as possible after injury to prevent excessive damage to the bladder muscle stretching, as well as for preventing urinary tract infections.
Permanent catheter placement in women causes less physical problems than men.
In males, the catheter can cause inflammation of the urethra and surrounding tissues. However, both women and men, the better the patient's catheter is introduced from time to time, 4-6 times a day and removed after the bladder is empty (temporary samokateterizacija).
People in whom overactive bladder can also introduce a catheter for bladder vacuity, if you prevent bladder contractions that are fully discharged.
In kvadriplegičnih men, who can themselves introduce the catheter, the sphincter (the muscle that closes the annular opening in the outlet) must be cut, to allow emptying and can handle an external urine collector. Electrical impulses may stimulate the bladder, the nerves that control it, or spinal cord, in order to reach the bladder contraction, this procedure is still experimental.
Medications can improve the storage of urine in the bladder. Control over-active bladder can be improved by drugs that relax the bladder, such as anticholinergic drugs.
However, these drugs often cause side effects like dry mouth and constipation, and improve bladder emptying in people with neurogenic bladder is not easy.
It is sometimes recommended for surgical procedures directing urine to the outside opening (DMD) has been done on the wall of the stomach or increase the urinary bladder. The urine from the kidney can be directed towards the surface of the body by removing a small portion of the small bowel, ureter connecting the small intestine and connecting the small intestine to an opening on the surface of the body. This process is called ileal loop.
The urinary bladder is a piece of bowel can increase a process called raising a cistoplastika performed and samokateterizacija. In children it is the connection between the bladder and the opening in the skin (vezikostoma) as an interim measure, until the child is big enough to make the final surgery.
Regardless of whether the urine is directed outwards or catheterization is used, great efforts are being made in reducing the risk of formation of urinary stones. Closely monitor the kidney function. Kidney infection is treated promptly. It is recommended to drink at least eight glasses of fluid a day. The position of real people often change, and others are encouraged to be as much as possible move. Although complete recovery in people with neurogenic bladder uncommon, some people with healing pretty well recovered.
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