Neurogenic Bladder

What is neurogenic bladder?

Your bladder is a hollow organ located in your pelvis or lower abdomen. One of the main jobs of your bladder is to store urine (pee). The other is to remove urine from your body in response to signals from your spinal cord and brain.

Neurogenic bladder is the term for what happens when neurological (nervous system) conditions affect the way your bladder works. There are two major types of bladder control problems linked to neurogenic bladder. Depending on the nerves involved and the nature of the damage, your bladder becomes either overactive (spastic or hyper-reflexive) or underactive (flaccid or hypotonic).

How common is neurogenic bladder?

Neurogenic bladder dysfunction is very common among people with spinal cord injuries, affecting more than 90% of them. About 95% of people with spina bifida have neurogenic bladder dysfunction. The condition also affects 50% to 80% of people who have multiple sclerosis. Neurogenic bladder affects people with stroke and Parkinson’s disease and many other types of nervous system conditions. Conditions that damage nerves like advanced diabetes can also cause neurogenic bladder.

What causes neurogenic bladder?

Neurogenic bladder can be congenital (present at birth). Birth defects that can cause neurogenic bladder include:

• Spina bifida (myelomeningocele): This disorder occurs when the spine doesn’t completely develop during the first month of pregnancy. Babies born with myelomeningocele often have paralysis or weakness that affects how their bladder works.
• Sacral agenesis: This is a condition in which parts of the lower spine are missing.
• Cerebral palsy: Cerebral palsy refers to a group of chronic (long-term) disorders that weaken a person's ability to control body movement and posture. These disorders result from injury to the motor areas of their brain. The problem causing cerebral palsy may occur while during development or after birth. Cerebral palsy isn’t always found during a child's first year of life.

Medical conditions that involve the nervous system can cause neurogenic bladder. Common causes include:

• Stroke.
• Parkinson's disease.
• Multiple sclerosis.
• Central nervous system tumors.

Other conditions include:

• Spinal cord injuries and spine surgeries.
• Erectile dysfunction.
• Trauma/accidents.

What are the symptoms of neurogenic bladder?

The most common symptom of neurogenic bladder is being unable to control urination. Other neurogenic bladder symptoms include:

• A weak or dribbling urinary stream.
• Frequent urination (urinating eight or more times daily).
• Urgency (a feeling or need to urinate immediately).
• Painful urination, which may mean there is a urinary tract infection.
• Urinary leakage.

How is neurogenic bladder diagnosed?

If your healthcare provider suspects neurogenic bladder, they’ll do an exam and probably order several tests of the nervous system and the bladder. Tests may include:

• Urodynamic studies: These bladder function tests measure how much urine your bladder can hold, the pressure within your bladder, how well urine flows, and how well your bladder empties when it is full. Special sensors may be placed on your skin near your urethra (the tube through which urine passes) or rectum to see if the muscles and nerves in those parts of your body are working properly.
• Cystoscopy: Your provider may perform this procedure to examine the inside of your bladder and urethra with the use of a small telescope (cystoscope).
• Ultrasound tests.
• X-rays.
• Computed tomography (CT) scans.
• Magnetic resonance imaging (MRI) scans.

Can neurogenic bladder be cured?

There is no cure for neurogenic bladder. However, symptoms of neurogenic bladder can be managed.

How is neurogenic bladder treated?

Your healthcare provider will work with you to decide on a treatment plan that is appropriate for what is causing neurogenic bladder. Some neurogenic bladder treatment options include:

• Lifestyle changes: These might include avoiding certain foods or drinks that can irritate your bladder. These include alcohol, certain caffeinated drinks like coffee and soda. Good blood glucose management for people with diabetes and constipation management can also help.
• Clean intermittent catheterization (CIC): Catheters are thin, flexible tubes that can be inserted through your urethra and into your bladder to drain urine. You can learn how to do this yourself so that you can empty your bladder on your schedule.
• Continuous catheterization: This method calls for a catheter to be worn at all times. The catheter is a small tube that can be placed through your urethra or through the lower abdominal wall (suprapubic tube).
• Drugs: Medications that treat neurogenic bladder include oxybutynin, tolterodine, mirabegron, solifenacin succinate and others.
• Injections of botulinum A toxin (Botox®): Your healthcare provider injects botulinum A toxin into your bladder or urinary sphincters.
• Bladder augmentation (augmentation cystoplasty): In this surgery, a surgeon removes segments of your intestine (sigmoid colon) and attaches them to the walls of your bladder. This reduces the bladder's internal pressure and increases its ability to store urine.
• Ileal conduit: Part of the small bowel is used to make a urine stoma. This stoma drains to a bag attached to the outside of the body.

Absorbent undergarments, pads, panty shields, panty liners and adult diapers can help prevent wetness and odors while protecting skin and clothing. Bed pads can protect sheets and mattresses.

What complications are related to neurogenic bladder?

People who have neurogenic bladder are at higher risk for other urological problems, including repeated infections, kidney damage, vesicoureteral reflux and stones that form in the urinary tract.

People with bladder control conditions such as neurogenic bladder may experience quality of life issues. It’s important to recognize these issues and get help with them.

How can I prevent neurogenic bladder?

Most cases of neurogenic bladder can’t be prevented.

When should I contact my healthcare provider about neurogenic bladder?

If you have any type of nervous system disorder, chances are that your healthcare provider will already know to address the issue of neurogenic bladder. Still, it’s important to be honest with your provider about the issues you face. Make sure you speak to your provider if you have new or worsening concerns, including things that might indicate infection like pain or fever.

A note from Cleveland Clinic

Neurogenic bladder can be managed, even though it can’t be treated. Methods for dealing with neurogenic bladder dysfunction are being refined. You can help by following the suggestions that you get from your healthcare provider about lifestyle changes and nutritional choices. Maintaining a healthy weight can help with urinary incontinence.