Neurogenic Bladder

Neurogenic bladder at a glance

  • Neurogenic bladder is a bladder control problem caused by a nerve, brain or spinal cord condition such as Parkinson’s disease, multiple sclerosis or a stroke.
  • Neurogenic bladder can result in symptoms of overactive bladder or underactive bladder.
  • Treatments include symptom management, medication and surgery to help the bladder function more normally.
  • It is important to treat neurogenic bladder to avoid developing renal disease (kidney disease).

What is neurogenic bladder?

Neurogenic bladder is a bladder control problem that is caused by a nerve, brain or spinal cord condition. Neurogenic bladder may occur in people who have had a stroke or who have Parkinson’s disease, multiple sclerosis (MS), a brain or spinal cord injury or infection, spina bifida or other conditions. It also can result from diabetes or as a complication of major pelvic surgery.

The term neurogenic bladder means a person has problems with the nerves that control the bladder, which is the organ that stores urine. The result may be overactive bladder (OAB), underactive bladder (UAB) or incontinence. Some people have both overactive and underactive bladder.

  • Overactive bladder muscles tell the body to urinate more often than normal. This condition means people feel they must urinate frequently and before the bladder is full. If the muscles aren’t tight enough, the condition can result in incontinence or involuntary urination before a person is ready. This can take the form of leaking or complete voiding.
  • Underactive bladder muscles do not squeeze the bladder enough to completely empty it. Sometimes the bladder will not empty at all. Underactive bladder can cause the bladder to distend or stretch. It can also decrease nerve sensations resulting in the patient not being aware of the problem.

Causes of neurogenic bladder

Certain health conditions can interfere with proper functioning of nerve messages that must travel between the brain and the muscles that control the bladder. When these nerve pathways don’t work correctly, bladder muscles might not tighten or release the way they normally do. The result is that the bladder might not hold urine or release it correctly.

The most common causes of neurogenic bladder are nervous system disorders, including:

  • Alzheimer’s disease
  • Brain or spinal cord tumors
  • Birth defects of the spinal cord
  • Cerebral palsy
  • Encephalitis
  • Learning disabilities, such as attention deficit hyperactivity disorder (ADHD)
  • Multiple sclerosis (MS)
  • Parkinson’s disease
  • Spinal cord damage or spinal surgery
  • Stroke.

Other causes include disorders or damage of the nerves that control the bladder, such as:

  • Accidents or trauma
  • Congenital (present at birth) abnormalities of the spine
  • Diseases such as syphilis, herpes zoster, diabetes and polio
  • Erectile dysfunction
  • Heavy metal poisoning
  • Herniated disc or stenosis of the spinal canal
  • General neuropathy
  • Long-term, heavy alcohol use
  • Some pelvic surgeries
  • Tumors of the central nervous system
  • Vitamin B12 deficiency.

Symptoms of neurogenic bladder

Among people who have conditions that might cause neurogenic bladder, the most noticeable symptom is the inability to control urination (urinary incontinence).

People might experience other symptoms including:

  • A weak urine stream or “dribbling”
  • Being unable to urinate (urinary retention)
  • Needing to urinate urgently/immediately
  • Straining to urinate
  • Painful urination (a possible indicator of a urinary tract infection (UTI) resulting from retained urine)
  • Urinating frequently (eight or more times daily).

Some people, especially those who have neurogenic bladder due to stroke, MS or herpes zoster, may have symptoms of both overactive bladder and underactive bladder.

Symptoms of overactive bladder may include:

  • Needing to urinate too frequently
  • Passing only small amounts of urine
  • Problems emptying the bladder all the way
  • Lack of bladder control (incontinence).

Symptoms of underactive bladder may include:

  • Being unable to know when the bladder is full
  • Inability to urinate
  • Inability to empty all the urine from the bladder
  • Urinary retention
  • Painfully full bladder
  • Possible leaking of urine due to overflow from a full bladder.

Complications of neurogenic bladder

Neurogenic bladder can seriously affect quality of life. In addition, it can cause physical complications including:

  • Skin problems, pressure sores or infections due to incontinence
  • UTIs due to urine not being passed in a timely manner
  • Kidney damage due to pressure from an overly full bladder.

For all of these reasons, it is important to seek treatment when a person suspects neurogenic bladder.

Diagnosis of neurogenic bladder

To diagnose neurogenic bladder, the doctor will perform a physical exam. He or she will ask for a thorough medical history. It is a good idea to be prepared with information about any conditions that could relate to nerve damage, and to have a list of all medications being taken.

Additionally, the doctor may order tests to diagnose the problem. These may study the bladder or the nervous system. Tests and studies may include:

  • Urine tests (urinalysis), including a urine culture, to identify an infection or blood in the urine.
  • bladder diary where the patient records when he or she goes to the bathroom, how the bathroom visits go, and any urine leakage. This can help the doctor understand daily symptoms.
  • Ultrasound imaging of the bladder to see whether it is emptying completely after urination.
  • Urodynamic studies (bladder function tests) to measure how much the bladder holds, how full it becomes, how well it empties and how urine flows.
  • Cystoscopy to examine inside the bladder and urethra (the tube that carries urine out of the body). The doctor will use a small camera inserted through a catheter.
  • Other imaging such as x-ray, CT (computed tomography) or MRI (magnetic resonance imaging) scans to study the urinary tract, spine and brain. 

Treatment of neurogenic bladder

Treatments for neurogenic bladder can range from symptom management and behavioral actions to medication to surgery. The treatment a doctor recommends will depend on the cause, the symptoms and the severity of a person’s neurogenic bladder.

Non-surgical treatment for neurogenic bladder may include:

  • Medications to help manage symptoms. These may include: drugs that relax the bladder; drugs to improve the way certain nerves work; anti-epileptic drugs; botulinum toxin (Botox) to calm the bladder; or others.
  • Behavioral techniques such as exercises (Kegel exercises) that help strengthen the pelvic floor, or keeping a diary and gradually training the bladder to wait longer between urination.
  • Urinary catheters to drain the bladder. Some people must use a catheter several times a day to keep the bladder from becoming too full. Others require an indwelling catheter, which remains in place all the time.

In some cases, neurogenic bladder requires surgical treatment. These treatments can include:

  • Bladder augmentation (augmentation cystoplasty) attaches segments of intestine to the bladder walls, increasing the bladder’s ability to store urine.
  • Implanting an electrical device near the nerves in the bladder in order to stimulate these muscles to operate in a more normal manner.
  • Installing an artificial sphincter to help the bladder relax and pass urine.
  • Sling surgery to support the bladder and, sometimes, other urinary tract structures.
  • Urinary diversion, which creates an opening (stoma) so that urine can be collected in a pouch outside the body.
  • Sphincter resection or removal, which removes part or all of the sphincter muscle so that the bladder can release.

It is important to treat neurogenic bladder to prevent kidney damage due to urinary problems. If neurogenic bladder goes untreated, a patient might develop renal disease. People with renal disease may require dialysis or a kidney transplant.