Neurogenic Bladder: Defining, Diagnosing, and Treating
This Common Medical Condition Causes Overactive Bladder and Urine Retention
What is Neurogenic Bladder?
The urinary system consists of a complex network of nerves and muscles working in conjunction with the brain and spinal cord. Under normal conditions, the brain and bladder communicate constantly about the proper time to hold and release urine. Neurogenic bladder occurs when neurological issues interrupt these important messages, and the bladder malfunctions.
This bladder dysfunction occurs in two ways. Either the bladder becomes overactive (often called spastic bladder) and squeezes even when it isn’t full. Or it become underactive (also known as a flaccid bladder) and won’t release urine at the right time.
Patients with an overactive bladder often feel the urge to urinate when they don’t really need to. They may also urinate more frequently than people with healthy bladders. In addition, an overactive bladder can also cause muscles to weaken, resulting in incontinence.
Patients with an underactive bladder won’t release urine even when their bladder is full. Some patients experience both an overactive and underactive bladder.
Video: Neurogenic Lower Urinary Tract Dysfunction
Hosted by Eric S. Rovner, MD; Professor of Urology - Medical University of South Carolina
If left untreated, a this can cause a number of other issues, including:
- Urine leakage: Caused when bladder muscles don't hold urine in.
- Urine retention: Caused when bladder muscles don’t release urine.
- Kidney damage: If the bladder becomes too full and urine backs up into the kidneys, the extra pressure may lead to blood in the urine.
- Infection: When urine is held in the body too long before being passed out, the bladder, ureters, or kidneys can become infected.
In addition to these medical issues, patients often suffer from physical discomfort, daily inconveniences, and the potential for personal embarrassment.
Neurogenic Bladder Symptoms
Patients experience a variety of symptoms, including:
- Urinary tract infections or painful urination.
- Incontinence, which can sometimes cause skin problems or infections.
- Frequent urination (eight or more times a day).
- Urinary retention or urinary obstruction.
- A weak or dribbling urinary stream.
- Urgency or feeling like you need to urinate immediately.
- Kidney stones.
Unfortunately, a number of other common medical conditions mimic the symptoms of neurogenic bladder. Because of this, it’s important that patients visit their health care professional for an examination and diagnosis.
Diagnosing Neurogenic Bladder
To arrive at a diagnosis, health care providers have several tools at their disposal. Of course every patient encounter should begin with a thorough medical history and physical examination. From there, diagnostic options include:
- A bladder diary: Patients track their day-to-day symptoms including how often they urinate and if they experience incontinence.
- Pad test: Some patients wear pads treated with a special dye that turns color when there’s urine leakage.
- Urine culture: Detects infection or the presence of blood.
- Cystoscopy: Uses a thin, lensed tube to check for blockages or irregularities inside the bladder.
- Urodynamic testing: Shows how well the bladder stores and releases urine.
- Imagery: Examines the bladder, brain, and spine for irregularities using MRI, x-ray, or CT technology.
What Causes Neurogenic Bladder?
This type of bladder dysfunction is typically caused by damage to the brain, spinal cord, or nerves. The brain and spinal cord can become impaired due to stroke, trauma from accidents or surgery, central nervous system tumors, infection, or heavy metal poisoning.
Diseases like multiple sclerosis (MS), Parkinson’s disease, or diabetes can cause nerve damage. As can erectile dysfunction, spinal cord injuries, or major pelvic surgery. Children born with congenital conditions like spina bifida, sacral agenesis, or cerebral palsy often also suffer from neurogenic bladder.
Treatment of Neurogenic Bladder
Treatment options will vary depending on the nature of the patient’s bladder dysfunction.
Overactive Bladder Treatments
Some patients find relief for their overactive bladder through exercises like delayed voiding, where they train themselves to delay urination for up several hours even though they may feel the urge to go. Others follow a strict voiding schedule where they urinate at set times every day. Some find success through pelvic floor exercises that strengthen pelvic muscles. Eliminating certain bladder irritating drinks like carbonated or caffeinated beverages, alcohol, soda, and citrus juices can also help. But these lifestyle changes aren’t effective for everyone.
Health care providers may prescribe anticholinergic medications like oxybutynin or tolterodine, that help calm spasmodic muscles. In some cases, botulinum A toxin (Botox®) injections into the bladder or urinary sphincters can help patients with brain or spinal cord injuries.
When lifestyle changes and prescription drugs don’t provide symptom relief, patients can also try neuromodulation therapy which delivers electrical stimulation directly to the nerves. They include:
- Sacral neuromodulation: The sacral nerves carry impulses between the spinal cord and bladder. Through sacral neuromodulation, a surgeon places a thin wire near the sacral nerve and then connects it to a battery pack placed just underneath the skin. The wire delivers harmless electrical impulses that stop the bad sacral signals causing an overactive bladder.
- Percutaneous tibial nerve stimulation: During this treatment, a healthcare professional inserts a needle into the tibial nerve in the patient's leg. A device then sends electrical impulses through the needle, up the tibial nerve, and into the sacral nerve, easing the symptoms of an overactive bladder.
Patients with underactive bladder symptoms can benefit from many of the same lifestyle changes and drug treatments that patients with overactive bladders receive. But when those measures aren't successful, patients must seek out more intrusive solutions.
Because patients with underactive bladders have difficulty eliminating urine, some use catheters to empty their bladders. But when done incorrectly, this method can lead to an increased risk of urinary tract infections. Intermittent catheterization is also ineffective for patients with nerve damage or hand coordination problems. These shortcomings lead some patients to choose continuous catheterization to void their bladders.
In more serious cases, there are surgical options available to treat an underactive bladder.
- Artificial sphincter: Surgeons implant an inflatable cuff around the urethra. Patients then use a pump implanted under the skin to open the artificial sphincter and release urine.
- Urinary diversion: Surgeons create a stoma so urine can move from the bladder into a storage pouch outside of the body.
- Bladder augmentation: A portion of the large intestine is removed and inserted into the bladder to increase its size so it can store more urine.
- Sphincter resection or sphincterotomy: Surgeons may elect to remove damaged portions of the sphincter or to remove the sphincter entirely.
If you’d like to read more about this condition, visit UroToday.com for the latest research and findings.
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