What is neurogenic bladder in children?

• Pediatric neurogenic bladder is a bladder dysfunction in children caused by damage to the body’s nervous system. The muscles and nerves of the urinary system work together to carry messages from the brain to the bladder and vice versa. But sometimes these communications break down due to a developmental malformation or physical injury to the nervous system or other impairment; when this happens, a child may experience incomplete bladder emptying or incontinence, caused by neurogenic bladder.

What causes neurogenic bladder in children?

• Neurogenic bladder is almost always related to another medical condition. Most commonly the problem stems from a birth defect of the spinal cord or brain such as:

  • Spina bifida

  • Cerebral palsy

  • Encephalitis

  • Multiple sclerosis

  • Spinal cord injury

  • Spinal cord tumors

What are the symptoms of neurogenic bladder?

• Symptoms can be a bit different for each child. They can include:

  • Urine leakage. This means urine coming out without control. This often occurs when the muscles holding urine in the bladder don’t get the right message.

  • Urine retention. This means having trouble releasing urine. This happens if the muscles holding urine in the bladder don’t get the message that it is time to let go.

• A child may also have:

  • Urinary tract infections (UTI) that cause pain or fever

  • Swollen Hydronephrotic kidneys

  • Thickened bladder wall on Ultrasound

How is neurogenic bladder diagnosed in a child?

• Diagnosis is done after history and clinical examination of the child. Voiding Diary (record of child urine habit) should be maintained  The tests required can be :

  • Urine tests

  • Urodynamic study ( Pediatric)

  • Ultrasound

  • MRI spine

 How is a neurogenic bladder treated in children?

• Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is. Treatment may include:

  • Timed voiding and Bladder Training

  • Using a catheter ( Clean Intermittent Catheterization CIC).

  • Medicine. Medicine can help relax the bladder muscles (Anticholinergic therapy) and prevent muscle spasm. Antibiotic medicine may be used to reduce the chance of urinary tract infections (UTIs).

  • Artificial sphincter. A small inflatable cuff is put around the neck of the bladder. It can be inflated to prevent urine leakage. And it can be deflated to empty the bladder. The child may still need a catheter from time to time to fully empty the bladder. 

  • Sacral neuromodulation: In this relatively new approach, small electrodes and a stimulator are inserted near nerves related to bladder function. The stimulator delivers the electrical impulses that the body would normally receive if the nerves were undamaged. However it is still experimental in children and device is approved for children above 18 years.

  • Surgery- Surgery may be done to:

    • Create a new opening in the belly where a short-term (temporary) catheter can be placed to empty the bladder

    • Make the bladder larger (Bladder Augmentation in children)

    • Tighten the sphincter so it can hold in urine better

Remarks

• For more details of Test, contact your surgeon/Radiologist.