In the neurogenic incontinence it is a certain form of a bladder dysfunction, the cause of which is a disorder or damage to nerve transmission. Since it is a chronic disease, a lifelong and holistic care of those affected is always required.
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What is neurogenic incontinence?
Neurogenic incontinence limits the natural ability to let water. Both the storage function of the bladder and the process of emptying the bladder may be affected. In this context, doctors also speak of neurogenic bladder, overflow bladder or reflex bladder. In the neurogenic bladder voiding disorder, the natural interaction of the involved nerves and muscles is so disturbed that it can involuntarily come to spontaneous bladder emptying, which is understandably very uncomfortable for those affected.
The function of the bladder muscles is controlled by the nervous system. It is a finely tuned loop that both conveys bladder filling to parts of the brain and triggers the bladder emptying reflex. Both circuits are disturbed by incontinence.
Also, internal diseases that cause nerve damage due to misguided metabolic processes may be responsible for a neurogenic overflow bladder. The most common internal cause of neural incontinence is diabetes mellitus, the problems with urination usually develop creeping over a longer period of time. In these cases, the patient notices the neurogenic bladder emptying disorder only when more than one drop already involuntarily escapes. Another clinically relevant cause of nerve bladder dysfunction is surgery that accidentally injures nerve components. The damage is mostly irreversible.
Symptoms and course
Typical symptoms of neurogenic incontinence:
Depending on the extent of nerve damage, you may experience very different symptoms. If the storage function of the bladder is disturbed, then the receptors on the muscular inner wall no longer respond to the filling state. In this case, it comes to the typical neural overflow bladder with droplet-like urine output, as soon as the bladder can no longer withstand the pressure.
In the neurogenic reflex bladder, on the other hand, involuntary contractions of the urinary bladder muscles with severe urinary urgency and non-randomly controllable bladder emptying occur. In the so-called autonomous neurogenic incontinence, the urinary bladder muscles work very uncoordinated due to the nerve damage, so that, for example, comes to a spontaneous emptying every 20 minutes. Regularly remains a larger amount of urine in the bladder, urologists speak of the so-called residual urine.
It can lead to urinary retention with pressure on both kidneys with the consequence of impairment of renal function to terminal renal failure with dialysis. The residual urine is also a reservoir for many types of pathological germs. Therefore, patients with neurogenic incontinence often suffer from recurrent bladder and urinary tract infections, which can further severely limit quality of life.
The suspected diagnosis of any form of incontinence results from the symptom of urinary bladder dysfunction, which allows the patient to record a daily basis, so that the extent of the nerve disorder can be better limited. In addition to the anamnesis, a detailed physical examination, in particular of the nervous system and the urogenital tract. An ultrasound examination of the bladder serves to determine whether it can be completely emptied or whether residual urine remains.
Also, the pressure on the inner wall of the bladder and the pressure during urination can be measured in urological practice. Advanced diagnostics include imaging techniques such as x-rays or magnetic resonance imaging, as well as laboratory tests of urine and blood for diagnosis and follow-up.
Treatment and therapy
The treatment of incontinence disorders of nervous causes always depends on the extent of damage to muscles and nerves. In the case of paraplegia treatment can only be carried out in specially established competence centers. If diabetes is the cause, then the blood sugar level must be optimally adjusted in the long term to avoid further nerve damage.
Prevention of the special form of neurogenic incontinence arises from their possible causes. If nerve cords of the bladder wall or the ureter are already damaged, a causal therapy is often no longer possible. Early diagnosis to avoid fulminant disease progression is just as important as consequent avoidance of superinfection by residual urine.
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