Neurogenic bladder

Definition

Neurogenic bladder is a problem in which a person lacks bladder control due to a brain, spinal cord, or nerve condition.

Causes

Several muscles and nerves must work together for your bladder to hold urine until you're ready to empty it. Nerve messages go back and forth between the brain and the muscles that control bladder emptying. If these nerves are damaged by illness or injury, the muscles may not be able to tighten or relax at the right time.

Disorders of the central nervous system commonly cause neurogenic bladder. These can include:

• Alzheimer's disease
• Birth defects of the spinal cord
• Brain or spinal cord tumors
• Cerebral palsy
• Encephalitis
• Learning disabilities such as attention deficit hyperactivity disorder (ADHD)
• Multiple sclerosis
• Parkinson's disease  
• Spinal cord injury
• Stroke recovery

Damage or disorders of the nerves that supply the bladder can also cause this condition. This can include:

• Alcoholic neuropathy (nerve damage due to long-term, heavy alcohol use)
• Diabetic neuropathy (nerve damage due to long-term diabetes)
• Nerve damage due to pelvic surgery
• Nerve damage from a herniated disc

Symptoms

The symptoms depend on the cause. They often include symptoms of urinary incontinence.

Symptoms of overactive bladder:

• Having to urinate too often in small amounts
• Problems emptying all the urine from the bladder
• Loss of bladder control

Symptoms of underactive bladder:

• Bladder becomes too full and you may leak urine
• Inability to tell when the bladder is full
• Problems starting to urinate or emptying all the urine from the bladder
• Urinary retention

Treatment

Medications may help manage your symptoms. Your doctor may recommend:

• Medicines that relax the bladder (oxybutynin, tolterodine, or propantheline)
• Medicines that make certain nerves more active (bethanechol)
• Botulinum toxin (Botox)
• GABA supplements
• Antiepileptic drugs

Newer drugs are also being studied.

Your doctor may refer you someone who has been trained to help people manage bladder problems. Skills or techniques you may learn include:

• Exercises to strengthen your pelvic floor muscles (Kegel exercises)
• Keeping a diary of when you urinate, the amount you urinated, and if you leaked urine. This may help you learn when you should empty your bladder and when it may be best to be near a bathroom.

Learn to recognize the symptoms of urinary infections (UTIs), such as burning when you urinate, fever, low back pain on one side, and a more frequent need to urinate. Cranberry tablets are used to prevent UTIs.

Some people may need to use a urinary catheter. This is a thin tube that is inserted into your bladder:

• You may need a catheter to be in place all the time (indwelling catheter)
• You may need a catheter to be placed in your bladder 4 to 6 times a day to keep your bladder from becoming too full (intermittent catheterization)

Sometimes surgery is needed. Surgeries for neurogenic bladder include:

• Artificial sphincter
• Electrical device implanted near the bladder nerves, to stimulate the bladder muscles
• Sling surgery
• Creation of an opening (stoma) in which urine flows into a special pouch (this is called urinary diversion)

Support Groups

See: Incontinence resources

Possible Complications

• Constant urine leakage can cause skin to break down and lead to pressure sores
• Kidney damage may occur if the bladder becomes too full, causing pressure to build up in the tubes leading to the kidneys and in the kidneys themselves
• Urinary tract infections

When to Contact a Medical Professional

Call your health care provider if you:

• Are unable to empty your bladder at all
• Have signs of a bladder infection (fever, burning when you urinate, frequent urination)
• Urinate small amounts, frequently

References

Wein AJ, Dmochowski RR. Neuromuscular dysfunction of the lower urinary tract. In: Wein AJ, Kavoussi LR, Novick AC, et al, eds. Campbell-Walsh Urology. 10th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 65.

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