Neurogenic incontinence
The neurogenic forms of incontinence and bladder emptying disorder are caused by diseases or disorders of the nervous system.
Causes
Both the central nervous system (i.e. the brain or spinal cord) and the peripheral nervous system may be affected. The disorders manifest themselves in disturbed functioning of the bladder, the sphincter muscle or both organs.
Examples of possible causes:
- Strokes
- Parkinson's disease
- Multiple sclerosis
- Paraplegia
- Herniated disc with damage to the spinal cord
- Malformations
- Injuries to the brain, spinal cord or peripheral nerves
- After operations on the spinal column or in the pelvis
- Medication
- Rare degenerative nervous diseases (e.g. Guillain-Barré syndrome)
- Infections of the nervous system (e.g. borreliosis).
Symptoms and clinical classification
Depending on the cause, the symptoms can differ widely. There may be excessive or reduced muscular activity on the bladder, and sensitivity to bladder filling may be increased or decreased. On the one hand, the sphincter muscle may only partially close the bladder, but on the other hand, it may only open incompletely when emptying, so that the bladder has to empty itself against increased pressure. In cases of this kind, people also speak of sphincter-detrusor-dyssynergy (DSD).
An important classification in everyday clinical practice is the distinction between a "low pressure" and "high pressure" system.
In the case of a low-pressure system, the pressures generated during progressive filling of the bladder and emptying of the bladder are no higher than in healthy individuals. However, patients often have incomplete emptying of the bladder, with recurrent infections as possible complications.
In a high-pressure system, very high pressures arise in the lower urinary tract through contractions of the bladder muscle against the closed sphincter. These high pressures cause the urine to flow back into the kidneys, which in the long term damages the kidneys and can lead to the need for dialysis. In order to detect such malfunctions of the urinary tract in good time, patients with a neurogenic micturition disorder should have regular bladder pressure measurements carried out (about once a year).
Treatment
Since restoration of the natural bladder function is usually not possible due to the respective cause, the primary goal of treatment is to maintain normal kidney function, with avoidance of increased pressures and infections in the urinary tract.
Other available options are medication therapy, emptying the bladder by means of disposable or permanent catheterisation, or even surgical measures where appropriate.
The treatment must always be adapted to the individual patient's needs.
