Neurogenic Bladder

Neurogenic bladder is a condition that affects how your bladder works when there’s a problem with your brain, nerves, or spinal cord. While it cannot be cured, there are many ways to manage the symptoms and improve your quality of life.

Table of contents

• What is neurogenic bladder?
• Types of neurogenic bladder
• Symptoms
• Causes and risk factors
• Complications
• How is it diagnosed?
• Treatment options
• Living with neurogenic bladder

neurogenic lower urinary tract dysfunction, NLUTD

What is neurogenic bladder?

Neurogenic bladder is the name for a group of bladder problems caused by nerve damage. Normally, your brain, nerves, and spinal cord work together to control when you urinate^[1]. Your nervous system sends electrical signals between your brain and every other part of your body. These signals tell your bladder when to hold urine and when to release it^[1].

When an injury or disease interrupts these electrical signals, your bladder may not work properly. This can cause you to lose control of when you urinate, or make it difficult to empty your bladder completely^[1]. Another name for this condition is neurogenic lower urinary tract dysfunction, or NLUTD^[1].

The normal process of urination requires several muscles and nerves to work together. Your bladder muscle (called the detrusor muscle) and two urethral sphincters must function properly to maintain healthy urinary control^[7]. When everything works correctly, your bladder can store up to 500 cc of urine without increasing pressure inside the bladder. This ability to store fluid without pressure buildup is called compliance and is essential for normal voiding^[7].

• Brain
• Spinal cord
• Nerves
• Bladder
• Urethra
• Urinary sphincters

Types of neurogenic bladder

There are two main types of bladder control problems linked to neurogenic bladder. The type you have depends on which nerves are affected and the nature of the damage^[1].

The first type is called overactive bladder, also known as spastic or hyper-reflexive bladder^[1]. With this type, you may feel sudden, strong urges to urinate even when your bladder is not full^[5].

The second type is underactive bladder, also called flaccid or hypotonic bladder^[1]. With this type, your brain may not receive the signal that your bladder is full. Your bladder may stretch and hold large amounts of urine, and you may not be able to empty it completely^[5].

Symptoms

The most common symptom of neurogenic bladder is being unable to control when you urinate^[1]. Other symptoms depend on which type you have.

If you have an overactive bladder, you may experience sudden urges to urinate immediately, a condition called urinary urgency^[1]. You may also have difficulty starting to urinate, a slow urine stream, or dribbling^[1]. Loss of bladder control (urinary incontinence) is common, and you may need to urinate eight or more times daily^[1].

With an underactive bladder, your bladder may not empty all the way or at all when you urinate, a problem called urinary retention^[1]. When your bladder becomes too full, urine may leak out. This is known as overflow incontinence^[1]. You may also not be able to tell when your bladder is full^[1].

Causes and risk factors

Neurogenic bladder can be present at birth, which is called congenital^[1]. Birth defects that may cause neurogenic bladder include spina bifida, caudal regression syndrome, and cerebral palsy^[1].

Several neurological conditions can lead to neurogenic bladder. Common causes include multiple sclerosis (MS), Parkinson’s disease, and stroke^[1]. Central nervous system tumors can also cause this condition^[1].

Other causes include spinal cord injuries and traumatic injuries such as falls or automobile accidents^[1]. Nerve damage can also result from long-term diabetes, pelvic surgery, heavy alcohol use, or vitamin B12 deficiency^[3]. Diseases such as Alzheimer’s disease, other forms of dementia, and ALS (Lou Gehrig’s disease) may also lead to neurogenic bladder^[3].

Degenerative changes or trauma to the lumbar spine can lead to narrowing of the space containing the spinal cord. This can compress the sacral nerve roots, cauda equina, or blood vessels, causing bladder dysfunction^[2]. The severity of bladder dysfunction depends on the location, nature, and degree of the lumbar problem^[2].

Complications

If you have neurogenic bladder, you are at higher risk for other conditions affecting your urinary system^[1]. These complications can be serious and require medical attention.

One common complication is repeated urinary tract infections (UTIs)^[1]. These infections occur when bacteria or other germs grow in your urinary tract^[5]. UTIs may actually be the first sign that your bladder is not working properly^[5]. People with symptoms of both overactive and underactive bladder can develop these infections^[5].

You may also develop kidney stones, which are hard masses made of minerals like calcium^[5]. These are more likely to form when urine stays in your bladder for a long time or becomes concentrated^[5]. Other stones can form in different parts of your urinary system, such as ureteral stones^[1].

More serious complications include kidney damage (kidney disease) and urine flowing backward from your bladder to your kidneys, a condition called vesicoureteral reflux^[1].

Men or people assigned male at birth who have neurogenic bladder can have problems with sexual function, including difficulty getting an erection, having an orgasm, or ejaculating^[5]. These problems may occur because of injury to the nerves or because of psychological factors^[5].

Neurogenic bladder can also affect your emotional well-being. You may feel nervous about going out in public because you worry about leaks or odors. This can cause feelings of anxiety, depression, and loneliness^[1]. It is important to recognize these feelings and reach out to a healthcare provider for help^[1].

How is it diagnosed?

A healthcare provider will start by reviewing your medical history, asking questions about your symptoms, and performing a physical exam^[1]. If they suspect neurogenic bladder, they may recommend several tests to check your nervous system and bladder function^[1].

One important test is called urodynamic testing. This test measures 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^[1]. During this test, a provider may place special sensors near your bladder to collect this information^[1].

Your doctor may also recommend a cystoscopy, which allows them to look inside your urethra and bladder^[1]. This procedure uses a thin tube with a camera on the end.

Imaging tests may be ordered to get a better picture of your urinary system and nervous system. These can include CT scans, MRIs, ultrasounds, and X-rays^[1]. These tests help doctors see the structure of your bladder, kidneys, and surrounding areas.

Treatment options

While neurogenic bladder cannot be cured, there are many treatment options available to help manage your symptoms^[1]. The goals of treatment are to protect upper urinary tract function, restore or partially restore lower urinary tract function, improve urinary control, reduce residual urine volume, prevent urinary tract infections, and improve your quality of life^[2].

Treatment typically starts with conservative approaches before moving to more invasive options. Your healthcare provider will work with you to develop a personalized treatment plan based on your specific condition^[2].

Lifestyle changes are often the first step in managing neurogenic bladder^[1]. You may be advised to make changes to your diet and fluid intake. Some foods and beverages can irritate the bladder, including coffee, tea, drinks with bubbles, alcohol, and chocolate^[11]. Avoiding these for about a week can help you see if your symptoms improve^[11].

Managing your fluid intake is also important. Drinking too much fluid can make bladder problems worse, but drinking too little can cause urine to become concentrated and irritate the bladder^[11]. If you wake up several times at night to urinate, try drinking more fluids in the morning and afternoon rather than at night^[11].

Bladder training can help you gain better control. This involves setting certain times to use the toilet and slowly increasing the time between visits^[10]. This may help lengthen the time your bladder can hold urine^[10]. Establishing a regular voiding schedule, such as every two to three hours during the day, helps prevent bladder overfilling and reduces urgency^[12].

Pelvic floor exercises, also called Kegel exercises, can tighten and strengthen pelvic muscles^[10]. To do these exercises, squeeze your muscles as if you were trying not to pass gas or stop the flow of urine. Hold the squeeze for 3 seconds, then relax for 5 to 10 seconds. Start with 3 seconds and gradually work up to 10 seconds. Repeat the exercise 10 times per session, doing 3 to 8 sessions a day^[10].

Medications can help manage symptoms. Your doctor may prescribe medicines that relax the bladder (such as oxybutynin or tolterodine), medicines that make certain nerves more active (bethanechol), or other drugs including botulinum toxin, GABA supplements, or antiepileptic medicines^[3]. Some medications help reduce bladder contractions that give you the urge to urinate, while others help the bladder store more urine or empty more fully^[8].

Botulinum toxin (Botox) injections can be given into the bladder muscle to help reduce the frequency of bladder contractions^[8]. These injections wear off over time and may need to be repeated about every 6 months^[8].

Catheterization is a common treatment option. With clean intermittent catheterization (CIC), you or a healthcare professional inserts a thin tube through the urethra and into your bladder several times during the day to empty it^[8]. Some people may need continuous catheterization, where a catheter remains in place all the time (indwelling catheter)^[3]. Your doctor may also recommend devices such as condom catheters or penile clamps for male patients with incontinence^[9].

Neuromodulation involves using electrical stimulation to improve bladder control. One option is electrical stimulation of the tibial nerve in the leg^[3]. This involves placing a needle into the tibial nerve, which is connected to an electrical device that sends signals up to the nerves in the lower spine that control the bladder^[3]. Another option is an electrical device implanted near the bladder nerves to stimulate the bladder muscles^[8].

Surgery may be needed in some cases^[1]. Surgical options include an artificial sphincter, sling surgery, creation of an opening (stoma) in which urine flows into a special pouch (called urinary diversion), or other procedures^[3].

Living with neurogenic bladder

Managing neurogenic bladder involves daily lifestyle adjustments that can significantly improve your quality of life. Working with a pelvic floor therapist can help you develop personalized management strategies to improve bladder control and prevent complications^[12].

You may benefit from keeping a diary of when you urinate, the amount you urinated, and if you leaked urine^[3]. This may help you learn when you should empty your bladder and when it may be best to be near a bathroom^[3].

Learn to recognize the symptoms of urinary tract infections, such as burning when you urinate, fever, low back pain on one side, and a more frequent need to urinate^[3]. Cranberry tablets may help prevent UTIs^[3].

For practical daily living, wash your pubic area with a mild soap and avoid deodorant soaps or soaps with heavy perfumes^[10]. Wear loose-fitting clothing that does not put pressure on your bladder^[10]. You may want to wear pads in your underwear to absorb urine leakage during treatment^[10].

If you smoke, try to quit. Smoking can irritate the bladder and cause bladder cancer^[10]. Talk to your doctor about stop-smoking programs and medicines that can help^[10].

Consider joining a support group^[10]. Sharing your experiences with other people who have the same problem may help you learn more and cope better. Organizations are available for further information and support if you are having urinary incontinence^[3].

Follow-up care is a key part of your treatment and safety^[10]. Be sure to make and go to all appointments, and call your doctor if you are having problems. It is also a good idea to know your test results and keep a list of the medicines you take^[10].

Contact your healthcare provider immediately if you have a fever not caused by influenza or other illness, severe pain in your lower back, blood or pus in your urine, cloudy or bad-smelling urine, pain or bleeding when you insert a catheter, swelling in your belly, or if you cannot urinate^[10].

Some studies have found that proper management of neurogenic bladder is more important for patients than the restoration of walking function^[2]. This highlights how significantly this condition affects quality of life and why effective management is so important.