Neurogenic bladder from spinal cord lesions

Neurogenic bladder dysfunction occurs due to spinal cord lesions and it poses a significant threat to the well-being of patients and quality of life.

Spinal cord injuries cause physical trauma, tumors, multiple sclerosis (MS), and other neurodegenerative conditions. It poses a serious threat to urinary incontinence, renal impairment, bladder or renal stones, urinary tract infection, and stone formation. Diseases or lesions of the spinal cord result in an overactive bladder and a frequent urge to urinate. Children born with myelomeningocele may have neurogenic bladder dysfunction from birth. They require efficient bladder management to ensure reservoir function of the bladder emptying, and dryness. The spinal anomalies are associated with lesions of the spinal cord or the spinal nerve roots. The majority of children born with Spina Bifida/spinal cord lesions are at risk of constipation and need a laxative to keep stooling regularly.

Spinal nerves that control the bladder did not function properly and cause neurological abnormalities. The bladder will have trouble storing urine in the bladder. Myelomeningocele is the most severe form of spinal cord lesions.

Spina bifida occulta causes a small separation or space in one or more of the bones of the spinal cord.

A myelomeningocele is a severe form of spina bifida or spinal nerve lesions in which spinal cord nerves develop outside of the body and that particular area loses all sensation. This creates muscle weakness, paralysis, urinary tract dysfunction, bladder, and bowel dysfunction.

Early management is focused on the optimization of bladder function and preventing injury to the upper urinary tract.

Meningomyelocele is a type of spinal cord lesion or Spina bifida. It's a birth defect that causes a portion of the spinal cord and adjacent tissues to protrude through the child's back. The spinal cord is not developed properly and the child might lose complete control of the bladder or bowel. some possible symptoms included:

• Problems moving parts of the body and deformities in legs
• Paralyzed or lack of sensation in legs
• No bowel or bladder control
• Too much cerebrospinal fluid in the head leads to swelling of the brain

When spinal cord nerves are injured by illness or lesions, the muscles and nerves become unable to tighten and relax bladder muscles. Other possible causes may include:

• Birth defects of the spinal cord, such as spina bifida or spinal cord lesions
• Spinal cord injury
• Lack of folic acid during early pregnancy impairs the development of the spinal cord
• Certain anti-seizure medications, such as valproic acid may cause neural tube defects during pregnancy.
• Pre-pregnancy obesity may increase the risk
• Disorders of the central nervous system
• Vitamin B12 deficiency in mother

Prenatal ultrasound diagnoses the myelomeningocele or spinal cord lesions in a baby.

• A maternal serum alpha-fetoprotein (MSAFP) test is done for checking the presence of alpha-fetoprotein (AFP) protein in a baby. High levels of AFP may suggest that the baby has a spinal cord defect.
• An ultrasound test is crucial to further evaluation of spinal cord lesions on a baby. An ultrasound test can detect an open spine or any features of spinal cord lesions in a baby.
• Amniocentesis removes a sample of fluid from the amniotic sac that surrounds the baby. Though, this process is risky and may cause a loss of pregnancy.

This condition is generally diagnosed during early pregnancy so termination of pregnancy is also an option. If this is not the case, the baby needs surgery after birth.

• Spina bifida can worsen after birth if not treated early. Prenatal closure of the open myelomeningocele defect can be initiated under expert doctors. Surgeons open the uterus and repair the baby's spinal cord and cover them with muscles and skin. They also place a shunt in the baby's brain to control hydrocephalus. This can be performed less invasively with a fetoscope. Early surgery minimizes the risk of infection associated with the exposed nerves.
• Myelomeningocele needed more repairments and management programs for treating a variety of complications. Routine bowel and bladder evaluations and management plans are done to ensure low-pressure reservoir function of the bladder, complete emptying, and dryness. It reduces the risk of organ damage and illness. Mobility aids and regular physical therapy prepare their legs for walking.
• Surgery for hydrocephalus is needed in most myelomeningocele babies. A surgical tube is placed in the brain to drain the accumulated fluids into the abdomen.
• Management of other complications is needed to help in daily functioning.

Children with myelomeningocele often require multiple cares of neurology, physical therapy, orthopedics, etc.