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Updated October 12, 2014.
The simple act of urination is actually rather complicated, calling on almost every division of the nervous system. Voluntary nerves works alongside both the autonomic system, with both sensory and motor nerves getting involved. Control of urination depends on centers in the brain, brainstem and the spinal cord.
With so many opportunities for things to go wrong, the term neurogenic bladder actually encompasses a number of different problems, each responding to a different treatment.
In addition to ensuring that the cause is in fact neurological and not due, for example, to obstruction by the prostate or inflammation due to a urinary tract infection, several tests can be used to better determine the exact cause of neurogenic bladder.
Lab Studies:
Laboratory studies may be done on the urine itself to ensure that a urinary tract isn’t present. Not only can UTIs cause incontinence in some cases, but in the case of neurogenic bladder poor urinary flow can set someone up to get an infection, and it’s best to catch that as soon as possible. Cytology may also be checked to investigate for possible bladder cancer. A blood urea nitrogen (BUN) and creatinine (Cr) level may be checked if it’s suspected that the kidney’s may have been damaged as a result of the urinary problem.
Monitoring:
Monitoring of how much urine is lost and at what times is best done with a voiding diary, a record of daily bladder activity. A pad test, in which someone wears a pad that changes color with urine, can also be used to determine if incontinence is occurring about which someone is unaware, as may be the case in some spinal injuries or dementia, for example.
Imaging:
Procedures:
Using an appropriate combination of the techniques above can permit doctors to hone in on the cause of urinary incontinence or retention. Doctors who diagnose neurogenic bladder can thereby rule out other problems such as obstruction by a tumor, and hone in on neurological causes of bladder dysfunction.
Sources:
JQ Clemens, Urinary incontinence in men. In M. O’Leary, DM RRind, eds. UpToDate, updated Oct. 3, 2013.
CE DuBeau. Approach to women with urinary incontinence. In Linda Brubaker, KE Schmader, MP O’Leary, eds. UpToDate, updated Oct. 3, 2013.
D Ginsberg. The epidemiology and pathophysiology of neurogenic bladder. Am J Manag Care. 2013 Jul; 19(10 Suppl)s191-6
Updated October 12, 2014.
The simple act of urination is actually rather complicated, calling on almost every division of the nervous system. Voluntary nerves works alongside both the autonomic system, with both sensory and motor nerves getting involved. Control of urination depends on centers in the brain, brainstem and the spinal cord.
With so many opportunities for things to go wrong, the term neurogenic bladder actually encompasses a number of different problems, each responding to a different treatment.
In addition to ensuring that the cause is in fact neurological and not due, for example, to obstruction by the prostate or inflammation due to a urinary tract infection, several tests can be used to better determine the exact cause of neurogenic bladder.
Lab Studies:
Laboratory studies may be done on the urine itself to ensure that a urinary tract isn’t present. Not only can UTIs cause incontinence in some cases, but in the case of neurogenic bladder poor urinary flow can set someone up to get an infection, and it’s best to catch that as soon as possible. Cytology may also be checked to investigate for possible bladder cancer. A blood urea nitrogen (BUN) and creatinine (Cr) level may be checked if it’s suspected that the kidney’s may have been damaged as a result of the urinary problem.
Monitoring:
Monitoring of how much urine is lost and at what times is best done with a voiding diary, a record of daily bladder activity. A pad test, in which someone wears a pad that changes color with urine, can also be used to determine if incontinence is occurring about which someone is unaware, as may be the case in some spinal injuries or dementia, for example.
Imaging:
- Cystogram—a cystogram allows doctors to see the bladder either at rest or during urination. This is useful for looking for structural problems such as fistulae, but also allows the doctor to look for abnormal flow patterns, such as stress incontinence or reflux.
- Neuroimaging—An MRI scan may be used to evaluate the spinal cord or other areas of the nervous system to find the lesion causing incontinence.
Procedures:
- Post-Void Residual— An ultrasound scan can be used to gauge how much urine is left in the bladder after someone urinates. In the case of overflow incontinence, as may be seen in an acute spinal cord injury or damage to the peripheral nerves, more urine will be retained than normal after urination.
- Electromyography (EMG)— EMG can be used to evaluate activity in various muscle groups while voiding. It can thereby assess whether the urethral sphincters relax while the bladder is contracting, permitting a diagnosis of detrusor sphincter dyssynergia which is common, for example, in multiple sclerosis.
- Uroflow Rate— This measures how much urine flows in a certain amount of time. If this is low, it is suggestive of either of outlet obstruction, such as in benign prostate hypertrophy, or of decreased detrusor activity, as in a sacral cord injury.
- Cystometrogram— A filling cystometrogram assesses whether the bladder distends normally when filling with fluid. This may be abnormal in the case of bladder spasticity. A voiding cystometrogram looks at the pressure of the bladder and the flow of urine during urination, thereby distinguishing between obstruction and detrusor contractility.
- Cystoscopy— Whereas a cystogram is a radiographic image of the bladder, cystoscopy uses fiberoptics so that the inside of the bladder can be viewed more directly. This can be useful, for example, in confirming the presence and location of a tumor.
Using an appropriate combination of the techniques above can permit doctors to hone in on the cause of urinary incontinence or retention. Doctors who diagnose neurogenic bladder can thereby rule out other problems such as obstruction by a tumor, and hone in on neurological causes of bladder dysfunction.
Sources:
JQ Clemens, Urinary incontinence in men. In M. O’Leary, DM RRind, eds. UpToDate, updated Oct. 3, 2013.
CE DuBeau. Approach to women with urinary incontinence. In Linda Brubaker, KE Schmader, MP O’Leary, eds. UpToDate, updated Oct. 3, 2013.
D Ginsberg. The epidemiology and pathophysiology of neurogenic bladder. Am J Manag Care. 2013 Jul; 19(10 Suppl)s191-6
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