Nonneurogenic Neurogenic Bladder
Nonneurogenic Neurogenic Bladder (Hinman-Allen syndrome) is the most severe form of Dysfunctional Elimination Syndrome, and if left untreated can lead to renal failure in children. This syndrome usually effects children past the age of potty training, but on rare occasion has been seen in in infants.
Children with a nonneurogenic neurogenic bladder, have the symptoms found in a neurogenic bladder, only there are no neurological defects, or upper urinary tract anomalies causing the condition. In many cases it is caused by the child holding their urine and not releasing it when needed. This may be caused by a number of reasons and is believed to usually be psychological. It is believed that this syndrome is a learned behavior. This condition is sometimes seen in children who have been victims of abuse.
When a child holds their urine, the bladder becomes full, and expands. Over time, this can cause the bladder to enlarge and retain more urine. This can lead to a number of problems including increased bladder pressure and higher incidence of urinary tract infection. Many children with this syndrome develop Vesicoureteral Reflux (VUR) due to the high pressures in the bladder. If the syndrome can be managed, the VUR is more likely to resolve on its’ own. If it is left untreated, it can cause irreversible scarring and damage to the kidneys.
Treatment for this condition varies depending on age, the severity of the dysfunction, and any damage done to the kidneys. Some children may undergo drug therapy, behavioral modification, or Biofeedback. In most cases, it is treated in the same way as a neurogenic bladder, and may include intermittent catheterization.
In very rare cases, Hinman-Allen Syndrome has been found in infants. In these rare cases, babies have shown signs of a neurogenic bladder, but with no neurological abnormalities. In these cases, renal failure was likely if aggressive, early intervention was not taken. In some cases early intervention included a vesicostomy, which in many cases preserved renal function. It is not known how or why infants develop this condition, but proves that it is not always caused by a psychological need to hold urine.
On a more personal note, the nonneurogenic neurogenic bladder is something that I have been very interested in, and there is not a lot of info out there. Since no doctor has been able to tell us what Lizzie’s actual diagnosis is, I have done tons of research on rare or unusual conditions. Hinman-Allen syndrome would actually fit quite well with most of Lizzie’s symptoms including, constipation, enlarged bladder, recurrent uti, high grade reflux, failed reimplantion, and the success of the vesicostomy. There is however, one huge missing link. That link is the synergic sphincter activity that was noted on her EMG. One would expect to find dyssergenic sphincter activity in a neurogenic bladder (or nonneurogenic). This might close the case for us except that the actual results of her urodynamics study have been “lost”, making it impossible to verify that information, plus I can’t find any research that states that there MUST be dyssergenia. I’ve also learned that her medical records are often wrong, so I’ve put this condition in the unlikely pile, but I’m not ready to rule it out just yet. We will be talking to our uro more about it next month.
For more links on Hinman-Allen syndrome, check out our links page.
