Managing Neurogenic Bladder Dysfunction: Seeking Neurology Solutions

Central nervous system damage?

Six years ago, I had chickenpox accompanied by a high fever, which has led to my current symptoms of frequent urination, urgency, nocturia, and urge incontinence.
During the storage phase of urination, my bladder often experiences involuntary contractions without warning.
If I cannot reach the restroom in time during an urgent need, I experience incontinence.
Coughing or sneezing also stimulates the bladder, causing a sense of urgency.
I frequently wet the bed while sleeping.
I have previously consulted a urologist, who indicated that there is an issue with my central nervous system and prescribed medication for overactive bladder and enuresis, but there has not been significant improvement.
When I experience involuntary bladder contractions and urgency, I try to continuously lift my legs, which occasionally provides temporary relief from the urgency, but soon the bladder starts contracting involuntarily again.
The amount of urine expelled is only about 200cc.
This situation greatly affects my daily life.
Could neurology provide any assistance?

Hans, 30~39 year old female. Ask Date: 2002/07/28

Dr. Ye Boshou reply Neurology

First, it is important to clarify whether your urinary issues occurred during the chickenpox infection six years ago or if they developed afterward.
If they occurred at that time and there were abnormalities in the cerebrospinal fluid analysis, it may indicate an infection such as myelitis.
If that is the case, the treatment options may be limited.
However, if the issues developed later, it raises suspicion for spinal cord pathology.
Further examinations are necessary.
Please visit a neurology clinic for an evaluation of your neurological function and lower limb reflexes.

Reply Date: 2002/07/28

More Info

Neurogenic bladder dysfunction is a condition that arises from neurological disorders affecting the bladder's ability to store and release urine. In your case, the symptoms you describe—frequent urination, urgency, nocturia, and urge incontinence—are indicative of an overactive bladder, which can occur due to central nervous system issues, such as those stemming from your previous varicella (chickenpox) infection and subsequent fever.

Understanding Neurogenic Bladder Dysfunction
The bladder is controlled by a complex interplay of the nervous system, including both the central nervous system (CNS) and the peripheral nervous system. When the CNS is affected, as in your case, it can lead to improper signaling between the brain and the bladder. This can result in involuntary contractions of the bladder muscle (detrusor), leading to the symptoms you experience.

Symptoms and Their Impact
The symptoms you describe—such as urgency and incontinence—can significantly impact your quality of life. The involuntary contractions of the bladder can occur without warning, making it difficult to reach the restroom in time. Additionally, activities like coughing or sneezing can exacerbate the urgency, leading to further episodes of incontinence. Nighttime bedwetting (nocturnal enuresis) is also common in individuals with neurogenic bladder dysfunction, as the brain may not adequately signal the need to void during sleep.

Current Management Strategies
You mentioned that you have been prescribed medications for overactive bladder and enuresis, but have not experienced significant improvement. Common medications include anticholinergics (like oxybutynin or tolterodine) and beta-3 adrenergic agonists (like mirabegron), which can help relax the bladder muscle and reduce urgency. However, these medications may not work for everyone, and side effects can also limit their use.

Neurology's Role in Management
Given that your symptoms are linked to a central nervous system issue, a neurologist can provide a comprehensive evaluation to determine the underlying cause of your bladder dysfunction. This may include:
1. Neurological Assessment: A thorough examination to assess for any other neurological deficits that may be contributing to your symptoms.

2. Urodynamic Studies: These tests measure how well the bladder and urethra are storing and releasing urine. They can help identify the specific nature of your bladder dysfunction.

3. Imaging Studies: MRI or CT scans may be used to evaluate the brain and spinal cord for any abnormalities that could be affecting bladder control.

4. Botulinum Toxin Injections: In cases where medications are ineffective, injections of botulinum toxin into the bladder muscle can help reduce involuntary contractions.

5. Neuromodulation Therapy: Techniques such as sacral nerve stimulation can help regulate bladder function by sending electrical impulses to the nerves controlling the bladder.

6. Behavioral Therapies: Bladder training and pelvic floor exercises may also be recommended to help manage symptoms.

Lifestyle Modifications
In addition to medical treatments, certain lifestyle modifications can help manage symptoms. These may include:
- Fluid Management: Adjusting fluid intake to reduce nighttime urination.

- Scheduled Voiding: Establishing a regular schedule for bathroom visits can help train the bladder.

- Pelvic Floor Exercises: Strengthening the pelvic floor muscles may improve bladder control.

Conclusion
Neurogenic bladder dysfunction can be challenging to manage, but with a comprehensive approach involving both urological and neurological evaluations, there may be options available to improve your symptoms. It is essential to communicate openly with your healthcare providers about the impact of these symptoms on your daily life, as they can tailor a management plan that best suits your needs. If you have not yet consulted a neurologist, it may be beneficial to seek their expertise to explore further diagnostic and treatment options.

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