neurogenic bladder called a violation of the function of urination, due to damage to the nervous system. Neurogenic bladder dysfunction cannot be considered as an independent disease. This is a collective syndrome that combines conditions that arise in connection with congenital or acquired lesions at various levels of the nerve pathways and centers that innervate the bladder and provide the function of voluntary urination.

Causes of neurogenic bladder:

Inflammatory-degenerative diseases and tumors of the brain and spinal cord(encephalitis; diabetic, alcoholic and post-vaccination neuropathies, cholesteatoma, tuberculoma, multiple sclerosis, etc.).

Traumatic injuries of the brain and spinal cord (strokes, ruptures, compression, destruction, surgical interventions on the pelvic organs).

· Congenital defects of the terminal spine, spinal cord, nervous system of the bladder.

Clinic

Violations in the neurogenic bladder are either in the form of pathological retention of urine, or in the form of its incontinence. True urinary incontinence is accompanied by a lack of sensation of filling the bladder. The patient cannot retain urine, it does not accumulate in the bladder and is continuously excreted drop by drop as it enters it.

With paradoxical urinary incontinence (sluggish bladder), the reflex emptying of the bladder is disturbed. The detrusor does not contract, the internal sphincter is closed. Bladder fills up, but the reflex does not work. When the bladder overflows, urine, due to mechanical stretching of the internal sphincter, flows out in small portions. In this case, a large amount of urine remains in the bladder (residual urine).

In the absence of cortical regulation of urination (in case of damage to the spinal cord above the centers of segmental innervation of the bladder), the bladder is emptied reflexively - the automatism of the bladder is formed: as it is stretched by accumulated urine, corresponding irritations of the stretch receptors (pressure) occur and reflex emptying occurs. Urine is released involuntarily. The feeling of filling the bladder and the urge to urinate are most often absent. In this case, there is intermittent urinary incontinence with constant residual urine in the bladder (spastic bladder).

Another violation of the sensitivity of the bladder may be the lack of a feeling of fullness and the urge to urinate. With this disorder, a person does not feel his bladder and the need to urinate must be constantly remembered. This disorder, especially in combination with sphincter spasm, can lead to abnormal expansion of the bladder, reflux of urine into the ureters and kidneys with the development of inflammation in them.

Along with the inability to control urination, there may be such pathological sensations in the bladder as a feeling of its excessive fullness with the so-called false urge to urinate. False urges can occur very often, depriving a person of the opportunity to work and communicate normally.

Due to the fact that denervation of the bladder leads to pronounced trophic disorders, the course of the disease is often complicated by interstitial cystitis, which causes sclerosis and shrinkage of the bladder. This severe complication exacerbates the danger to the kidneys and in some cases requires special surgical interventions to increase the capacity of the bladder.

Diagnostics

In addition to examination, laboratory and instrumental studies are of great importance in the diagnosis of neurogenic bladder. Laboratory diagnostics includes general analysis urine, Zimnitsky test, complete blood count, biochemical blood test. From X-ray studies are carried out plain radiography, urethrocystography (normal and voiding), excretory urography, ascending pyelography. Significant methods of instrumental diagnostics are ultrasound of the kidneys and bladder, radioisotope renography, cystoscopy, urodynamic study and video urodynamic study (uroflowmetry, cystometry, sphincterometry).

Treatment

Treatment of a neurogenic bladder directly depends on the cause of nerve damage and requires, first of all, treatment. primary disease. There are three main areas of treatment: medication, electrical stimulation and surgery.

The main treatment is the use pharmacological agents. Urinary retention also requires adequate drainage of the bladder using an indwelling catheter; prevention of urinary tract infection or treatment of urological infection in the event of its development with antiseptics and / or antibiotics. In patients with urinary incontinence, measures are taken to resume reflex emptying of the bladder. For this purpose, regular clamping of the indwelling catheter every 2-3 hours and other methods are used.

You can undergo diagnostics and treatment of the disease in the Department of Neurology of the Center for Spinal Cord Pathology of our clinic.

Incomplete emptying of the bladder is often perceived as a subjective sensation. But this can be one of the symptoms of diseases of the urinary system.

There are two options for the development of this process. In the first case it is really a subjective sensation and the bladder is empty. In the second, the so-called true incomplete emptying of the bladder is observed. This is due to the fact that the exit of urine from the urinary canal is difficult. In men, the second variant of the pathology is most common.

The main causes of pathology

Impaired urination is an alarming symptom, a man should consult a doctor. The main reasons for this phenomenon:

If there is a false feeling of fullness, the situation is most often associated with inflammation of the bladder and irritation of its walls. In men, cystitis is less common than in women, but the disease should not be ruled out. Exactly the same symptom is characteristic of urethritis. Sometimes a false sensation is caused by psychogenic factors.

Associated symptoms and diagnosis

Whatever pathologies of the urinary organs provoked this phenomenon, it is usually accompanied by a number of common symptoms. If we are talking about true overcrowding of the bladder, then a pain syndrome is characteristic, which is felt in the pubic area, genital organs, radiates to the lower back or even the anus. The pains are moderate, felt like aching or pulling. But their intensity increases after sexual intercourse or emptying the bladder.

The process of urination is disturbed. The jet is significantly reduced, the pressure of the urine drops. Urination in almost any of these diseases is accompanied by pain or discomfort. At the advanced stage of the pathology, urinary incontinence is observed.

The erection is broken. The reasons for this phenomenon are initially physiological, but over time, they can be supplemented by psychological factors.

In order to determine a specific disease, you need to undergo a complete diagnosis. For this, an ultrasound is prescribed. It is carried out immediatelyto determine the degree of fullness of the bladder. Previously, instead of this, catheterization was immediately done, today it is performed only according to indications.

Informative methods are:

• contrast radiography of the bladder;
• cystoscopy to determine the presence of stones;
• uroflowmetry to assess the intensity of urination.

Treatment

Treatment of an overflowing bladder involves eliminating the cause of this phenomenon. But urgent action must be taken to empty the bladder. For this, catheterization is performed.

Purpose drug treatment depends on the characteristics of the disease itself, the nature of its course, the severity of symptoms.

With cystitis, antispasmodics (No-shpa, Drotaverine) are more often used to relieve pain.

For prostatitis, non-steroidal anti-inflammatory drugs - Ibuprofen - are used for the same purposes. Men also have neurogenic pain in the organs of the genitourinary system. For this, they are used various drugs including neuromodulators, antidepressants, etc.

In the treatment of prostatitis, alpha-blockers are prescribed - Terazosin, Tamsulosin, Alfuzosin. They relieve pain, reduce spasm, and promote the outflow of urine. At the same time, antibiotics are used to kill bacterial infection. Mostly funds from the group of tetracyclines, Levofloxacin.

Since urinary retention in this case occurs due to a strong proliferation of tissues, then when the process is started, its partial excision is prescribed. With an adenoma, complete removal is also possible.

In the treatment of any of these diseases, you can not take alcohol. Often prescribe therapeutic exercises, but severe physical exercise limited. It is necessary to reduce the load on the muscles of the perineum, especially with adenoma or prostatitis. Permissible activities are walking, swimming in the pool.

Acute urinary retention (ischuria) in men - what is it and how to deal with it

Operations

At urolithiasis, due to which blockage of the urinary tract occurs, conservative and surgical methods are possible. But the first, involving the dissolution of the stone with the help of citrate mixtures and preparations such as Blemaren, are designed for a long period of time and are only suitable for initial stage diseases.

In the future, especially if there is acute urinary retention, doctors prefer surgical methods as more reliable.

In the presence of stricture of the urethra, surgical methods are used. Laser correction is often used.

Folk remedies

Bladder treatment folk remedies is of an auxiliary nature. It is aimed at eliminating the disease, which became the root cause of the feeling of fullness. Such drugs mainly enhance the effect of medications, or are used for symptomatic treatment.

Decoctions

For the treatment of prostatitis, a decoction of dried celandine grass is recommended. This tool is used after the end complex therapy which consists of taking antibiotics, physiotherapy and therapeutic gymnastics.After relieving acute inflammation, take the following medicine:

1. 1. Take 100 g of vegetable raw materials per 1 liter of boiling water.
2. 2. Bring to a boil again and keep on low heat for about 15 minutes.
3. 3. Cool and filter through cheesecloth.
4. 4. Add 400 g of natural honey, stirring it properly. The finished product is stored in the refrigerator.
5. 5. Drink in small quantities, 1 tbsp. l. three times a day.

It is recommended to drink a decoction of oats (2 tablespoons per glass of boiling water). Take it 200 ml three times a day. The course of treatment with any home remedy will be very long, at least 2 months. When taking oats, you need to take a two-day break every 5 days.

Urethral stricture cannot be cured with folk remedies. But a decoction of lingonberry leaves, which has a diuretic and anti-inflammatory effect, will be effective during remission to normalize the function of the genitourinary system. Prepare it in the standard way - 1 tbsp. l. leaves in a glass of boiling water. You can drink a herbal remedy in the morning instead of tea, a cup a day is enough.

1. 1. Select 2 tbsp. l. chopped vegetable raw materials in 2 cups of boiling water.
2. 2. Insist for an hour, and before use, filter through gauze. In a similar way, you can make tea from one chamomile - it relieves inflammation.

Neurogenic disorders of urination significantly reduce the quality of life.

Having to get up to go to the toilet at night prevents you from getting a good night's sleep. Frequent urination during the day, inability to control the urge, leakage or incontinence against the background of a strong urge significantly limit daily activities, interfere with work and personal life. Long trips and walks, trips to the theater, concerts, etc. become impossible. All this leads to depression, worsening the course of the underlying neurological disease and exacerbating the symptoms of the lower urinary tract.

Neurogenic disorders of urination in the absence proper treatment lead to serious complications from the upper urinary tract.

Least danger in terms of complications, it represents an overactive bladder without a violation of the outflow of urine. It greatly interferes with life, but does not shorten its duration.

greatest danger present (detrusor-sphincter dyssynergy). In such cases, during urination, the pressure inside the bladder becomes very high, and the urine, which cannot be expelled through the spasmodic sphincter, rises up the ureters. This is vesicoureteral reflux which leads to kidney damage. Developing ureterohydronephrosis, kidney tissue becomes thinner, appears kidney failure.

The presence of residual urine in the bladder is always accompanied by urinary tract infection, manifested by cystitis (inflammation of the bladder itself) and ascending pyelonephritis (inflammation of the kidneys). Due to overactive bladder and vesicoureteral reflux, pyelonephritis in patients with neurogenic

urination disorders, usually severe course and high risk of developing urological sepsis.

In men, prostatitis can also be a complication of neurogenic urinary disorders.

Infected residual urine easily forms stones that require surgical treatment.

Difficulty urinating leads to protrusion of the bladder wall( diverticula), the size of which can reach the size of the bladder itself. Diverticula can also form stones and tumors.

Stages of ureterohydronephrosis.

Diverticula.

In a separate group, complications associated with the prolonged presence of a permanent urethral catheter or cystostomy in the bladder can be distinguished.

Indwelling ureral Foley catheter(with a balloon that inflates in the bladder) - the method that threatens the greatest number of complications.

The bacteria form a colony on the surface of the catheter called a biofilm. The special organization of this colony makes microorganisms resistant to action. antibacterial drugs. Deal with infection urinary tract turns out to be almost impossible.

A catheter balloon constantly present in the bladder injures the mucosa, which leads to the development of bladder cancer.

Urine flows continuously through the catheter, therefore, the bladder is constantly empty, which causes it to shrink over time. Cases are known when the bladder was reduced to the size of a urethral catheter balloon (20 ml). Shrinkage of the bladder makes it impossible to restore normal urination in the future.

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Another option for diversion of urine is a cystostomy. This is the same Foley catheter with a balloon, only installed in the bladder through the anterior abdominal wall. This method is more secure. Since the contact area foreign body(catheter) with less mucosa, infections are less common. There will be no bedsores in the urethra. However the risk of bladder shrinkage and cancer is also high as if using an indwelling catheter in the urethra.

It also has its complications. There is a risk of formation urethral strictures(cicatricial narrowing) due to trauma to the urethra during catheterization. The formation of a stricture is not life threatening and is easily treated by endoscopic dissection of the scar tissue. The use of lubricants and careful insertion of the catheter will avoid such problems.

Also exists risk of infectious complications, but it is incomparably lower than when using an indwelling urethral catheter or cystostomy. When there is no permanent foreign body in the urinary tract, the infection is easier to fight. Compliance with the technique of introducing a catheter and the use of an antiseptic for the treatment of hands and genitals will allow the risk of infectious complications to be minimized.

The constant presence of a foreign body in the urethra causes inflammation of the mucosa (urethritis) and the formation of bedsores, which may require plastic surgery on the penis.

In addition, the constant presence of a catheter in the urethra or a cystostomy not only makes the problem visible to others, but is also a contraindication for undergoing some rehabilitation measures.

Today, throughout the civilized world, it is used as the main method of excreting urine. In the recommendations of international societies for the treatment of neurogenic urinary disorders, this method is called "gold standard". In Europe, the introduction of this technique in patients with spinal injury in the 70s of the XX century led to a sharp decrease in mortality from urological complications, the same as the appearance of the first antibiotic penicillin in the 40s. Urine excretion with disposable catheters 6-8 times a day mimics the natural rhythm of urination. This is allows you to maintain the physiological capacity of the bladder. Absence of a permanent foreign body in the urinary tract eliminates the risk of cancer and the formation of bedsores, reduces the likelihood of biofilm formation.

Often patients who have suffered a spinal injury use various techniques (tapping on the anterior abdominal wall, irritation of the anus or other trigger zones, straining, etc.) to trigger the urination reflex. This method would be very good, if not for three points.

1. What we have already talked about above. Since the sphincter of the bladder, as a rule, is strongly clamped and does not allow urine to come out, during the process of reflex urination, the pressure in the bladder rises to abnormally high numbers. Urine travels up the ureters to the kidneys, leading to dilatation of the upper urinary tract, ascending infection, and kidney failure. Diverticula form in the bladder.

2. Reflex urination in patients with spinal cord injury above the Th6 segment can provoke - pulsating headache, anxiety, rise blood pressure, redness of the face, sweating, bradycardia, spasticity, etc. An episode of autonomic dysreflexia due to a significant rise in blood pressure can be life threatening.

3. The bladder may not empty completely during reflex urination. We have already talked about the dangers of having residual urine.

You can not use the method of reflex emptying of the bladder without the permission of a neuro-urologist who performed a comprehensive urodynamic study (CUD) and made sure that the pressure in the bladder at the time of reflex urination remains within acceptable values, which is extremely rare.

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can be triggered not only by reflex urination, but also by bladder overflow or concomitant urinary infection.

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The feeling of incomplete bladder emptying is a common problem that both men and women often face. This phenomenon is not normal and is accompanied by significant discomfort due to the constant urge to empty the bladder of fluid.

As a rule, in women retention of urine inside the bladder indicates the presence of serious illnesses urogenital area requiring immediate treatment.

The urge to urinate is completely controlled by the reflexes of the body. In the normal state, the desire to visit the toilet occurs in an adult with the accumulation of at least 200-300 ml of fluid in the bladder. However, with inflammatory processes or diseases of the pelvic organs, this process can be significantly disrupted and the desire to urinate occurs even with a minimum amount of fluid.

Symptoms and causes of incomplete bladder emptying

It is possible to identify the pathology of the organs of the genitourinary system by the characteristic symptoms:

• After urination, there is a feeling that the bladder is not completely freed from urine.
• Literally a few minutes after visiting the toilet, a man or woman again experiences the urge to urinate. Thus, the sick person cannot go far from the toilet, which greatly interferes with their usual daily activities.
• Bladder emptying is accompanied by painful sensations, burning sensation and discomfort. This is the result of stretching of the walls of the urine reservoir and its increase in size due to the accumulation of a large volume of fluid.

Incomplete emptying of the bladder is rarely an independent disease. In most cases, the pathology is secondary symptom indicating the development of another disease in the body. There are many diseases that can be accompanied by a feeling of incomplete emptying of the bladder:

• In women, such a pathology in most cases acts as one of the main symptoms of cystitis or urethritis, which occurs in acute or chronic form.
• The presence of stones in the kidneys or urinary tract.
• Neoplasms in the pelvic area, which can be both malignant and benign.
• A neurogenic bladder is often accompanied by a sensation of incomplete emptying.
• If the feeling that the bladder is not emptying completely worries a man, this may indicate the development of prostatitis or prostate adenoma.
• The inability to completely empty the urine reservoir in women may be hallmark genital herpes, severe postpartum complications, inflammation in the vagina and vulva, infection directly into the urinary canal.
• Atony, urinary incontinence, or hypoatonia, that is, a decrease in the activity of the muscular walls of the urinary organ.

Incomplete emptying of the urine reservoir can be a sign not only of pathologies of the pelvic organs, but also of general diseases. For example, many diseases of the spinal cord are accompanied by the inability to fully empty the bladder. Such diseases include various mechanical injuries of the spine, sciatica, multiple sclerosis.

In some cases, the causes of such a pathology include increased brain impulses. What does this mean? During urination, the bladder is completely emptied, but impulses are sent to the brain that it is full. Naturally, there is an erroneous urge to urinate. Most often, excessive impulsation occurs against the background of pyelonephritis, appendicitis, andexitis, salpingo-oophoritis. In addition, incomplete excretion of urine may have psychological causes - prolonged stress, nervous shock, or a state of shock.

Incomplete emptying of the bladder should not be treated casually, since this pathology not only significantly reduces the quality of life, but can also have dangerous consequences. In residual urine, pathogenic bacteria and pathogenic microorganisms actively multiply, provoking the development inflammatory processes and serious diseases of the pelvic organs.

Treatment of pathology

Incomplete emptying of the urinary organ can have two forms - complete and partial. Full form pathology is characterized by the inability in women or men to release the urinary organ from fluid: there is an urge, but the fluid is not released, the patient feels cramps and sharp pains in the lower abdomen. Partial voiding is a slight discharge of urine. Fluid is excreted from the urinary tract, but a short time after urination, the person is forced to go to the toilet again.

To eliminate the dysfunction of the bladder and restore its normal functioning, it is necessary to establish the root cause of the pathology. You can't do without consulting an experienced specialist. The urologist will examine the patient and prescribe special laboratory tests. Only on the basis of complete clinical picture you can start treatment.

All medical measures are aimed at eliminating not the pathology as such, but the causes that led to its occurrence. Accordingly, if the inability to completely empty the bladder arose against the background of infectious diseases, a man or woman is prescribed a course of antibacterial drugs, antibiotics, in the presence of stones in the urinary tract - medicines, the action of which is aimed at removing stones.

If the causes of the disease are psychological in nature, the patient is prescribed sedatives and other medications aimed at normalizing psychological state. If the feeling that urine does not come out of the bladder completely, a woman arose against the background of a certain gynecological disease, then the main efforts of physicians should be aimed at eliminating the root cause. In some cases it is recommended to use hormonal drugs that normalize the condition of the female genital organs.

In severe cases, when the conservative method of treatment has not brought the expected results, the patient is prescribed surgery. Most often the precondition for surgical treatment become stones in the organs of the genitourinary system, which are too large, as well as malignant or benign neoplasms in the pelvic area.

The patient can significantly alleviate his condition on his own, following a few simple rules:

1. During urination, you need to relax as much as possible and not strain the muscles of the bladder and abdominal cavity. A tense bladder cannot completely get rid of fluid.
2. If you lightly press your palm on the area of ​​​​the bladder at the time of urination, this stimulates its contraction, contributing to a more complete emptying.
3. The sound of running water stimulates the excretion of urine. So, during urination, you need to turn on the water from the tap. So the bladder will be released much more completely.
4. In some cases, the urge to urinate becomes so strong that the patient simply does not have time to run to the toilet. Do not be shy to tell the doctor about this - this will help the doctor to more accurately diagnose the disease and prescribe adequate treatment.

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