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Symptoms of neurogenic bladder disease
Last reviewed: 06.07.2025
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All symptoms of neurogenic bladder are conventionally divided into three groups:
- manifestation of bladder diseases of exclusively neurogenic etiology;
- symptoms of complications of neurogenic bladder (cystitis, pyelonephritis, vesicoureteral reflux, megaureter, hydronephrosis);
- clinical manifestations of neurogenic lesions of the pelvic organs (colon, anal sphincter).
Without detailing the forms of neurogenic bladder, the frequency of symptoms of urination disorders is as follows: enuresis occurs in 74.5%, imperative urges - in 68.3%, imperative urinary incontinence - in 67.8%, pollakiuria - in 60.4%, an increase in the morning effective volume of the bladder in 18.6%, difficult urination in large portions in 3.6%.
Imperative urges are noted when children complain of periodic desires to urinate without urinating.
Enuresis is involuntary urination in children over 3 years of age. There are nocturnal and daytime enuresis.
Pollakiuria is an increase in the frequency of urination, with a decrease in the intervals between them to 1/5 - 2 hours and a decrease in the volume of the bladder.
Urgent urges and imperative urinary incontinence do not have an age dependence, while enuresis and pollakiuria decrease by 12-14 years, which is an indirect sign of the restoration of the bladder reflex.
In 1.5-2% of cases, urination disorders are combined with encopresis, which indicates concomitant disorders of the innervation mechanisms of the rectum.
Hyperreflexive bladder (or hyperreflexive bladder dysfunction) is characterized by frequent urination in small portions (with the average portion being smaller than normal). Enuresis is often detected.
A type of hyperreflexive is the postural bladder. In the vertical position (daytime) - urine portions are small, and urination is frequent. In the horizontal position (nighttime) urine accumulates as in a healthy person and the morning urine is of normal volume. Daytime urinary incontinence is typical.
Hyporeflexive bladder (or hyporeflexive bladder dysfunction) is characterized by rare urination in large portions, the average portion of urine is larger than normal, and there is a lot of residual urine. Enuresis usually does not occur. A cystogram reveals a large bladder. With this type of neurogenic bladder, a decrease in receptor sensitivity is determined. Sometimes paradoxical ischuria is formed: the bladder is stretched, but there is no urge, urine comes out in drops. Against this background, complications can develop: pyelonephritis, cystitis, vesicoureteral reflux.
At an early age, neurogenic bladder of the hyperreflexive type is more often observed (61.3%). Against the background of neurogenic bladder of the hyporeflexive type, nocturnal enuresis is observed in a large percentage of cases, and with neurogenic bladder of the hyperreflexive type - daytime urinary incontinence. The presence of neurogenic bladder predisposes to the development of cystitis or pyelonephritis in 84% of cases.
Each of the existing forms of dysfunction does not have clear clinical symptoms. Therefore, we can only talk about some features of urination disorders in general.
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