NEUROGENIC BLADDER

It is the altered bladder function due to defects anywhere in the pathway of micturition reflex.

 CAUSES

• Tabes dorsalis
• Spinal cord trauma
• Diabetes mellitus
• Disc prolapse
• Cerebral diseases-
• Spina bifida
• Poliomyelitis
• Spinal cord root lesions

TYPES

UNINHIBITED NEUROGENIC BLADDER

• It occurs in CNS diseases due to block in the corticospinal tract.
• There is increased frequency, urgency and incontinence.
• There is early desire to micturate with inability to hold urine.
• Bladder capacity is decreased.
• Awareness of filling and distension, and voiding pressure is normal.
• No residual urine.

REFLEX NEUROGENIC BLADDER (AUTOMATIC BLADDER)

• Lesion here is above the level of micturition centre S2, S3 and S4.
• There is no desire to micturate.
• No awareness of filling or distension.
• Bladder capacity is normal or increased.
• Voiding pressure varies.
• Residual urine present.
• Infection is common.

AUTONOMOUS BLADDER

• Here micturition centre is destroyed (S2, S3, S4). Both sensory and
• motor parts are destroyed.
• There is no awareness of filling.
• Bladder is incapable of contraction and so bladder capacity is
•  
• No voiding pressure.
• High residual urine and infection.
• Stress incontinence is present.
• Patient empties the urine by manual pressure.

SENSORY PARALYTIC BLADDER

• Here sensation from the bladder to micturition centre is selectively
•  
• It is common in tabes dorsalis and pernicious anaemia.
• There is complete loss of awareness of filling.
• Varying voiding pressure.
• Increased bladder capacity and residual urine.
• Infection is common.

MOTOR PARALYTIC BLADDER

• It is due to selective destruction of motor pathway from the micturition centre to the bladder.
• It is seen commonly in polio, tumours, trauma.
• There is normal awareness of filling and painful distension.
• Voiding pressure is zero. It is atonic bladder.
• There is residual urine with normal bladder capacity.

INVESTIGATIONS

• Spine X-ray.
• Micturating cystogram.
• Urodynamic studies.
• Ultrasound abdomen to find out residual urine.
• Urine culture and microscopy.

HOMOEOPATHIC MANAGEMENT :

• Merc SoL
• Lycopodium
• Petroselinum
• Pulsatilla
• Thuja
• Chimaphila
• Clematis
• Sarsaparilla
• Staphisagria
• Cantharis
• Apis Mellifica