Neurogenic Bladder

Neurogenic bladder is a bladder malfunction caused by an injury or disorder of the

brain, spinal cord, or nerves. The condition can lead to voiding difficulties, such as
urinating too often or at the wrong time or being unable to completely empty the
bladder. Left untreated, neurogenic bladder can result in kidney damage.
-So ang cause kung bakit nagkakaroon ng Neurogenic bladder ang isang tao ay dahil
sa injury or disorder sa ating brain, spinal cord or nerves. So isa sa mga yan ang
dahilan kung bakit nagkakaroon ng neurogenic bladder ang isang tao. Yung meron mga
neurogenic bladder nahihirapan sila mag urinate or madalas o hindi nila ma control
yung pag urinate nila. At pag hindi naagapan mag reresult ng pagkasira ng kidney. So
ang bladder ay isang hollow organ na located sa pelvis or lower abdomen. So one main
jobs ng bladder ay mag store ng urine. At mag remove ng urine in our body in response
to signals from our spinal cord and brain.
Predisposing factors - Spinal cord trauma is the most common causes of neurogenic
bladder in the adult and pediatric population, respectively. The voiding reflex in the
normal adult relaxes the urinary sphincter during bladder contraction. Loss of this
coordinated reflex in patients with neurogenic bladder results in bladder contraction
against a closed sphincter, known as detrusor sphincter dysenergia (DSD).
-So spinal cord trauma ang pinaka common causes kung bakit nagkakaroon ng
neurogenic bladder ang isang tao in adult man or pediatric. The voiding reflex in the
normal adult relaxes the urinary sphincter during bladder contraction. Loss of this
coordinated reflex in patients with neurogenic bladder results in bladder contraction
against a closed sphincter, known as detrusor sphincter dysenergia (DSD).
-and also High-pressure voiding puts the patient at risk of bladder deterioration and
upper urinary tract damage.
Precipitating factors - Injury or damage to the nerves is a primary cause of neurogenic
bladder. Some conditions or diseases of the body can result in nerve damage and,
subsequently, neurogenic bladder. Examples of such conditions are diabetes, heavy
alcohol use, vitamin B12 deficiency, neuropathy, and syphilis. The nerves can also be
damaged directly, as from pelvic surgery or spinal canal stenosis.
-So yung nga injury or damage sa nerves ang primary cause ng neurogenic bladder.
Some conditions or diseases of the body can result in nerve damage and,
subsequently, neurogenic bladder. Examples yung mga conditions kagaya ng diabetes,
heavy alcohol use, vitamin B12 deficiency, and neuropathy. The nerves can also be
damaged directly, as from pelvic surgery or spinal canal stenosis.
- Neurogenic bladder dysfunction is very common among people with spinal cord
injuries, affecting more than 90% of them. The condition also affects 50% to 80% of
people who have multiple sclerosis. Neurogenic bladder affects people with stroke and
Parkinson’s disease and many other types of nervous system conditions. Conditions
that damage nerves like advanced diabetes can also cause neurogenic bladder.

The disease process - Neurogenic bladder occurs when a person’s nerves, spinal
cord, or brain have problems sending electrical signals to the bladder. This causes
difficulty with urination.
There are two broad types of neurogenic bladder: overactive and underactive. An
overactive bladder may leak urine, whereas an underactive bladder may struggle to
release urine.
The causes of neurogenic bladder relate to problems with the nervous system. Because
the nerves in the spinal cord cannot communicate well with the muscles in the bladder
wall, the brain does not know when the bladder is full or empty.
If the muscles are overactive, they contract too much and squeeze the bladder when it
is not full. Alternatively, if the muscles are underactive, they do not contract, and a
person cannot urinate.
Signs and symptoms of neurogenic bladder
The most common symptom of neurogenic bladder is being unable to control urination.
Other neurogenic bladder symptoms include:
 A weak or dribbling urinary stream.
 Frequent urination (urinating eight or more times daily).
 Urgency (a feeling or need to urinate immediately).
 Painful urination, which may mean there is a urinary tract infection.
 Urinary leakage.
Complications related to neurogenic bladder
 People who have neurogenic bladder are at higher risk for other urological
problems, including repeated infections, kidney damage, vesicoureteral reflux
and stones that form in the urinary tract.
 Urine leakage often happens when the muscles holding urine and do not get the
right message.
 Urine retention happens if the muscles holding urine and do not get the
message that it is time to pass urine.
 Damage to the tiny blood vessels in the kidney may happen if the bladder
becomes too full and urine backs up into the kidneys. This causes extra pressure
and may lead to blood in the urine.
  Infection of the bladder, ureters, or kidneys often results from urine that is
held too long before it’s passed out of the body.

Nursing Management
 Encourage overall fluid intake but limit the fluid intake before bedtime.
 Reducing the drinks that stimulate urination, like cola, coffee or tea.
 Monitor the intake and output of the patient.
 Scheduled toileting or prompted voiding regiments is one therapy in which
patients are toileted on a schedule (usually every 2 h).
 Encourage regular intake of cranberry juice.
Medical Management
 Lifestyle changes - avoiding foods or beverages that can irritate your bladder
may be one of them. These include soda, some caffeinated drinks like coffee,
and alcohol.
 Clean intermittent catheterization (CIC) - is used when the patient has a
urinary retention. It involves inserting a catheter—a tiny tube—into the bladder to
drain the urine.
 Bladder Botox Injections – this treatment helps relax the bladder muscle and
allows the bladder to store more urine.
 Bladder augmentation (augmentation cystoplasty) - a surgeon performs this
procedure to remove sections of your sigmoid colon and attach them to the
bladder walls. With this surgery the bladder's ability to store urine will increase
while the internal pressure is reduced.

Pharmacologic Management
Medications that treat neurogenic bladder include oxybutynin, tolterodine and
mirabegron
Oxybutynin- is indicated for the relief of symptoms of bladder instability associated with
voiding in patients with uninhibited neurogenic or reflex neurogenic bladder
Tolterodine- used to treat people who have urinary problems such as urinary
incontinence or frequency which are caused by an overactive bladder. It works by
preventing spasms of the bladder muscle which can help to reduce the episodes of
urinary incontinence or reduce the feeling of urgency that bladder spasms can cause.
Mirabegron- used in adults to treat overactive bladder with symptoms of frequent or
urgent urination and urinary incontinence.
Health Teachings
 Discuss the importance of adequate fluid intake.
 Advise patients to restrict fluid intake approximately two hours before starting any
activity where no bathroom will be available and avoid drinking fluids after dinner
to prevent nocturia
 Keep the patient dry and comfortable, they should be check regularly (at least
every 2 hours)
 Assist them in toilet if needed
 Let them wear comfortable clothes and easy to take off.