What is Neurogenic Bladder in Children?

Neurogenic bladder means that the bladder does not work normally due to damage to the nerves of the bladder. Neurogenic bladder can cause the child to have problems with holding or releasing urine, as well as causing problems with the kidneys. You can read our article on urine retention physiology. In summary, the bladder's urine storage and the structure we call siphincer, which allows us to hold the urine in the bladder neck, must work in harmony. This harmony is called Detrusor Sphincter Synergy. This occurs under the control of the central nervous system (cerebrospinal cord) and peripheral nerves to the bladder.

 

What are the Causes of Neurogenic Bladder in Children?

Neurogenic bladder in children may develop as a result of congenital or acquired nerve damage. The main treatments for acquired neurogenic bladder in children are trauma or tumours.

The most common causes of neurogenic bladder in children are;

• Spina bifida (myelomeningocele); Spinal cord defects that occur during the development of the baby in the womb
• Spinal cord injury; It usually occurs due to spinal cord damage caused by traffic accidents or falls from a height, sometimes due to spinal cord damage during surgery.
• Sacrum (coccyx bone) agenesis
• Cerebral Palsy; It is a congenital or acquired damage to the brain region that controls the motor movements of the body.
• Central nervous system tumour.
• Infection; Very rarely occurs due to brain and spinal cord infection.
• Peripheral Nerve Damage due to Pelvic Surgeries; Anal atresia, Teraatom, tumour surgeries such as bladder cancer are the main causes.

Which Children are at Risk for Neurogenic Bladder?

If children have congenital and acquired (such as postnatal trauma, infection) spinal cord problems, the risk of neurogenic bladder is high. In addition, children who have undergone pelvis, rectum and anus surgery, which is the last part of the large intestine, are also at risk. Again, children with congenital bladder pathology who have undergone surgery are at risk.

What are the Symptoms of Neurogenic Bladder in Children?

Symptoms may be slightly different for each child. These may include the following:

• Incontinence; i.e. urinary incontinence, bedwetting.
• Urine leakage and drip urination; This means that urine comes out uncontrollably. This usually occurs when the muscles holding the urine in the bladder do not receive the correct message.
• Reduced urine flow or difficulty urinating.
• Urine retention. This means having difficulty releasing urine. This occurs when the muscles in the bladder that hold the urine do not receive the message that it is time to release.
• Infection of the urinary tract; The bladder's inability to empty the urine completely and Vesicoureteral Reflux secondary to neurogenic bladder are the main causes.
• Feeling of frequent urination.
• Feeling of urgent urination.
• Stones in the urinary tract; due to incomplete emptying of the bladder and continuous urine in the bladder.
• Inability to feel urine coming.
• Developmental retardation; Due to frequent urinary tract infections, children cannot be fed regularly and developmental retardation occurs.
• High fever: It usually occurs due to a urinary tract infection.
• Thickened bladder wall
• Enlargement of the renal pelvis and ureters

How is Neurogenic Bladder Diagnosed in Children?

The two most important things in the diagnosis are the patient's history and a detailed and careful physical examination. However, some tests will be needed to investigate the cause and its effects. Here, your physician will decide which tests will be performed according to the patient's condition.

Some of these are;

• Urine and blood tests ; Administration tests will show us whether the kidneys are affected by infection and neurogenic bladder.
• Urination diary.
• Urodynamic Study; This test will give us information about the work of the bladder muscles. It will also give information about the outlet pressure of the bladder and the condition of the pelvic muscles. A thin, flexible catheter (probe) is inserted into the bladder through the urethra. It is filled with serum and shows how the bladder pressure changes during filling and emptying.
• Ultrasonography; The anatomical structure of the kidneys and bladder is evaluated by means of sound waves. In neurogenic bladder, bladder wall thickness is usually found to be increased.
• Magnetic Resonance Imaging: It is usually performed to evaluate the spinal cord and other central nervous system to investigate the cause of neurogenic bladder.
• Scintigraphy; It is performed to evaluate the functional status of the kidneys.
• Voyding Cystography; It is performed to investigate the anatomical structure of the bladder and especially the presence of vesicoureteral reflux.

How is Neurogenic Bladder Treated in Children?

The treatment plan depends on the child's symptoms, age, gender, general health, the presence or absence of kidney damage, the presence or absence of reflux and is patient-specific. Treatment may include:

• Changing Lifestyle; It is planned individually, coffee and carbonated drinks are avoided, regular and sufficient fluid consumption is ensured, weight loss is ensured if fat, constipation is treated, fibre and healthy nutrition is provided.
• Timed emptying of the bladder; It is the emptying of the bladder regularly and at certain intervals. If possible, it is done spontaneously, if not, it is done with catheters.
• Using a catheter; You may need to insert a thin, flexible tube into your child's urethra and up to the bladder. This is done to empty the bladder at regular times during the day. This is called Clean Intermittent Catheterisation (CIC).
• !!!'For detailed information on the subject, you can read our article titled Clean Intermittent Catheterisation.
• Medication. Medication can help relax the bladder muscles and prevent muscle spasms. Anticholinergic drugs are used for this purpose. Antibiotic medication may be used to reduce the chance of urinary tract infection (UTI). Botox can also be used to regulate bladder function.
• Botulinum (BOTOX) Injection; Depending on the doctor's decision, it can be applied to the physiological sphincter in the bladder or bladder neck. It should not be forgotten that its effect is temporary (6- 9 months).
• The first treatment in these patients is Clean Intermittent Catheterisation and use of anti muscarinic drugs. Botulinum toxin A (Botox) administration into the bladder muscle is a very good treatment alternative in selected patients who do not benefit from this treatment.
• Botulinum toxin A (Botox) can temporarily restore bladder function in patients with neurogenic bladder.

How is Botilinum Procedure Performed?

Under general anaesthesia, the bladder is entered into the bladder with a camera system called cystoscope, the bladder is mapped and the dose appropriate for weight is injected into the intra-bladder muscle in small amounts in 20-30 areas. The patient can go home on the same day by continuing his/her previous treatment.

Does Botulinum Application Need to be Repeated?

Botulinum toxin A (Botox) treatment applied into the bladder loses its effect in an average of 6-9 months and the procedure may need to be repeated again. The procedure can be repeated, studies have shown that repeating the procedure has no negative effect.

Despite all these, pelvic floor exercise programme can be applied in unsuccessful patients.

!!! For more detailed information about Pelvic Floor Exercise, you can read our article with the same name.

In patients with Neurogenic Bladder, it may be necessary to perform bladder augmentation (Ileocystoplasty) and Mitrofanof Surgery to prevent Urinary Tract Infection and to protect kidney functions, to correct the patient's incontinence, in short, to live a life close to normal psychologically, socially and physiologically.

!!! For detailed information on this subject, our article titled Augmentation (Ileocystoplasty) Mitrofanoff can be read.

What Complications Does Neurogenic Bladder in Children Cause If It Is Not Treated Appropriately and On Time?

It may cause permanent physical and psycho-social damages that negatively affect life. Vesico-ureteral reflux may lead to increased intra-bladder pressure due to detrusor sphincter dyssynergia (the harmony of the bladder muscle and the muscles called sphincter at the beginning of the urethra) and may cause developmental retardation and renal failure due to frequent urinary tract infections.

Due to urinary incontinence, the child escapes from the social environment, does not want to go to school and develops a pathological sense of shame, school and individual achievements are negatively affected. Depending on all these, it may lead to serious psychological damages such as lack of self-confidence, depression, anxiety and social isolation.

How Can Families Help Children Live with Neurogenic Bladder?

Living with a neurogenic bladder can be difficult. Incontinence is considered embarrassing. It can lead to self-esteem problems in your child. It is vital that you are supportive and patient with your child's treatment and emotional development. It takes work and time to learn how to best manage your child's condition. Encourage your child's success by making sure he or she follows the treatment plan. In some cases, a psychotherapist can help the child and family follow the treatment plan. It should be remembered that any treatment and healthy development and life success in these children depends on trust in the physician and the interaction between the physician, the family and the child in harmony and understanding.

*** The information provided here, the content of the website is designed to inform the visitor, especially the families. No information should be considered as advice by the visitors and should not lead to any decision or action. Families should definitely have their patient examined by a paediatric surgery specialist and make a decision by consulting with him/her and consulting his/her one-to-one information.