Treatment for Neurogenic Bladder
Therapies for neurogenic bladder fall into four categories: physical-psychological, electrical-stimulatory, drug therapy and surgery. The correct therapy or combination of therapies is determined by symptoms, type and extent of nerve damage, and a comprehensive consultation with the patient to determine his needs, abilities and desires.
Physical-psychological therapy, also called timed voiding, can reduce problems caused by overactive bladder. It combines will power and exercise. The patient is asked to keep a voiding diary, which is a daily record of the amount and time of fluid intake, times of urination, and episodes of leakage. The record creates a pattern that may initially allow patients to determine the times of the day they should be in close proximity to a bathroom. These are also the times when a patient should attempt to urinate. The intervals between voiding times are gradually extended as the patient gains control over voiding. This conditioning is often coupled with physical exercises, principally Kegel exercises, which strengthen pelvic muscles. The Valsalva maneuver, an exertion used to pass stool, may also be sufficient to empty a bladder.
Electrical-stimulatory therapy is a recent advance. Electrodes and a small stimulator are implanted in a minor surgical procedure. The electrodes are placed near targeted nerves. The stimulator is placed beneath the skin. The stimulator delivers electrical impulses that mimic those that would normally be delivered by nerves if they were undamaged. The device has been approved by the U.S. Food and Drug Administration to treat urge incontinence, urgency-frequency syndromes, and urinary retention in patients in whom other therapies have failed.
There are as yet no drugs that target specific muscles such as the sphincter. However there are classes of drugs that reduce muscle spasms and tremors and other drugs that induce contractions. These can sometimes be effective in appropriate neurogenic bladder conditions.
Catheterization, although not strictly a surgical procedure, is not infrequently employed to ensure complete bladder drainage. It involves the insertion of a thin tube through the urethra and into the bladder. A number of patients can learn to insert the catheter themselves. The therapy is called Clean Intermittent Catheterization (CIC). Exceptional sanitary procedures must be followed as the risk of urinary tract infection is significant with any type of catheterization. Another therapy, indwelling catheterization, places a catheter in the bladder for extended periods. These prevent bladder distension by continually draining urine into a bedside collector. Again, infection is a concern.
Urethral stents, something like an internal catheter, can be surgically inserted through the sphincter muscle to expand it and allow urine to be drained.
The sphincter can be surgically weakened by a procedure called sphincter resection, which removes a portion of the muscle or the muscle may be removed in its entirety in a sphincterotomy.
Artificial sphincters are a mechanical intervention. These devices consist of a cuff that fits around the bladder neck, a pressure regulating balloon and a pump that inflates the cuff. The balloon is placed beneath the abdominal muscles. The pump is placed in the labia in women and in the scrotum for men. Other locations include placement beneath the skin of the abdominal wall or thigh. Activation of the pump diverts fluid from the cuff to the balloon allowing the sphincter muscle to relax and urine to pass. The cuff automatically re-inflates automatically in 3 to 5 minutes.
Urinary diversion creates a stoma (opening) through which urine is diverted to a collection pouch.
Although many of these procedures may initially appear to create a burden, they have the purpose of preventing kidney damage. If left untreated, Neurogenic Bladder could lead to renal disease (kidney failure) which requires either a kidney transplant or dialysis to maintain life.