Neurosphincter disorders are dysfunctions affecting the urinary and anorectal spheres. These problems can result from a variety of causes, including spinal cord malformations, pelvic injuries or sphincter pathologies. In this article, we’ll look at understanding these conditions and their main causes.
Spinal cord malformations and neurosphinxes
The spinal cord is an essential structure of the central nervous system, ensuring the transmission of information between the brain and the rest of the body. Spinal cord defects are congenital or acquired anomalies affecting this region, often resulting in neurosphincter disorders.
Spina bifida
Spina bifida is a congenital malformation characterized by a defect in the closure of the neural tube during embryonic development. Depending on the severity of the malformation, spina bifida can cause partial or complete impairment of sphincter function, leading to urinary or fecal incontinence, or even acute retention.
Syringomyelia
Syringomyelia is a progressive condition characterized by the formation of a cyst or cavity within the spinal cord. This condition can lead to neurosphincter disorders, notably vesico-sphincter dyssynergia (lack of coordination between detrusor contraction and sphincter relaxation).
Pelvic injuries and sphincter dysfunction
Pelvic lesions can also cause neurosphincter disorders. These injuries can be caused by a variety of factors, including road accidents, falls, surgery and inflammatory diseases.
Pelvic trauma
Pelvic trauma can damage the nerves responsible for urinary and fecal control, leading to problems of incontinence or retention. In some cases, medical or surgical techniques may be required to improve symptoms.
Surgical interventions
Pelvic surgery, such as radical prostatectomy or hysterectomy, can also cause neurosphincter disorders. Indeed, the risk of nerve damage during these procedures is high, which can lead to post-operative complications, including sphincter dysfunction.
Sphincter pathologies and their impact on the neurosphincter
Finally, certain sphincter pathologies can cause neurosphincter disorders. These include damage to the internal and external sphincter of the anus, and detrusor dysfunction.
Sphincter atrophy
Sphincter atrophy is a progressive reduction in the size and strength of the sphincter muscles. It can result from natural aging or be caused by certain neuromuscular diseases, such as multiple sclerosis. People suffering from sphincter atrophy are often confronted with problems of urinary or anal incontinence.
Vesico-sphincter dyssynergia
Vesico-sphincter dyssynergia is a disorder of coordination between contraction of the detrusor muscle (responsible for emptying the bladder) and relaxation of the urethral sphincter. This condition can lead to difficulties in emptying the bladder completely, resulting in recurrent urinary tract infections, incontinence or urinary retention.
Treatment of neurosphincter disorders
Treatment of neurosphincter disorders varies according to their cause and severity. It may include :
- Anticholinergic drugs to inhibit involuntary detrusor contraction;
- Alpha-blockers to relax the urethral sphincter and facilitate bladder emptying;
- Perineal re-education to strengthen pelvic floor muscles;
- Use of an intermittent or permanent catheter in cases of severe urinary retention;
- Surgical interventions, such as sacral neurostimulation, to improve sphincter control.
In conclusion, neurosphincter disorders are complex dysfunctions that can be linked to a variety of causes, such as spinal cord malformations, pelvic lesions and sphincter pathologies. Diagnosis and treatment of these disorders require multidisciplinary management, including urologists, gastroenterologists, neurologists and physiotherapists.