Bladder and bowel dysfunction following neurological disease

The lower urinary tract (bladder and urethra) has two roles: storage of urine and emptying at appropriate times. Detrusor muscle contraction is predominantly controlled by parasympathetic influence while sphincter muscles are controlled by sympathetic and pudendal nerves. The pontine micturition centre is responsible for coordinated activity of the detrusor and sphincters during the storage and voiding phases. Lesions anywhere in the nervous system can cause lower urinary tract dysfunction. Information obtained from history-taking and supplemented by using a bladder diary forms the cornerstone of evaluation. Ultrasonography is used to assess the degree of bladder emptying and to assess upper tract damage. Urodynamic tests, with or without simultaneous fluoroscopic monitoring, assess detrusor and bladder outlet function. Impaired voiding is most often managed by clean intermittent self-catheterization and should be initiated if post-void residual urine is greater than 100 ml. Storage symptoms are most often managed using antimuscarinic medications. Other options include desmopressin or detrusor muscle injection of botulinum toxin type A. Patients with neurological disease commonly have bowel complaints and may alternate between constipation and incontinence. Understanding of the underlying mechanism is crucial for effective management.