Neurogenic detrusor overactivity (NDO) is a bladder dysfunction caused by nerve damage affecting bladder control. This damage leads to involuntary contractions of the detrusor muscle, the main muscle of the bladder wall. Individuals with NDO often face challenges with bladder control, impacting their daily routines and well-being. NDO is manageable, with various approaches available to help individuals regain control and improve quality of life.
Understanding Neurogenic Detrusor Overactivity
The bladder stores and empties urine, a process regulated by nerve signals. During filling, the detrusor muscle relaxes to allow the bladder to expand and hold urine. When urinating, the brain sends signals through the spinal cord to the bladder, prompting the detrusor muscle to contract and expel urine.
In neurogenic detrusor overactivity, nerve pathway damage disrupts normal communication between the brain, spinal cord, and bladder. This causes the detrusor muscle to contract suddenly and without warning, even when the bladder is not full. These uninhibited contractions lead to urgency and involuntary urine leakage. The neurological impairment prevents the brain from properly signaling the bladder to remain relaxed during filling, leading to its hyperactive state.
Neurological Conditions Leading to NDO
Neurogenic detrusor overactivity arises from various neurological conditions that impair nerve signals governing bladder control.
Spinal Cord Injuries
Damage to the spinal cord directly interrupts pathways connecting the brain to the bladder.
Multiple Sclerosis
This chronic disease affecting the brain and spinal cord can also lead to NDO.
Parkinson’s Disease
This progressive disorder impacting the nervous system often results in NDO.
Strokes
These can damage areas responsible for bladder control, leading to detrusor overactivity.
Spina Bifida
This birth defect inherently compromises nerve function to the bladder.
Brain Tumors
These can damage nerve centers in the brain that regulate bladder function.
Recognizing the Symptoms
Individuals with neurogenic detrusor overactivity experience a range of symptoms related to bladder control. Urinary urgency is a frequent complaint, characterized by a sudden, intense need to urinate that is difficult to postpone. This often leads to urinary frequency, where a person needs to urinate more often than usual throughout the day and night. Urge incontinence, the involuntary leakage of urine immediately following a strong urge to urinate, is also a common symptom.
Nocturia, waking up multiple times during the night to urinate, disrupts sleep patterns. Some individuals might also experience incomplete bladder emptying. This can contribute to a higher risk of recurrent urinary tract infections (UTIs) because residual urine provides a breeding ground for bacteria.
How NDO is Diagnosed
Diagnosing neurogenic detrusor overactivity typically begins with a thorough medical history and physical examination. Urinalysis is routinely conducted to check for urinary tract infections or other kidney issues.
Specialized tests evaluate bladder function. Urodynamic studies are a primary diagnostic tool, involving a series of tests that measure bladder pressure, urine flow rates, and bladder capacity during filling and emptying. These studies help identify the involuntary detrusor contractions characteristic of NDO. Imaging studies, such as magnetic resonance imaging (MRI) or computed tomography (CT) scans, may also be performed to visualize the brain or spinal cord and identify the underlying neurological condition.
Treatment Options
Managing neurogenic detrusor overactivity often involves a tailored approach that can combine several strategies. Lifestyle modifications are frequently the first step and include managing fluid intake, such as reducing fluids before bedtime, and practicing timed voiding, which involves urinating at scheduled intervals to prevent urgency and accidents. Pelvic floor exercises, also known as Kegel exercises, can help strengthen the muscles that support the bladder and aid in maintaining continence.
Medications are commonly prescribed to help relax the bladder muscle and reduce involuntary contractions. Anticholinergics, such as oxybutynin or tolterodine, work by blocking nerve signals that cause bladder spasms, while beta-3 agonists, like mirabegron, relax the detrusor muscle.
When oral medications are not sufficient, minimally invasive procedures may be considered. Bladder injections of botulinum toxin can temporarily paralyze parts of the detrusor muscle, reducing its overactivity. Sacral neuromodulation involves implanting a small device that sends mild electrical impulses to the sacral nerves, which regulate bladder function.
For severe and refractory cases, surgical options may be explored, such as augmentation cystoplasty, which involves enlarging the bladder using a segment of the intestine to increase its storage capacity. Urinary diversion, creating an alternative pathway for urine to exit the body, is typically considered a last resort.