Neurogenic Bladder

Neurogenic bladder is a condition where nerve damage disrupts bladder control.

Neurogenic bladder occurs when normal bladder function is disrupted due to nerve damage, leading to difficulties in storing or emptying urine.

Nerve damage in the brain, spinal cord, or other areas of the body can cause neurogenic bladder. This nerve damage can happen from conditions like stroke, diabetes, multiple sclerosis, spinal cord injury, or birth defects.

Neurogenic bladder can cause an overactive bladder or an underactive bladder. The symptoms depend on which type of neurogenic bladder you have. The most common symptom is being unable to control when you urinate.

There are therapies and treatments for neurogenic bladder. These range from lifestyle changes to medicines and urologic surgery, depending on the severity of the problem.

Learn more about neurogenic bladder, including its definition, causes, symptoms, diagnosis, and treatment.

What is neurogenic bladder?

Neurogenic bladder is a dysfunction of the urinary bladder caused by damage to the nerves that control bladder function. This condition can lead to problems with bladder storage, emptying, or both, resulting in urinary incontinence, retention, or a combination of both.

What are the types of neurogenic bladder?

There are two main types of neurogenic bladder problems. An overactive bladder makes you feel like you need to pee more often and urgently, while an underactive bladder makes it difficult to fully empty your bladder or know when you need to go.

What causes neurogenic bladder?

Neurogenic bladder can be caused by different factors. These can include congenital birth defects, neurological disorders, damage caused by injury, or other problems.

Neurological disorders

• Multiple sclerosis (MS): A chronic condition that damages the nerves in the brain and spinal cord, affecting bladder control.
• Parkinson’s disease: A progressive neurological disorder that impacts muscle control, including the bladder.
• Stroke: Can affect the areas of the brain that control bladder function.
• Tumors: Growths in or near the spinal cord or brain can compress nerves and affect bladder control.

Congenital conditions

• Spina bifida: A birth defect where the spinal cord does not develop properly, leading to neurogenic bladder.
• Cerebral palsy: A group of disorders affecting movement and muscle tone, often leading to bladder control issues.

Other conditions

• Diabetes: Long-term diabetes can cause neuropathy, affecting bladder function.
• Pelvic surgery: Surgical procedures involving the pelvic region or lower abdomen can damage nerves that control the bladder.
• Spinal cord injury: Trauma to the spinal cord can disrupt the nerve signals between the bladder and the brain.

Symptoms of neurogenic bladder

The main symptom of neurogenic bladder is being unable to control your bladder function (called urinary incontinence). The other symptoms can differ depending on the type of neurogenic bladder problem.

Overactive bladder symptoms

• Urinary hesitancy: Slow or delayed start of urination.
• Urinary incontinence: Involuntary leakage of urine, ranging from occasional dribbling to severe, constant leakage.
• Frequent urination: Needing to urinate more often than normal.
• Urgency: Sudden, strong urge to urinate that may be difficult to control.

Underactive bladder symptoms

• Urinary retention: Difficulty emptying the bladder completely, leading to the sensation of needing to urinate frequently.
• Weak stream: Reduced force of the urine stream.
• Not being able to tell when your bladder is full

Additional symptoms

• Recurrent urinary tract infections (UTIs): Due to incomplete bladder emptying or frequent catheterization.
• Bladder distension and discomfort: Sensation of fullness or pain in the lower abdomen.

Diagnosis of neurogenic bladder

A health care provider may use a combination of tests and questions to help diagnose neurogenic bladder. These may include:

• Symptom assessment: Detailed inquiry about urinary habits, symptoms of incontinence, retention, and any discomfort.
• Medical history: Review of any past injuries, surgeries, medical conditions, and medications related to bladder function.
• Physical examination: Comprehensive examination, including neurological assessment, pelvic exam in women, and rectal exam.
• Urinalysis: Testing urine for infections, blood, and other abnormalities.
• Bladder diary: Recording fluid intake, urination times, and leakage episodes over several days.
• Post-void residual measurement: Measuring the amount of urine left in the bladder after urination using ultrasound or catheterization.
• Urodynamic testing: Assessing bladder function and pressure during filling and emptying.
• Cystoscopy: Visualizing the inside of the bladder and urethra using a thin, flexible camera.
• Imaging studies:
  • Ultrasound: Imaging to assess kidney and bladder structure.
  • MRI or CT scan: Detailed imaging of the spine, brain, and urinary tract to identify potential structural causes.

How is neurogenic bladder treated?

Treatment can help manage symptoms of neurogenic bladder. Your health care provider will talk to you about treatment and management options and help you decide on the best course of action based on your symptoms and goals. Treatments may include:

Lifestyle modifications

• Timed voiding: Establishing regular urination schedules.
• Fluid management: Regulating fluid intake to avoid bladder over-distension.
• Dietary changes: Avoiding bladder irritants such as caffeine, alcohol, and spicy foods.

Medicines

• Anticholinergics: To relax the bladder and reduce urgency and frequency.
• Alpha-blockers: To relax the bladder neck and improve urine flow.
• Desmopressin: To reduce urine production at night.
• Botulinum toxin injections: To relax bladder muscles in cases of overactive bladder.

Catheterization

• Intermittent catheterization: Regular catheterization to empty the bladder completely and prevent retention.
• Indwelling catheter: A catheter left in place for continuous drainage, replaced periodically.
• Suprapubic catheter: Surgically placed catheter through the abdomen for long-term drainage.

Nerve stimulation

• Sacral nerve stimulation: Implanting a device to stimulate nerves that control the bladder.
• Percutaneous tibial nerve stimulation: Non-invasive therapy stimulating a nerve in the ankle to improve bladder control.

Surgical treatments

• Bladder augmentation: Surgery to increase bladder capacity using a segment of the intestine.
• Urinary diversion: Redirecting urine flow to an external pouch or internal reservoir.
• Sling procedures: To support the urethra for patients with stress incontinence.
• Artificial urinary sphincter: Device implanted to keep the urethra closed until manually opened for urination.

Follow-up care

• Regular check-ups: Routine follow-up appointments to monitor bladder function, manage complications, and adjust treatment plans.
• Monitoring for infections: Regular screening for UTIs, especially in patients using catheters.
• Bladder training: Continued education and support for bladder training techniques.

Potential risks and complications

Untreated neurogenic bladder can cause complications, including recurrent urinary tract infections (UTIs), kidney damage, bladder stones, and bladder damage.

Treating neurogenic bladder can help reduce the risk of these complications. Treatment can also have quality of life benefits, including:

• Physical comfort: Effective treatment can alleviate symptoms and improve daily comfort and activities.
• Emotional well-being: Improved bladder control can reduce anxiety and enhance social interactions.
• Lifestyle freedom: Increased confidence and independence in engaging in work, hobbies, and social activities.

Neurogenic bladder is a challenging condition that requires a multidisciplinary approach for accurate diagnosis and effective management. Understanding the causes, symptoms, diagnostic methods, and treatment options is essential for improving quality of life and preventing complications. If you or a loved one are experiencing symptoms of neurogenic bladder, consulting with a health care provider and a specialized urologist will help develop a comprehensive treatment plan tailored to your specific needs and circumstances.