Types of Neurogenic Bladder Disorders - Diane Newman

March 24, 2020

Diane Newman, adult nurse practitioner and a continence nurse specialist in urology outlines four types of neurogenic bladder disorders: atonic bladder, hyper-reflexive bladder, uninhibited bladder, and sensorimotor paralytic bladder. In addition to describing their symptoms, she also advises on how to diagnose and treat these disorders.


Diane K. Newman, DNP, ANP-BC, FAAN, Adjunct Professor of Urology in Surgery, Perelman School of Medicine, University of Pennsylvania and Co-Director of the Penn Center for Continence and Pelvic Health. She is the author of several books. The most recent is as lead editor of the 1st edition of the SUNA Core Curriculum for Urologic Nursing and of Clinical Application of Urologic Catheters, Devices and Products.

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Diane Newman: Hi, I'm Diane Newman and I am a nurse practitioner and basically a continence nurse specialist as I practice in urology for 35 years. I'm also the Editor of the UroToday Bladder Health Center. You will find a lot of information on the center, especially around bladder disorders and ways to manage the bladder through catheterization. What I like to present in this presentation is the types of neurogenic bladder disorders that we see in patient populations in urology or in rehabilitation. So I'd like to go through the different types.

There are several types of neurogenic bladder disorders. The new term that's being used now in this field is neurogenic lower urinary tract dysfunction. And as you can see in the first column, I had the different types of bladder dysfunction. And in the second column on the right is how it affects a bladder and what the causes are. So I'd like to go through these in a little bit more detail.

The flaccid or atonic bladder usually occurs after an acute spinal cord injury. And basically, the bladder fails to contract and these individuals will have urinary retention and will need initially probably an indwelling urinary catheter. And then if the spinal cord injury such that they will not regain any type of a bladder function, then they will be the group that goes into intermittent catheterization longterm. And there's actually quite a bit of research now on this population, which in the United States is growing due to gunshot wounds actually. But these individuals performed catheterization for many, many years and the largest group that we're seeing is spinal cord injury. We also see atonic bladder of unknown etiology in other patients. I have several in my practice that are older gentlemen that we're really not sure why they have a bladder that basically is not functioning. They also do intermittent self-catheterization longterm.

The second type is spastic or hyper-reflexive bladder, and this occurs when there's a spinal cord injury above the level of the sacral two to four spinal cord levels. It results usually in frequent uncontrolled voiding because of bladder spasms and there's really a lack of sensation, so these individuals do not know when their bladders fill. They do not feel an urgent sensation because of that injury in the sacral area, and these individuals will have usually urinary incontinence urgency/frequency.

An uninhibited bladder is the third type, and what you see with this is symptoms of urgency and frequency because of changes in the brain. You may see this with individuals who have a traumatic brain injury, maybe for secondary, maybe a motor vehicle accident. It can also be caused by a stroke or in those who have multiple sclerosis, especially in those advanced stages of MS. What's interesting about the uninhibited bladder with patients with MS and sometimes with stroke is you'll see a combination of urinary symptoms such as urinary frequency and urgency, but they may also have incomplete bladder emptying. And it's not uncommon for these individuals to be on antimuscarinic and Beta-3 adrenergic for their urgency and frequency symptoms, but also performing periodic intermittent catheterization maybe only once or twice per day depending on the post for residual.

The last type is a sensorimotor paralytic bladder, and this is the inability for the bladder to empty because of damage to the peripheral nervous system. So we're now on the periphery as far as not the brain or the spinal cord, but the peripheral nervous system. You see this with individuals who may have diabetes, especially longterm diabetes who have neuropathic bladders, or if they've had extensive or maybe not even extensive pelvic surgery where you have sometimes damage to the peripheral nervous system. And in these individuals, they may have incomplete bladder emptying. Some of them also may go through urinary retention. This is an important type to really diagnose, especially as we may have many patients who have diabetes and we really want to think about the fact is, are they emptying completely? Something I always think about in this population. 

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