Neurogenic bladder in children: treatment, symptoms
Failure of the function of urination is quite a common disease. Neurogenic bladder in children is found in 10% of young patients and is manifested in infancy. The disease is congenital or acquired in nature, depending on the reasons for a nervous disorder. While boys are less likely to experience illness than girls.
Neurogenic bladder is a term, implying the failure of his tank, valve or evacuation function. Bladder person collects, holds and excretes urine from the body. This process is closely connected with the activity of the kidneys, ureters and Central nervous system. The slightest disturbance in the nervous system affect urination.
Children suffering from this disease have problems with uncontrolled release of urine. This creates many physiological and psychological problems. The child is unable to cope with the problem, and often exposed to ridicule from peers. As a result, developing a number of diseases, cystitis, pyelonephritis, urolithiasis, and depression.
Why is this happening?
Reflex managed incontinence has a conditional nature and depends on brain activity and the work of his Central nervous system. Any neurological disorder contribute to the disorder of the work of detrusor or external sphincter. Causes of disease are divided into congenital and acquired. Crashes occur because of these problems:
- birth injuries;
- pathology of the hypothalamus or pituitary gland;
- Cerebral palsy;
- congenital anomalies;
- of diabetes;
- hernias of the spine.
To cause disruptions in the nervous system can:
- stretching of the bladder muscles;
- inflammation of the ureters;
- malignant or benign tumors of the spinal cord or brain.
The types of pathology
Neurogenic dysfunction of bladder in children is due to the ability of muscles to contract at the time of accumulation of urine or emptying. To classify neurogenic disease made precisely according to the variety of violations. Additional indicators can be form of the disease or the amount of urine present in the body, before it happens emptying. Distinguish neurogenic mocevic type:
- Hyporeflectivity (hypotonia of the bladder). At the stage of excretion of urine muscles bladder weakly decreasing. This leads to its excessive content. The result is incontinence.
- Hyperreflection bladder. In the phase of accumulation of urine, the muscles contract more often the norm. As a result, urine is not retained in the bladder and out the ureters frequently and in small quantities.
- Reflectory — bladder, muscles which do not respond to the volume of urine contained in it, and not be reduced. Thus, the function of urination is uncontrolled CNS.
Due to the ability of bladder muscle to stretch and adapt to the volume of urine, the body may be adapted or unadapted. At the same time manifested in milder forms (enuresis, stress incontinence, incontinence due to physical stress). May have an average degree of gravity (reflex excretion of urine) or to be in a heavy running phase syndrome (Ochoa syndrome Hinman).
Neurogenic bladder in a child develops depending on its causes, stages and species. The symptoms of the disease indicate not only disease, but also provide an opportunity to diagnose a specific disease. Hypertension of the bladder in a child can be traced:
- the imperative urge to urinate;
- small amounts of urine;
- pain in mochevyvodjashie;
- frequent (up to 10 times per day) urination.
For hypoactive neurogenic bladder is characterized by:
- rare urination (1-3 times daily);
- constant feeling of fullness of the bladder;
- feeling that urination is incomplete;
- a large amount of urine;
- pain in the abdomen.
If the child is striking syndrome Hinman, he suffers from chronic constipation, kidney infections, and genitourinary system. The child wants to use the toilet, only when the horizontal position moves to the vertical. Syndrome Ochoa, possessing all the above characteristics, has hereditary character and is accompanied by arterial hypertension.
Neurogenic disorder of the bladder entails the loss of control over urination. The first signs appear at the age of one and a half to 4 years, as the reflex control of the body’s needs in the evacuation by this time have already formed. It should be noted that teenage girls uncontrolled urination often occurs during physical exercise and even laughter. This is due to the fact that women (especially in puberty) significantly increases the level of estrogen.
Function disorder urination is not accompanied by pain, but creates a considerable discomfort. First and foremost, the children often suffer psychological disorders, depression. In this case, it is important to support the baby and give him to lower the self-esteem. The consequences of neurogenic bladder depend on the type of dysfunction. For example, in hypotonic variant of the disease in the bladder is the stagnation of urine in large volumes. This provokes a reflux of urine into the kidneys. As a result develops uremia — a disease in which the urine toxins penetrate into the blood. Another effect is peritonitis — inflammation of peritoneum due to rupture of the bladder wall as a result of excessive accumulation of urine. If the baby has an overactive bladder that entails cystitis, pyelonephritis, urolithiasis, renal failure, chronic inflammation of the pelvic organs.
Diagnosis of neurogenic bladder dysfunction in children
Diagnosis of neurogenic bladder is aimed not only at detection of the disease, and, primarily, the elucidation of the causes of the disease. Therefore, upon detection of symptoms of dysfunction of urination parents should not attempt to draw conclusions, and to refer to specialists in this field, pediatrician, pediatric urologist, nephrologist and, if there are psychological conditions, to a psychologist or psychiatrist. Specialists conduct the diagnosis of the disease in several stages.
- The study of anamnesis of life of child and disease. At this stage, the doctor examines the patient’s complaints, finds out about a possible head injuries, spine or pelvic organs. Here parents, it is important to tell your doctor about disorders or urination of the child.
- The reasons of the disease, laboratory and instrumental methods.
Experienced pediatricians, urologists determine the neurogenic bladder in children laboratory and instrumental methods. Laboratory techniques include:
- Biochemical analysis of blood. Is done to determine the amount of metabolic products in the blood.
- General analysis of blood.
- The General analysis of urine.
- The analysis of urine on Nichiporenko. Gives information about the level of white blood cells, red blood cells and protein blood.
- Analysis of urine by zimnitskiy. Allows to examine the ability of the bladder to concentrate urine. Conducted by collecting the urine, derived from the body during the day.
- Buck urine.
Instrumental methods of diagnosis of bladder dysfunction:
- Ultrasound of the kidneys and bladder;
- excretory urography;
- contrast x-ray.
Urinary channels play an important role in the activity of the sphincter apparatus. So after research on the state of the kidneys, bladder and blood is important to eliminate the problem at the level of the urinary tract. To do this, hold electromyography, and retrograde cystometry and uroflowmetry.
If previous studies rule out the causes of disease at the level of the sphincter are checking the nervous system of the child. To do this, your doctor may order an MRI or CT scan of the brain and neurosonography. Such procedures will help to see the reason for that lies in the cortex of the child. In this case, the treatment of the disease significantly differs from the usual in pediatric urology.
Treatment and its types
Treatment of neurogenic bladder depend on the symptoms and type of disease. Important in the fight against disease in young patients conduct comprehensive therapy. It includes nutrition and lifestyle of the child, medication, physiotherapy, therapeutic gymnastics, physiotherapy, and, if the disease is not amenable to conservative methods, surgical intervention.
Lifestyle and nutrition
Children suffering from disorders of urination, need of care and constant monitoring on the part of parents. They must monitor the observance of a day regimen and prescribed by doctors diet. First and foremost, adults must provide a healthy daytime sleep your child. The baby should not be exposed to stress, physical loads are contraindicated. The body needs fresh air, so the room of the patient must be ventilated. The food must be balanced. Sour, salty or spicy should be excluded from use. Drinking mode and time of voiding should be monitored by parents and physician.
Although physical stress in the pathology of the bladder is contraindicated, therapeutic exercise is one of the methods of complex therapy. Effective is a set of exercises Kegel. It is aimed at improving the functioning of the pelvic floor muscles and, in particular, of the bladder. As a result of passing such a course and stretch the muscles come in tone. This gives you the ability to hold urine in the bladder and to improve urination.
Correctly selected physiotherapy have a beneficial effect on restoration of function of the bladder. However, to pass their children should be exclusively under the supervision of a doctor to avoid negative reactions. If neurogenic pathology of the urinary act, the child could take:
- electrophoresis with drugs;
- hyperbaric oxygenation;
- electrical stimulation of the bladder;
- therapy magnetic waves;
- the ultrasound procedure;
Prescriptions neurogenic bladder in children depends on the type of disease. The doctor chooses the funds with the least amount of side effects on the young organism. In the treatment of any type of bladder dysfunction, must be used vitamin preparations, namely vitamin B1, B6, B2, PP, A and E. When the hypertonicity of the muscles of the bladder with the disease are struggling:
- anticholinergics — «Atropine», «Oxybutynin», «Bellataminalum», «Imipramine» (for children older than 5 years);
- calcium channel blockers «Nifedipine», «Terodiline»;
- a tincture of motherwort or Valerian;
- «Desmopressin» — if you have frequent night urination.
To combat hypotonic bladder must be periodically katterbach the ureters. The child should urinate every 2-3 hours, gradually increasing the intervals. Additionally used:
- tincture of Eleutherococcus.
Not only the urogenital system requires complex therapy. Do not forget that well-functioning Central nervous system of the child greatly influences the elimination of the causes of the disease. This little patients can understand «Glutamic acid», «Piracetam», «Picamilon» or «Pantogram». The choice of drug and dosage purpose always remains with the attending physician.
Conservative therapies provide an opportunity to overcome the disease. If this does not happen, it is necessary to resort to surgery. Depending on the clinic of the disease may hold:
- surgery ganglia;
- implantation of collagen under the entrance gate of the ureters;
- transuretralna excision of the bladder neck;
- the bladder volume increases.
Treatment of folk remedies
To treat neurogenic bladder of the child folk remedies is also possible. Alternative medicine offers to use herbal teas that promote calming of the nervous system and release stress. Such herbs include chamomile, Melissa, mint. A beneficial effect has tea with blueberries. Alcohol tincture of Valerian, of sage or of Eleutherococcus are relaxing on the brain. Is not denied the option of recourse to the wise woman, who, shaking his egg on the head of the child, as if removed the disease.
Prevention and forecasts
If the child’s body is prone to violation of urination, appropriate in order to prevent take uroseptic «Furagin», «Taktivin», «Levamisole», «Kanefron» and like electrophoresis of drugs. A good prevention from parents is providing healthy lifestyle Chad and a balanced diet. It is important to monitor the frequency and characteristic of urination, and if detected symptoms, do not self-medicate but to consult a pediatric urologist, nephrologist. Neurogenic disease of majevica prone to relapse.