The autonomic nervous system regulates the functions of the bladder and genital organs. Many chronic neurological disorders cause disorders of the bladder or sexual functions. These can affect the quality of life early in the course of polyneuropathy, Parkinson's disease, multiple sclerosis or dementia. Successful treatment requires collaboration between urology and neurology. It usually consists of a combination of drug treatments, supplies of aids and a training of the pelvic floor.
Nerves control the bladder function
The normal bladder function involves the filling phase and the emptying of the bladder. Control functions are located at all levels of the autonomic nervous system. The filling phase of the bladder is controlled by a switch in the lower end of the spinal cord, the onuf core. From there, sympathetic nerve fibers move to the bladder sphincter. The control of bladder emptying (micturition) is the task of corresponding urinary bladder switching points in the brain stem (pontine micturition center) and the cerebrum (frontal bladder center). Bladder emptying requires precise coordination between the contraction (contraction) of the bladder filling muscle (detrusor) and the opening of the bladder sphincter. The coordination of these two functions succeeds through the bladder-evacuation reflex (micturition reflex).
The neurogenic bladder disorder may be associated with either overactivation or dysfunction of the detrusor muscle (bladder muscle). In everyday life, the increased activity of the bladder muscle can be felt by frequent urinary urgency. In the course of the neurogenic bladder disorder, multiple nocturnal bladder emptying may become necessary or already habitual. A number of 10 or more visits to the toilet during the day is not uncommon in hyperactivity of the bladder muscle. It is particularly annoying when the urinary urgency does not tolerate any delay and determines everyday life. Not infrequently, this unpleasant change leads to drinking little or too little liquid. This can promote problems such as circulatory disorders or urinary tract infections and.
The overactivation of the bladder muscle causes increased urination with frequent nocturnal emptying and finally also incontinence. The diminished bladder function (detrusor hypocontractility) leads to delayed or incomplete bladder emptying. As a result, incontinence may also occur, overflow incontinence.
Neurological causes of bladder disorders
The underactive bladder muscle may result in delayed and incomplete emptying. Occasionally, the compression of the lower abdomen by hand (abdominal pressure) is used to empty. Often, those affected by the urine remaining in the urinary bladder shortly after using the toilet again urinary urgency. If urine remains in the bladder in this way, it can lead to an increase of bacteria in the urine and thus to a bladder infection. Occasionally, a bladder disorder only by an accumulation of bladder infections. This is especially typical for chronic neurological disorders. These include both nerve diseases such as polyneuropathy and diseases of the central nervous system such as multiple sclerosis.
Disorders of bladder emptying (micturition) can be caused at different levels of the nervous system. Depending on the disease, the impulse transmission of the nerves of the bladder and the sphincter, but also the function of the switching points in the spinal cord, brainstem or cerebrum may be damaged.
As part of the urological examination initially other causes such as obstacles or narrowing of the urinary tract are excluded. It is also helpful to accurately assess a bladder disorder over a period of a few days, including the frequency of urinary bladder emptying, nocturnal toilet visits, and urinary problems such as delayed urination, painful urination, and the frequency of daily bladder emptying.
Examination of neurological bladder disorders
In order to detect a neurogenic or neurological cause of the bladder disorder, specialized examinations are required. For this purpose, we work closely together with neurourological specialists. A very helpful study of bladder function is video urodynamics. The urodynamic examination makes it possible to differentiate the named forms of neurogenic bladder disorders. Based on a urodynamic examination, the urinary bladder pressure and flow curves are recorded before and during bladder emptying. In the field of video urodynamics, an X-ray examination unit is used, with the aid of which the change in the filling state of the bladder during the urodynamic examination can be documented.
In neurogenic bladder disorder, the Autonomous Functional additionally contributes to understanding the damage of parasympathetic or sympathetic nerves. Thus, the question can be answered, whether a chronic bladder disorder, for example, a result of general dysautonomia (disorder of the autonomic nervous system) as, for example, in a Parkinson's disease. The studies help to identify autonomic neuropathy as part of a neuropathy such as polyneuropathy. If the urinary bladder disorder is the result of a spinal cord injury, the extent of the nerve damage as well as the location of the lesion can be better limited by neuro-vegetative examinations.
The neuro-urological treatment
The treatment planning of neurological bladder disorders is done in coordination between neurological and urological specialists. First, non-drug treatment options are exhausted. These included bladder training and hydration planning for the day. If medications are needed to improve bladder function they should be selected with careful consideration and avoidance of drug interactions.
Neurogenic bladder dysfunction is often associated with erectile dysfunction in men and decreased vaginal lubrication in women. The erectile dysfunction results from the disturbance of parasympathetic nerve fibers of the spinal cord and a reduced release of vasodilator and circulation-enhancing nitric oxide. The treatment of erectile dysfunction is an important part of the neurourological treatment plan.
Patients recalled the following experiences:
At the beginning of Parkinson's disease, my bladder often pushed me. Then it had to be fast. Thanks to early diagnostics by ANS Clinic in cooperation with a neuro-urologist I received an effective medication.
„You have questions about ANS Clinic or would like to make an appointment? I'm happy to help.“
Prof. Dr. Med. Christina Haubrich