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Symptoms of a neurogenic bladder
Last reviewed: 23.04.2024
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All the symptoms of a neurogenic bladder are conventionally divided into three groups:
- manifestations of bladder diseases of exclusively neurogenic etiology;
- symptoms of complication of the neurogenic bladder (cystitis, pyelonephritis, vesicoureteral reflux, megaureter, hydronephrosis);
- clinical manifestations of neurogenic involvement of pelvic organs (colon, anal sphincter).
Without detailed description of the forms of the neurogenic bladder, the frequency of symptoms of disorders of urination is as follows: enuresis occurs in 74.5%, imperative urges in 68.3%, imperative urinary incontinence in 67.8%, pollakiuria in 60.4%, increase the morning effective volume of the bladder in 18,6%, difficult urination in large portions in 3,6%.
Imperative urges are noted when children make complaints about periodic appearing desires to urinate without urinating.
Enuresis - involuntary urination in children older than 3 years of age. Isolate night and daytime enuresis.
Pollakiuria - increased frequency of urination, with a decrease in intervals between them to 1/5 - 2 hours and a decrease in the volume of the bladder.
Imperative urges, imperative urinary incontinence do not have age dependence, while enuresis and pollakiuria decrease by 12-14 years, which is an indirect sign of recovery of the vesicular reflex.
In 1,5-2% of cases, disorders of the act of urination are combined with encopresis, which indicates concomitant disorders of the innervation mechanisms of the rectum.
Hyperreflective urinary bladder (or hyperreflexive dysfunction of the bladder) is characterized by frequent urination in small portions (the mean portion is less than the norm). This often reveals enuresis.
A type of hyperreflex is a postural bladder. In an upright position (in the afternoon) - portions of urine are small, and urination is frequent. In a horizontal position (at night), urine accumulates in both a healthy person and a morning urine of normal volume. Characteristic of the day urinary incontinence.
For a hyporeflective urinary bladder (or hyporeflective dysfunction of the bladder), a rare urination in large portions is typical, the average urine dose is higher than normal, and a lot of residual urine. Enuresis usually does not happen. The cystogram reveals a large bladder. In this type of neurogenic bladder, a decrease in receptor sensitivity is determined. Sometimes a paradoxical ishuria is formed: the bladder is stretched, but there is no urge, the urine drips away. Against this background, complications may develop: pyelonephritis, cystitis, vesicoureteral reflux.
At an early age, the neurogenic bladder is more often observed in the hyperreflective type (61.3%). Against the backdrop of a neurogenic bladder, the hyporeflectory type is observed in a large percentage of cases of nocturnal enuresis, and in the case of a neurogenic bladder, the hyperreflexive type is a daily urinary incontinence. The presence of a neurogenic bladder predisposes to the development of cystitis or pyelonephritis in 84% of cases.
Each of the existing forms of dysfunction does not have a clear clinical symptomatology. Therefore, we can talk only about some features of urination disorders in general.
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