What is Neurologic Lower Urinary Tract Dysfunction?
Neurologic lower urinary tract dysfunction (NLUTD) refers to the abnormal bladder function in patients with any relevant neurologic disorder. Examples of this include dementia, stroke, Parkinson’s disease, congenital spine conditions and multiple sclerosis. Such neurologic disorders also tend to affect bowel function, sexual and reproduction function, mobility, and cognition. NLUTD falls under the umbrella of a larger range of symptoms known as lower urinary tract symptoms (LUTS).
What causes Neurologic Lower Urinary Tract Dysfunction?
A healthy nervous system is crucial to having normal bladder function as it regulates the interactions between the brain, spine, bladder and the urinary sphincter. During normal storage, the bladder is relaxed and stores urine while the urinary sphincter is tightened to prevent any leaking.
In contrast, during urination, the bladder contracts to increase pressure while the urinary sphincter relaxes to release urine. In the presence of certain neurologic disorders, these coordinated functions may be disrupted, leading to a number of urinary symptoms.
What are the symptoms of Neurologic Lower Urinary Tract Dysfunction?
The symptoms of NLUTD will generally depend on the underlying neurologic disorder. However, some common symptoms to look out for are:
- Slow voiding
- Inability to empty the bladder completely
- Lack of sensation in the bladder
- Bladder spasticity
- Feeling fullness in the abdomen
- Frequent urges to urinate
- Incontinence
- Pelvic pain
Over time, these symptoms may lead to more serious complications such as kidney damage, deterioration of the bladder, and recurrent urinary tract infections (UTIs).
When should I visit a doctor?
Please visit us if you experience any of the above symptoms, especially if you have a confirmed neurologic disorder. This is to begin treatment promptly and provide advice on what changes you can make to your lifestyle to alleviate your symptoms.
Sometimes, your condition may not cause much discomfort. However, delaying treatment might worsen your urinary tract function, making early diagnosis and treatment key! Some short and long term complications are:
- Damaged kidney function
- Damaged bladder with voiding issues
- Incomplete emptying or backflow of urine to the kidneys
What can I expect during my first consultation?
In order to better understand your condition, your urologist will ask a series of questions to find out more about your symptoms and medical history. You may also be asked to keep a bladder diary for over 24 hours and three consecutive days.
A physical examination and various diagnostic tests such as blood tests or uroflowmetry will also be conducted.
How is neurologic lower urinary tract dysfunction diagnosed?
When it comes to NLUTD, it is crucial to obtain a diagnosis and begin treatment as early as possible to prevent further complications. The tests used to diagnose NLUTD include:
- Urinalysis and Urine Culture
Your urine sample will be sent to a laboratory to check for the presence of blood or infection. - Various Blood Tests
The most common of these is a renal panel to check kidney function. - Bladder Diary
To keep a bladder diary, you will be asked to record how much fluid you drink, how often you urinate, and the volume of urine produced throughout a three-day period. - Pad Test
A pad test involves having to wear an absorbent pad for 1 to 24 hours, which will then be weighed. - Uroflowmetry
This is a test that will measure your voiding function by analysing the speed and volume of your urination. - Urodynamic study
This is a real-time functional study of the bladder involving the infusion of saline into the bladder via a small urethral catheter and observing the voiding pattern. It aims to replicate any voiding issues in order to tailor the most appropriate treatment plan. - Flexible Cystoscopy
This is a relatively painless test that uses a fibre-optic telescope to inspect the bladder and urethra. In males, the prostate gland will also be examined. - Ultrasound Bladder
An ultrasound bladder can show any potential issues with the structure of the bladder. This test is commonly used in conjunction with a uroflowmetry test to check for residual urine after urination.
Can neurologic lower urinary tract dysfunction be cured?
Unfortunately, many neurologic disorders do not have a cure. However, there are various treatments options available to alleviate symptoms of NLUTD and minimise any disruptions to your daily life.
How is neurologic lower urinary tract dysfunction treated?
When it comes to the treatment of NLUTD, your urologist’s main goal is to protect the kidneys, as kidney failure is the most serious complication that can arise when NLUTD is improperly managed. Other treatment goals will include restoring bladder function, reducing incontinence and urinary tract infections and achieving a better overall quality of life. Treatment plans will vary depending on the underlying neurologic disorder and the severity of your symptoms. Treatment options for NLUTD include:
Drug Treatment
For NLUTD, medication is typically prescribed in combination with other forms of treatment. Some common medications prescribed to patients with NLUTD are:
- Muscarinic Receptor Antagonists (MRAs)
These medications work to reduce abnormal contractions in the bladder. - Alpha-blockers
These help to relax the muscles in the bladder neck and sphincters - Parasympathomimetics
These medications may be used to stimulate bladders to contract and help to empty better.
Non-invasive treatments
- Bladder Training
This involves deliberately delaying urination in order to train the bladder to hold urine more effectively. - Double Voiding
This refers to urinating, then waiting for a few minutes and trying to urinate again. It helps to completely empty the bladder to prevent leaking. - Pelvic Floor Exercises
More commonly known as Kegels, these help to strengthen the muscles that control urination. - Electrical Stimulation Therapy
This is a method of strengthening the pelvic floor muscles over time using an external device. - Use of Medical Devices
One example of this is a catheter, which can be inserted into the urethra to help empty the bladder completely. - Injection of Neurotoxin A
Neurotoxins may be injected into the bladder muscles to relax them and prevent spasms. - Neuromodulation
Various devices may be used to stimulate the tibial and sacral nerves in order to help with bladder control.
Surgical Procedures
- Sphincterotomy
In cases where the urinary sphincter is too tight, it can be cut in a procedure known as a sphincterotomy to reduce any tightness. The risk is permanent incontinence.
- Bladder Augmentation
In this procedure, the bladder is surgically expanded using expandable tissue, such as that of the intestines.
- Urinary Diversion
This is a surgical intervention that creates an artificial diversion of urine from the kidneys while bypassing the bladder completely. It is only used in extreme cases of NLUTD.
Lifestyle Changes
- Changing your diet
- Reducing alcohol consumption
- Reducing caffeine consumption
- Losing weight
- Avoiding certain physical activities
- Wearing absorbent pads or adult diapers
- Bladder training
Summary
NLUTD is a complicated disorder that can have serious consequences. However, it is possible to lead a normal life by properly managing the condition. Your urologist will guide you and work with you to actively manage your symptoms and provide you with the best quality of life possible. The aims are to empty the bladder as completely as possible, prevent urinary tract infections, avoid urinary leakages and protect the kidney function.
If you have a confirmed neurologic disorder and are experiencing any urinary symptoms, please make an appointment as soon as possible. Your doctor will be able to diagnose and begin treatment for any issues you face and provide you with suitable management techniques that you can easily incorporate into your lifestyle for long-term management.
