Lower urinary tract dysfunction in neurological disease

Urinary symptoms can arise due to neurological disease in the brain, the suprasacral spinal cord, the sacral spinal cord or the peripheral nervous system

• damage within each of these areas tends to produce characteristic patterns of bladder and sphincter dysfunction
• nature of the damage to the nervous system is also important
  • in children the neurological damage is often the result of congenital defects such as spina bifida or sacral agenesis
  • conditions may produce a relatively fixed or stable injury to the nervous system (for example, stroke, spinal cord injury and cauda equina compression) or progressive damage (for example, dementia, Parkinson's disease, multiple sclerosis and peripheral neuropathy)

Clinical features:

• symptoms of neurogenic lower urinary tract dysfunction may relate to impaired urine storage and/or bladder emptying difficulties
• symptoms of impaired storage include increased frequency of urination and urinary incontinence

Notes:

• proximity of the neurological centres controlling bowel and sexual functions to those involved in lower urinary tract function means that many people with neurological disease will have a combination of urinary, bowel and sexual dysfunction
• secondary effects can also arise as a result of neurogenic lower urinary tract dysfunction. For example, there is a marked increase in the risk of urinary tract infection in people with neurogenic lower urinary tract dysfunction and kidney function can be lost as a result of abnormally high pressures within the bladder, from the effects of urinary tract infection and as a result of kidney stones
  
  

Reference:

• 1) NICE (August 2012). Urinary incontinence in neurological disease - Management of lower urinary tract dysfunction in neurological disease