Neurogenic bladder dysfunction in children Komarovsky

The term neurogenic bladder refers to urinary dysfunction associated with various lesions of the nervous system.

Normal emptying of the bladder is a rather complex process from the point of view of the transmission of special nerve impulses throughout the body.

A whole chain of reactions takes place so that when the organ is filled, the muscle tissue contracts, the sphincter relaxes and urine is excreted. By analogy, the actions of holding urine take place when the bladder is not yet full. If this circuit incorrectly transmits an impulse to the spinal cord or brain, then various types of disturbances occur.

Why does this happen in children?

Uncontrolled urination plagues children in infancy, but starting from 3-4 years old, if there are no special pathologies or disorders, the baby should already be aware of and manage this process. The nervous system is already adapted to this age, capable of regulating the reservoir functions of the bladder, as well as valve and evacuation functions.

There are children who cannot regulate urination; even as they grow older, the problems do not disappear. These children are eventually diagnosed with a neurogenic bladder. The reasons for this may be the following:

• disorders of the brain associated with dysfunction of the pituitary gland and hypothalamus;
• birth injuries affecting the nervous system, muscle fibers and pelvic organs;
• strokes, compression of blood vessels, surgical interventions and other violations of tissue integrity;
• congenital anomalies in the region of the brain, spinal cord, spine, in particular the thermal region;
• Cerebral palsy, HIV;
• inflammatory diseases of the bladder, adjacent organs and tissues;
• oncological tumors, hernias.

The still fragile children's body is susceptible to various influences and loads, and this increases the risk of acquiring a neurogenic bladder in children and adolescents.

Causes

By the age of 3-4 years, the child should learn to fully control urine output during the day and night. If this does not happen, then there is a high probability that the baby will develop neurogenic bladder dysfunction. What could lead to this?

• Lower back injury during childbirth.
• Perinatal encephalopathy.
• Nervous system disorders.
• Surgical interventions, violations of tissue integrity.
• Compression of blood vessels.
• Cerebral palsy, HIV.

In rare cases, urinary incontinence occurs in babies with a weak conditioned reflex, which is responsible for the process of urine excretion. In such children, the maturation of the corresponding brain structures is delayed. The disease occurs more often in girls. This is due to the high susceptibility of the muscular organ.

Types of pathology

Since the neurogenic bladder has various symptoms, it is customary to classify pathology into certain types. The following types are distinguished:

1. Hyporeflex . The disturbances are associated with the lack of timely outflow of urine, although the filling of the organ itself passes. In this regard, urine can accumulate, leak uncontrollably (incontinence) or linger in the urinary tract for a long time, which provokes inflammatory processes. Such reactions are possible with dysfunction of the nerve endings in the sacral region.
2. Hyperreflexive . If there are problems with the nervous system, hyperreflex syndrome may occur, when urine does not accumulate in the urinary tract, but is immediately excreted. In such cases, the urge to urinate occurs very often, and urine output is minimal.
3. Areflexory . It is characterized by involuntary excessive urination, since the organ is not able to contract qualitatively and transmit signals for emptying. Urine accumulates and when the bladder is completely filled, it simply flows out spontaneously. Often diagnosed with disorders of the central nervous system.

Depending on the dysfunction of the nervous system, disturbances in the genitourinary system can vary in intensity.

Causes of neurogenic bladder

This pathology occurs as a consequence of a violation of the nervous regulation of urination at one or several levels: peripheral, spinal, cortical. As a result of these disorders, the ratio and degree of activity of the detrusor and external sphincter of the bladder change, and the patient experiences certain complaints.

The following diseases can cause the development of a neurogenic bladder in children:

• congenital malformations of the central nervous system organs;
• trauma to the nervous system, including birth trauma;
• malignant and benign neoplasms of the spine;
• spina bifida;
• cerebral palsy;
• encephalitis;
• neuritis;
• underdevelopment of the sacrum and coccyx;
• dysfunction of the autonomic nervous system;
• weakness of the reflex that controls urination;
• hypothalamic-pituitary insufficiency.

It has been proven that female sex hormones - estrogens - increase the sensitivity of the smooth muscle receptors of the bladder. That is why the diagnosis of “neurogenic bladder” is given more often to girls than to boys.

How does the disease manifest?

The main symptoms of a neurogenic bladder will vary depending on the type of pathology that develops in children. The following relationship is noted between the type of neurogenic bladder and symptoms:

The hyporeflex type is characterized by the following symptoms:

• urination is rare and profuse, can reach up to 1.5 liters;
• feeling of fullness of the bladder, even after emptying;
• pain in the lower abdomen.

For the hyperreflex type, the following symptoms are observed:

• scanty urination, but extremely frequent and sudden;
• incontinence both at night and during the day;
• discomfort in the form of pain is possible.

A reflex or lazy bladder manifests itself as:

• periodic changes in the structure of urination, incontinence may be observed for some time, and then a long-term absence of urine excretion;
• pain, manifestation of symptoms of inflammatory diseases, since often with such work of the bladder, infectious and inflammatory reactions progress;
• constipation

Symptoms for each child can be individual, it all depends on the degree of nervous system disorders, age and neglect of the syndrome. All this information should be analyzed by specialists and timely measures should be taken to select the optimal treatment. There is no need to ignore the child’s complaints, since neurogenic bladder syndrome may not go away on its own, which can lead to unpleasant consequences.

What symptoms indicate this pathology?

An experienced doctor will be able to identify neurogenic bladder dysfunction in a child without any problems. Treatment at an early stage is always effective. Pathology usually manifests itself through certain urinary disorders. In this case, the severity of the disease will depend on the intensity of the deviations.

Experts have identified several symptoms that require the child to be taken to the hospital immediately:

• the baby has problems with urinary control;
• urges arise unreasonably and suddenly;
• too many urges per day. If a child runs to the toilet more than 9 times a day and cannot empty himself completely.

Symptoms may manifest themselves more clearly when the child was in a sitting position and then suddenly stood up. If it's a girl, the signs will be different. Here, the manifestations of pathology are more associated with the application of great efforts for complete emptying and a small volume of urine excreted.

Common symptoms of a neurogenic bladder include the following:

• the child’s complete lack of desire to go to the toilet throughout the day;
• the stream of urine is thin and weak;
• complaints of pain in the urinary canal;
• inability to completely empty even with additional efforts;
• a constant feeling that the bladder is enlarged due to the large volume of accumulated urine;
• uncontrolled urination.

Note! If urine does not leave the bladder in time, it will be a favorable environment for the proliferation of harmful microorganisms. They can provoke inflammation not only of the bladder or urethra, but also of the ureter or kidneys.

Signs of a neurogenic bladder in a child with organ dysfunction will be as follows:

1. Postural. This means that involuntary urine discharge will be triggered by a change in body position.
2. Ochoa syndrome. Here the child will suffer from infections and difficulty urinating.
3. Lazy urinary. This type of symptoms is characterized by incontinence and rare urges.
4. Pollakiuria. Frequent urge to go to the toilet, approximately every 25-35 minutes. There is no pain.

Possible complications

Lack of treatment for neurogenic type pathology leads to concomitant diseases of the pelvic organs and the whole body. For example, with the constant accumulation of urine and its presence for a long time, there is a risk of it rising into the glasses, developing infections, peritonitis, and infection of the whole body.

Dysfunctions lead to cystitis, which turns into a chronic form and dangerous advanced stages. Subsequent complications may also affect other pelvic organs, the normal functioning of which will be difficult to restore.

The other side of a neurogenic bladder is the psychological state of the child. If for children such problems do not cause special emotional discomfort, then for growing children, incontinence and frequent trips to the toilet can cause depression and the development of complexes.

How it manifests itself

The symptoms of the disease directly depend on the stage of the disease and the type.

The hyperreflex variant of the disorder is characterized by the fact that the child very often wants to urinate, a false, sharp desire to visit the restroom appears, urine is released in small portions, incontinence develops, and a normal volume of fluid cannot accumulate in the bladder. With this type of pathology, the “breakdown” of the urination mechanism lies in the central nervous system.

There is a type of disease that manifests itself when the position of the body changes, and it is also characterized by frequent urination during the day. At night, the process of urination proceeds normally.

Stress incontinence usually occurs in females; it is provoked by physical overload and a small volume of urine leaks out.

If there is detrusor-sphincter disconnection, then urination occurs under tension, the bladder is not completely emptied, and there may be a complete delay in the act of urination.

The hyporeflex bladder develops as a result of a pathological process in the sacrum. The main signs of this type of disorder are rare urination (up to 3 times in 24 hours), a large residual amount of fluid in the bladder (about 300 ml), a constant feeling that it is not emptied enough, urine flows out in huge quantities, but very sluggishly.

Lazy bladder is a combination of infrequent urination, urinary incontinence, susceptibility to infections and intestinal atony.

As for the most severe types of neurogenic bladder, these are undoubtedly Hinman and Ochao syndromes.

The first is characterized by urinary incontinence, regardless of the time of day, constant infectious diseases of the genitourinary system, and constipation. When examining the child, there are no pathologies in the structure of the urinary tract or neurological disorders.

Ochao syndrome (urofacial) is hereditary and occurs more often in boys. With it, a sick baby's face becomes distorted when laughing; the grimace on it resembles a person who is screaming. Also typical are urinary incontinence both day and night, constipation, urinary tract infections, and urinary retention may occur.

With Ochao, complications such as hypertension and chronic kidney disease are not uncommon.

All of the above disorders have common features; they consist in a change in the emotional state of the child. Against the background of a neurogenic bladder, he becomes whiny, withdrawn, sleeps poorly, and has difficulty making contact with peers.

Basic diagnostic methods

To determine the causes of pathological processes and dysfunctions of the bladder, including the neurogenic type, the child undergoes a comprehensive examination. Complaints from a young patient, comments from parents, and the presence of pre-existing diseases are taken into account. Research of biological materials is used, various hardware procedures are carried out, consultations with specialized specialists and other activities are carried out.

Since the research will be complex, it is necessary to mentally prepare the child for the need for all procedures, since there will be many of them. The main ones include:

• general and biochemical blood tests;
• urine test, including a general test for the presence of bacteria, if necessary according to Zimnitsky and Nicheporenko;
• Ultrasound of the bladder, kidneys, and pelvis, which is more often practiced in girls;
• urethrocystography or contrast x-ray examination of normal and voiding type;
• cystoscopy or visual assessment of bladder tissue;
• MRI and CT for obvious suspicions of disorders of the patient’s nervous system.

In addition to the above diagnostic measures, specific urological studies may be prescribed, for example, urofluometry, sphincterometry, and urethral profilometry.

For each individual case, based on examination and symptoms, specific diagnostic procedures are prescribed.

Diagnostics

As soon as parents notice a violation of the urinary process in their child, they should immediately contact an experienced specialist. The attending physician begins the examination of the baby by collecting an anamnesis: possible injuries to the head, back or pelvic area, complaints of the little patient, features and disorders of bladder emptying.

For a clearer picture of the pathology, laboratory and instrumental diagnostic methods will be required:

• general blood and urine tests;
• blood biochemistry (to determine the amount of metabolic products);
• urine analysis according to Nechiporenko (gives information on the content of red blood cells, leukocytes and protein);
• bacteriological culture of urine (allows us to identify pathogenic microflora in urine);
• urine analysis according to Zimnitsky (can show the degree of urine concentration in the bladder);
• ultrasound examination of the bladder and kidneys (allows you to determine the degree of organ damage, the residual amount of urine in the bladder after emptying);
• fluoroscopy using a contrast agent;
• excretory urography.

In the absence of an accurate diagnosis, the doctor prescribes additional examinations aimed at carefully studying the functioning of the urinary canals: uroflowmetry, electromyography, cystometry. If the problem of a neurogenic bladder does not lie in the organs of the urinary system, a more thorough examination of the child’s central nervous system will be required. For this purpose, methods such as encephalography of the brain, CT, MRI, and X-ray of the spine are prescribed.

Treatment of the disease and its types

After identifying the cause of pathological disorders, treatment is prescribed, which is almost always comprehensive. It includes not only direct medical impact on problem areas, but also conservative measures. Conventionally, all types of possible treatment can be divided into the following positions:

1. Lifestyle and nutrition . For a growing body, it is important to have a balanced and proper diet, with sufficient fluid consumption. A routine and timely sleep must be observed; stressful situations for the child are excluded, as the disease may worsen. Urination is monitored, walks and moderate physical activity are organized.
2. Physiotherapy . Exercises are selected exclusively by a doctor, for example, according to the Kegel program, and the feasibility of therapeutic exercises is also agreed with a specialist. The actions are aimed at training the pelvic muscles and urinary tract. For some diseases, it is recommended only with significant improvements and normalization of urination.
3. Physiotherapy . Direct effects on the bladder will become auxiliary measures for successful treatment. Electrophoresis, including medicinal therapy, manipulation with laser, ultrasound, diadynamic therapy, heat treatment, and electrical stimulation may be prescribed.
4. Drug treatment . The drugs are selected by the doctor based on the root causes of the disorder and the type of pathology, and are a priority. Vitamin complexes with components of group B, PP, E are considered auxiliary. Sedatives are recommended, but not of a strong effect, for example, motherwort tincture, glycine, and so on.
5. Surgical intervention . Initially, all efforts are aimed at a conservative solution to the problem, but if there is no result, surgical intervention has to be performed. Mainly this is the use of transurethral resection of the bladder neck, increasing the volume of the organ, collagen implantation at the mouth of the ureter, as well as ganglion surgery.

Treatment and restoration of a neurogenic bladder in children is possible, but parents should take action as early as possible, before the pathology leads to serious complications. You may need to consult with specialized specialists, for example, a nephrologist, a neurologist, or a gynecologist for girls.

With a neurogenic bladder, the state of the nervous system has a great influence. Some folk remedies can help balance the psychological situation. Some preparations for diuretic and anti-inflammatory effects also show good results.

There are a lot of recipes for such remedies; they may contain chamomile, St. John's wort, berries and leaves of lingonberries, blueberries, as well as other herbal ingredients.

When using folk remedies, it is important to understand that they need to be agreed with a doctor, especially when treating a child; they are not the main therapeutic drugs.

Fundamentals of Anatomy and Physiology

The bladder is a hollow, pear-shaped organ located in the pelvis with the base upward. Essentially, it acts as a reservoir for urine. It has a wide body and a narrow neck. Two ureters, left and right, flow into the body, and the neck passes into the urethra. The smooth muscle wall of the bladder, which ensures its contraction, is called the “detrusor”, and the muscle sphincter located in the neck is called the sphincter.

Urine is formed in the kidneys, then through the ureters it enters the bladder, where it accumulates, and when the amount becomes large enough, the act of urination occurs. Let's take a closer look at the storage and emptying phases of the bladder.

Accumulation phase

The detrusor is very elastic and during the period of urine accumulation it is relaxed - in a passive state. The sphincter, on the contrary, is tightly compressed - it creates high urethral resistance, which blocks the exit of urine from the bladder. In addition to the sphincter apparatus, urethral resistance is also provided by the pelvic muscles - the so-called pelvic diaphragm.

In the muscles of the bladder neck there are α-adrenergic receptors, which, interacting with the hormone norepinephrine, cause contraction of the sphincter muscles.

On the surface of the smooth muscles of the bladder there are β-adrenergic receptors, with the interaction of norepinephrine with which the detrusor relaxes, ensuring the accumulation of urine in the bladder.

Emptying phase

When the bladder is full, a person feels this and, with an effort of will, contracts the detrusor, which is accompanied by relaxation of the sphincter and emptying of the bladder.

Newborns and children of the first year of life cannot control urination: they occur involuntarily. This is due to the fact that at an early age the reflex arc is closed only at the level of the spinal and midbrain, and cortical and subcortical control of the act of urination is absent. The child grows, the capacity of his bladder increases, control over the sphincter is gradually acquired, the urination reflex is inhibited with the participation of the cortical and subcortical centers, and the frequency of urination is reduced. The baby acquires full cortical control over the act of urination by the age of 2.5-3 years, but already from the age of one and a half he feels the filling of the bladder and begins to ask to go to the potty.

Symptoms of neurogenic bladder appear when urinary control is already established - usually starting at age three.

What does Dr. Komarovsky say?

Many young parents listen to the opinion of the famous pediatrician Komarovsky, who is not a supporter of using excessive amounts of medications for children. It is better to pay attention to long walks, proper nutrition, and bladder training. Up to 6 years, unless there is an urgent need for it, it is advisable to abstain from strong drugs.

Parents need to try to motivate their child to urinate regularly and use toilet discipline, since some children, simply due to their character and development, ignore timely visits to the restroom. There are timed urination programs that help the child learn to control the urge to void. If your child is predominantly bedwetting, you can give him less fluids to drink in the evening and before bed.

For a more detailed study of the opinion about the neurogenic bladder and enuresis in children, you can watch a video from the famous doctor Komarovsky.

Treatment

How to treat neurogenic bladder in children? There are drug and non-drug treatment options. The second option is more gentle and does not provoke side effects.

Non-drug treatment

The set of measures includes maintaining the correct daily routine and physical therapy to strengthen the abdominal muscles. The child should get proper rest. The duration of daytime sleep should be at least two hours. Stress factors that can negatively affect the child’s psyche should be excluded. It is useful to walk in the fresh air. Physiotherapy is very effective in treating neurogenic bladder.

Drug treatment

Medications are prescribed depending on the type of pathology detected. If a child has an overactive bladder, he is prescribed medications to reduce the tone of the corresponding muscle groups. If a child has neurogenic bladder weakness, medications are prescribed to increase tone.

Surgical intervention

It is used in severe cases when the first 2 treatment options did not give the desired result.

Prevention and prognosis

If bladder dysfunction is already observed, then it is necessary to immediately carry out a high-quality complex diagnosis. When the cause of the disease is determined in a timely manner and adequate measures are taken, the chances of successful treatment without negative consequences increase.

There is no need to immediately raise a child when incontinence is detected, especially at a conscious age; you should delicately ask the child about the symptoms and at the same time observe his behavior.

Prevention of neurogenic bladder involves timely diagnosis and treatment of diseases that can cause malfunction of the urinary organs. Self-medication is excluded, since symptoms may indicate both the development of the initial stage of cystitis and serious pathologies, including problems with the nervous system.

Neurogenic bladder dysfunction in children

Failure of urination function is a fairly common disease. Neurogenic bladder in children occurs in 10% of young patients and manifests itself in infancy. The disease is congenital or acquired, depending on the causes of the nervous disorder. However, boys are less likely to experience the disease than girls.

General information

Neurogenic bladder is a term that implies a failure of its reservoir, valve or evacuation function. The human bladder accumulates, holds and removes urine from the body. This process is closely related to the activity of the kidneys, ureters and central nervous system. The slightest disturbances in the functioning of the nervous system negatively affect urination.

Children suffering from this disease have problems with uncontrolled urine production. This creates many physiological and psychological problems. The child cannot cope with the problem and is often ridiculed by his peers. As a result, a number of diseases develop - cystitis, pyelonephritis, urolithiasis, depression.

Why is this happening?

The controlled urination reflex is conditional in nature and depends on the child’s brain activity and the functioning of his central nervous system. Any neurological disorders contribute to disruption of the detusor or external sphincter. The causes of the disease are divided into congenital and acquired. Failures occur due to the following problems:

• birth injuries;
• pathologies of the activity of the hypothalamus or pituitary gland;
• cerebral palsy;
• congenital anomalies;
• HIV;
• diabetes mellitus;
• strokes;
• spinal hernia.

The following can lead to disruptions in the functioning of the nervous system:

• injuries;
• bladder muscle strain;
• inflammation of the ureters;
• malignant or benign tumors of the spinal cord or brain.

Symptoms of the disease

Neurogenic bladder in a child manifests itself depending on the causes of its occurrence, stage and type. Signs of illness not only signal illness, but also make it possible to diagnose a specific type of disease. With bladder hypertension in a child, the following can be observed:

• imperative urge to urinate;
• a small amount of urine excreted;
• pain during urination;
• frequent (up to 10 times a day) urination.

A hypoactive neurogenic bladder is characterized by:

• rare urination (1-3 times a day);
• constant feeling of fullness of the bladder;
• feeling that urination is incomplete;
• a large amount of urine;
• painful sensations in the lower abdomen.

If a child is affected by Hinman syndrome, he suffers from chronic constipation, kidney and genitourinary tract infections. At the same time, the child wants to go to the toilet only when he moves from a horizontal position to a vertical one. Ochoa syndrome, having all of the above symptoms, is hereditary and is accompanied by arterial hypertension.

Neurogenic bladder dysfunction results in loss of urinary control.

The first signs appear at the age of one and a half to 4 years, since the reflex of control over the body’s needs for emptying should already be formed by this time.

It should be noted that in teenage girls, uncontrolled urination more often occurs during physical activity and even laughter. This is due to the fact that estrogen levels increase significantly in women (especially during puberty).

Source: https://03-med.info/kidney-pochki/neyrogennaya-disfunktsiya-mochevogo-puzyrya-u-detey.html