Incontinence may be related to defects in the nervous system, which conducts urination signals between the bladder and the brain. Such cases of neurogenic bladder -- for example, in patients with diabetes, Parkinson's disease, or myelomeningocele (bulging out of the spinal cord through a defect in the spine) -- may not be associated with the severe irritative symptoms seen in bladder infections. Instead, patients may have severe, total incontinence, a rigid bladder and a nonfunctional sphincter mechanism.

On the other hand, people with a neurogenic bladder may have a functional sphincter mechanism, but a rigid bladder that allows high pressures to build in the bladder and prevents urine drainage. In such instances, hydronephrosis (urine-caused swelling of the upper ureter) and renal insufficiency (inadequate kidney function) may result.

Risk Factors

Below are the two main risk factors for neurogenic urinary incontinence.

• Pelvic Surgery
  Like pregnancy and childbirth, pelvic surgery can weaken and damage the pelvic floor muscles. As a result, the pelvic floor muscles may no longer be able to provide the necessary support to the bladder neck and urethra, and these structures may drop freely when downward pressure is applied. This condition, which is known as hypermobility, causes incontinence during physical activity, when the urethra cannot close tightly enough to resist increased abdominal pressure on the bladder.

  Urinary incontinence can result from common forms of pelvic surgery, including abdominal resection for colorectal (intestinal) cancer, gynecologic (female genital tract) surgery such as radical hysterectomy (complete removal of the uterus) or hysterectomy for benign (noncancerous) disease, and failed prolapse (restabilization) surgery for stress urinary incontinence.

  Most patients with postoperative incontinence have either detrusor instability (DI or unstable bladder: an involuntary, downward-pushing contraction of the bladder) or urethral/bladder neck incontinence (abnormal function) due to nerve damage. Successful management of DI incontinence usually can be achieved by drug therapy and urinary catheterization (passage of a tube through the urethra into the bladder to drain urine into a bag outside the body); patients with bladder neck incontinence may require additional surgical measures.

  

• Diabetes mellitus
  Diabetes is a disease that is characterized by producing large amounts of urine. The bodily changes caused by diabetes can result in nerve damage that affects the bladder. The bladder malfunction specifically associated with diabetes mellitus is called diabetic cystopathy. Diabetic cystopathy progresses with few noticeable symptoms, although patients may lose bladder sensation. Over time, impaired bladder sensation may lead to increased bladder volume and overdistension (overstretching), urinary retention (bladder-emptying) problems, and overflow incontinence. The few existing treatments for diabetic cystopathy include catheterization, timed voids and control of hyperglycemia (too much blood sugar).

  

Treatment

Intermittent Catheterization
Intermittent Catheterization involves inserting a catheter thru the urethra into to bladder to empty it of urine. Once the bladder is empty the catheter is removed. Intermittent catheterization should be performed every 3 to 8 hours or as recommended by your physician.

Oxybutynin chloride (Ditropan)
Oxybutynin is an anticholinergic drug medication that also directly relaxes bladder smooth muscle. It is prescribed for neurogenic bladder patients, and patients who have symptoms of bladder instability with voiding: that is, patients with urge incontinence, frequency, urinary leakage, or painful urination. The typical dosage is 2.5-5.0 mg to be taken orally 3 to 4 times/day). Oxybutynin's notable side effects are dry mouth, dry skin, visual blurring, nausea and constipation.

Prosthetic occluding devices
Prosthetic occluding devices can be used to block the flow of urine by squeezing the urethra shut. For men, such mechanical devices include penile clamps (for example, the Cunningham clamp) and compression rings. The penile clamp is a V-shaped casing with a foam cushion that fits over and under the penis. When closed, the penile clamp should stop the flow of urine without causing discomfort. Compression devices are adjustable rings that surround the penis and, when inflated with air, pinch off the urine flow. Occluding devices usually are reserved for temporary use by individuals with intrinsic sphincter deficiency. These devices must be removed at regular 2- to 3-hour intervals to empty the bladder. Therefore, they should be used only by mentally competent individuals who are able to adjust them by hand and who are able to remember the bladder-emptying schedule. Improper use of penile clamps and compression devices can result in penile and urethral erosion, penile edema (swelling), pain and obstruction.