The treatment of neurogenic bladder is important for patients with it because of its unpleasant symptoms such as urinary incontinence. The treatment of neurogenic bladder disease is carried out either by conservative treatment, through medication, or by resorting to surgery.
Introduction to neurogenic bladder treatment in Turkey
Neurogenic Bladder is a common disease and its symptoms appear in many patients. It is divided into two main types that differ slightly from each other in symptoms and treatment, but the mechanism of occurrence of these two types is often the same.
The first type is the overactive bladder, in which the bladder is overactive and the number of urinations is more than 8 times a day.
The second is the Underactive Bladder, in which the bladder is underactive and it is difficult for the patient to start urinating in this case.
To treat these two types, there are many ways, starting with the approved treatment, some exercises, lifestyle changes and diet, through drug treatment and injection of some compounds into the bladder, and ending with surgery.
Presents Bimaristan Medical Center Support for the treatment of neurogenic bladder, provides advanced healthcare and quality surgeries for the treatment of neurogenic bladder disease in Turkey.
How does neurogenic bladder disease occur?
The natural process of urination in humans occurs through the coordination of nerve signals coming to the muscles of the bladder, so urine flows out through the urethra (a tube through which urine passes from the bladder to outside the body).
The bladder wall consists of muscles that are subject to the commands of the autonomic nervous system (involuntary), and the beginning of the urethra is surrounded by a ring-shaped muscle called the urethral sphincter that is also subject to the commands of this same system.
The normal process of urination interferes with orders from the brain bearing the nature of will, that innervate an additional urethral sphincter (other than the previous one), and thus the person does not urinate in inappropriate places and can control his desire to urinate until he reaches the bathroom.
When the patient reaches the bathroom and begins the process of urination, the muscles of the bladder wall contract and the urethral sphincters relax, and urine comes out until the bladder is emptied, then its wall relaxes and the urethral sphincters contract again.
In the case of neurogenic bladder, damage occurs to the nerves controlling the action of its muscles. There is no coordination between the muscles that may not contract at all or may be in a permanent state of contraction.
As a result, one of the two types of neurogenic bladder (overactive or underactive bladder) occurs and the patient has symptoms that vary depending on the type of this disease.
Neurogenic bladder symptoms
There are two main types of neurogenic bladder, so the symptoms differ from one person to another, and with different symptoms, they may be present together in the same patient, and these symptoms include:
- Urinary tract infection: It is the first symptom, inflammation and infection of the urinary tract occurs due to the lack of complete emptying of urine, which encourages bacteria to grow. Symptoms include burning when urinating and a high temperature of the patient.
- incontinence (Involuntary urination) and urinary drip: Leakage occurs because the urethral sphincter does not close or the bladder is overstrained.
- Urinary urgency: It occurs in an overactive bladder, where the bladder contracts even when there is a small amount of urine in it, so the patient feels an immediate, non-delayable urgency with the need to enter the bathroom, but only a little urine comes out, and if ignored, urinary incontinence may occur.
- Frequency (too often): It also occurs in an overactive bladder where the number of times to go to the bathroom more than 8 times a day
- Loss of sensation of bladder fullness: It occurs in one of the secondary types of neurogenic bladder, which is when the injury is in certain areas of the brain (central brain defect), and the patient urinates without feeling and suddenly with his inability to hold the urine to reach the bathroom.
- Difficulty starting to urinate and urinary retention: This occurs in an underactive bladder where the bladder expands and becomes full and the patient cannot empty it, and even when urination occurs, the patient does not have the ability to empty the entire urine in it and it remains full (and this is one of the predisposing factors for the occurrence of urinary infections).
Complications of neurogenic bladder
In the event that neurogenic bladder is not treated and its symptoms persist for a long time, serious complications may occur that lead to several diseases, some of which may be life-threatening in the long term. These types of complications of neurogenic bladder may occur:
- Kidney stones Or bladder, or in the urethra
- Kidney damage and hydronephrosis (and may develop to renal failure) due to retention of urine in the kidneys
- Recurrent infections and pyelonephritis may occur
- Skin infections due to urinary drip or incontinence and lack of flushing
Predisposing factors for neurogenic bladder
The neurogenic bladder is considered a neurological disorder, so the predispositions for its occurrence are neurological diseases or diseases that have led to injuries to the nerves supplying the bladder, leading to the occurrence of symptoms. The neurogenic bladder affects patients with:
- diabetes: It leads to a lack of blood supply to the nerves, and they die, and thus the bladder loses innervation.
- Sepsis: especially viral infection of the nerves of the bladder (such as herpes zoster).
- Hereditary abnormalities of the nerves (in children, neurogenic bladder symptoms may be seen here)
- Some congenital neurological diseases such as spina bifida
- Poisoning with some heavy metals such as arsenic and lead (battery factory workers due to constant exposure)
- Brain tumors Or a spinal cord or a stroke
- Injuries and severe trauma that cause damage to the brain and spinal cord
- Alzheimer, multiple sclerosis andParkinson's disease
- Major pelvic surgeries
Neurogenic bladder treatment in Turkey
Neurogenic bladder treatment in Turkey is done according to the patient’s symptoms, after determining its type. Bimaristan Medical Center will guide you to the best doctors in Turkey, where the latest methods of treating neurogenic bladder will be presented to you. Treatment plans include several methods, and the treatment method varies according to the severity of the patient’s condition.
Neurogenic bladder disease is an incurable disease, so it is a chronic disease, but it is manageable, meaning that we cannot completely cure it and restore the nerves to its previous state, but we can control its symptoms in an excellent way and improve the patient's quality of life.
The treatment of neurogenic bladder begins with conservative, non-pharmacological methods. If the patient does not show improvement, we resort to the use of medications, and finally, we may resort to a surgical solution if the above does not work.
Overactive bladder treatment
Lifestyle change therapy
It has five main points:
- Delayed urinary emptying: That is, not responding to the urgent urge to urinate and not going to the bathroom immediately, the patient begins by delaying some minutes first and then gradually increases this period.
- Determining urinary emptying dates: That is, going to the bathroom at specific times of the day and sticking to these dates (for example, going to the bathroom every 3 hours).
- Contraction of the pelvic floor muscles: This movement is used when feeling the need to enter the bathroom, where the patient here contracts and relaxes the pelvic floor muscle as many times as he can and as quickly as possible.
This allows nerve signals to be sent to the contracting bladder to relax. This movement is accomplished by closing the anus and urinating voluntarily (as when we prevent defecation or urination when we feel an urgent need to defecate). - Bladder diary: It is a method by which the patient records the times he enters the bathroom, the number of urination times in the day, and if it is accompanied by a certain food or drink, or if the symptoms are worse if he does not drink fluids.
- Changing the patient's diet: Reducing weight and avoiding soft drinks, coffee, tea, alcohol, and citrus fruits such as oranges may help in treating nervous bladder.
Drug therapy
To treat an overactive neurogenic bladder, an antispasmodic drug such as oxybutynin and tolterodine, which are cholinergic receptor antagonists that relax the bladder (the best medicine for neurogenic bladder), is often used.
Treatment of nervous bladder through Botox injections in Turkey
This method is used in an overactive nervous bladder, where Botox (Botox is the muscle-parallel botulinum toxin) is injected into the spastic bladder and it relaxes. This method may be useful in treating many patients, but some of them may relapse and need to be re-injected after 6 months or a year.
Treatment of neurogenic bladder by modulating nerve signals in Turkey
This method of treatment is done by sending deliberate, harmless and painless electrical charges that counteract the nerve signals coming to the bladder (those that stimulate it to contract).
This method is used to treat neurogenic bladder with overactivity, and a battery may be installed under the skin to pass these charges or by injecting needles into one of the leg nerves.
Treatment of underactive neurogenic bladder
Lifestyle change therapy
It includes four main points:
- Determining urinary emptying dates: Every 3 hours, for example
- double emptying: That is, while you are urinating and the urine flow has stopped, wait a few minutes and then try to empty your bladder again.
- Bladder diary: It determines when to go to the bathroom and is affected by food and drink, giving the doctor an idea of your symptoms and whether they are getting better or worse.
- Diet change: And stay away from the foods and drinks mentioned above.
Catheter treatment of an underactive neurogenic bladder
This method is done either by using a temporary catheter where the patient is taught how to perform the installation of the catheter in sterile and clean conditions to prevent urinary infections (to avoid infection of the tract).
Or a permanent catheter may be installed for a patient with neurogenic bladder to drain urine in case he cannot install it himself.
Surgical treatment of neurogenic bladder in Turkey
In the event that the symptoms of neurogenic bladder do not improve by following the previous treatments, the alternative is to resort to surgical treatment in order to improve the patient’s life. Surgical operations in the treatment of neurogenic bladder include several types of procedures as follows:
Urethral sphincter biopsy surgery
Where the treatment is done here by the surgeon removing a part of the muscle surrounding the urethra and restoring the area to enable the patient to hold urine better, and the biopsy may be partial or complete.
Installation of an artificial urethral sphincter
Where the treatment is through the installation of an industrial sphincter equipped with a battery that is implanted under the skin in order to open the sphincterat the time of urination and close it at the rest of the times.
Bladder augmentation
The treatment is done here by cutting a part of the patient’s intestines and making it in the form of a bag connected to the bladder so that it can absorb a larger amount of urine and reduce the pressure of fullness in it.
Urethral diversion in Turkey
The treatment here is through the installation of an external bag for the patient in order for the urine to exit into it, eliminating the role of the patient’s urination process and relieving him of the problems and symptoms of the neurogenic bladder.
Contact Us In the event that you want to get rid of the symptoms of nervous bladder and live a life closer to normal, the doctors of Bimaristan Medical Center offer the latest techniques for treating nervous bladder in Turkey.
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