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My Child Has:
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Neurogenic Bladder
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The muscles and nerves of the urinary system work together to hold urine in the bladder and then release it at the appropriate time. Nerves carry messages from the bladder to the spinal cord and then to the brain and from the brain, down the spinal cord to the muscles of the bladder and sphincter, telling them either to tighten or release. (See Urinary Tract Anatomy). In a child with neurogenic bladder dysfunction, the nerves that are supposed to carry these messages do not work properly, essentially paralyzing the bladder and/or the sphincter. Neurogenic bladder may also be called neuropathic bladder.
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In children a neurogenic bladder may be secondary to a birth defect usually involving the spinal cord or it may be acquired as the result of a different problem. The following are some of the most common causes of neurogenic bladder:
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- spina bifida - a defect in the spinal cord and spinal bony formation that occurs during early fetal development. The defect consists of incomplete bony closure of the spinal canal and injury to the developing spinal cord. Some types of spina bifida are obvious with an open defect of the back noted at birth, while others are subtle and only detected by careful inspection of the spine and legs.
- spinal cord trauma
- central nervous system tumors
- pelvic tumors
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- urine leakage (this often occurs when the muscles holding urine in the bladder do not get the right message)
- urine retention (this often happens if the muscles holding urine in the bladder do not get the message, and relax when it is time to let go)
- infection of the bladder or ureters (this often results from urine that is held too long before being eliminated or occurs with frequent wetting episodes from not being able to retain urine long enough)
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The following are the most common symptoms of neurogenic bladder. However, each child may experience symptoms differently. Symptoms may include:
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- urinary incontinence (small urine volume during voiding, urinary frequency and urgency, dribbling urine, loss of sensation of bladder fullness)
- urinary tract infection
- kidney injury due to high pressures of back up urine in the bladder
- kidney stones - these may be difficult to determine because your child may not be able to feel pain associated with kidney stones if they have spinal cord abnormalities. Symptoms of kidney stones include:
- blood in urine (hematuria)
- fever, chills (indicating a urinary tract infection secondary to an obstructing stone)
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The symptoms of neurogenic bladder may resemble other conditions and medical problems. Always consult your child's physician for a diagnosis.
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In addition to a complete medical history and careful physical examination, diagnostic procedures for neurogenic bladder may include:
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- urine tests
- urodynamic study - during this study, your child's bladder will be filled with saline so that the bladder volume and pressure may be measured. The tone or amount of contraction of the bladder can also be determined.
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Specific treatment for a neurogenic bladder will be determined by your child's physician based on:
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- your child's age, overall health, and medical history
- the extent of the disease
- your child's tolerance for specific medications, procedures, surgeries or other therapies
- expectations for the course of the disease
- your opinion or preference (parental imput)
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- insertion of a catheter or hollow tube (to empty the bladder at regular intervals)
- prophylactic (preventive) antibiotic therapy (to reduce the incidence of infection)
- placement of an artificial sphincter - a procedure that involves placing an artificial cuff around the neck of the bladder that can be inflated to prevent urinary incontinence and deflated when it is time to empty the bladder. These children will still require intermittent catheterization to completely empty the bladder.
- surgery to enlarge the bladder when it is very small; to increase the bladder outlet resistance to in order to prevent wetting at bedtime
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