A focused neurological examination is also recommended. A rectal exam can identify changes in anal sphincter tone. The physical examination should include an abdominal exam and the external genitalia in men, as well as a pelvic examination in women to check for prolapse.

These factors will help determine the range of available treatment options. The patient's overall health, mobility, cognitive ability, hand function (strength, coordination, and control), and social support network should be assessed. The timing and clinical course of the voiding dysfunction should be documented as well as any bowel issues, sexual dysfunction, or neurological deficits. A questionnaire about voiding habits can be used for all patients (frequency, number of voiding episodes, voiding volume, sense of incomplete evacuation or not, symptoms of a UTI ( burning, associated fever), anorectal issues (constipation, stool impaction, bowel incontinence). Usual voiding habits should be noted, particularly if there was a significant change at a specific time.Īll potential traumas, associated diseases such as diabetes or Parkinson's, medications, significant family medical history, and all surgical procedures should be reviewed and documented. Therefore, the history should focus on urinary tract issues and any neurological symptoms. Ī thorough history is always the first step in evaluating a neurogenic bladder. By definition, a neurogenic bladder involves some disorder or problem with the nerve control of continence and voiding function.

When associated with high bladder pressures, there is an increased risk of developing vesicoureteral reflux with subsequent renal deterioration. Possible voiding dysfunctions include a flaccid or spastic pelvic floor, detrusor overactivity, detrusor sphincter dyssynergia, or some combination of these disorders. Vesicoureteral reflux is present in up to 40% of the cases in children by age 5, and up to 60.9% of adults with spina bifida experience some degree of urinary incontinence. In these patients, some kind of bladder dysfunction is present permanently. Ībout 1427 babies are born in the United States with spina bifida roughly one out of 2758 live births. The worldwide yearly incidence of spinal cord injuries resulting in neurogenic bladder dysfunction has been estimated at between 12 to more than 65 cases/million population.

Research shows that 70% to 84% of patients with spinal cord injuries have neurogenic bladder dysfunction at some point in their lives. In the United States, a neurogenic bladder is found in 40% to 90% of persons with multiple sclerosis (with detrusor hyperreflexia in 50% to 90% of cases), 37% to 72% in patients with Parkinson disease, and 15% of all stroke patients. The mean age of neurogenic bladder patients is 62.5 (standard deviation of 19.6.) Any disturbance to the normal functionality of the structures mentioned above as a result of trauma or disease can cause bladder dysfunction. The internal urethral sphincter is in the bladder neck and proximal urethra, while the external sphincter is in the membranous urethra. The dome of the bladder is made up of interlocking smooth muscle cholinergic activated fibers, while the base consists of the trigone and bladder neck that is closely connected to the pelvic floor-two urethral sphincters at the bladder outlet control normal voluntary micturition. (The bladder's ability to store fluid without increasing intravesical pressure is called compliance and is an essential characteristic of normal voiding.)Īnatomically, the bladder is divided into two parts: the dome and the base. It passes through the ureters into the bladder, where it is stored until it approaches the maximum normal bladder storage capacity, usually up to 500 cc. The kidneys excrete nearly 1.5 L/day of fluid as urine. The voluntary micturition process consists of bladder filling, storage, and emptying. The micturition process is controlled by the central nervous system, which coordinates the activity of the sympathetic and parasympathetic networks with the somatic nervous system to maintain urinary continence. Normal functionality of the detrusor muscle and a physiologically competent internal and external urethral sphincter is necessary to maintain healthy urinary functionality and continence. The normal micturition process requires the proper function of both the bladder and urethral sphincters.

Overflow incontinence definition