Neurogenic bladder is a term used by medical professionals to describe bladder dysfunction caused by nerve complications. Keep reading to learn more about neurogenic bladder and how it can be diagnosed and managed by your healthcare team.
The bladder requires nerve and muscle coordination to fill, hold, and empty urine. When these nerves are damaged or disrupted, the bladder cannot work properly, and special interventions may be required. Although neurogenic bladder can bring challenges, it can often be addressed through lifestyle modifications and medications. Complications are often avoidable with appropriate treatment and medical supervision.
Causes
Neurogenic bladder is caused by disease or injury of the nervous system. Some common causes of neurogenic bladder include:
- Injury to the brain or spinal cord
- Tumors of the brain or spinal cord
- Disorders of the nervous system such as multiple sclerosis
- Birth defects such as spina bifida or cerebral palsy
- Diabetes-induced neuropathy
- Stroke
- Parkinson’s disease
- Guillain-Barré syndrome
Neurogenic bladder may be temporary or permanent, depending on the root cause. For example, people with multiple sclerosis may find that neurogenic bladder symptoms worsen when the disease intensifies and lessen when the disease is in remission. People who develop neurogenic bladder from spinal cord compression may see symptom resolution with spinal decompression surgery. Individuals who have had a traumatic injury or birth defect of the spine may have permanent neurogenic bladder symptoms, as the nerves controlling the bladder are not functional and cannot be repaired.
Symptoms
Neurogenic bladder symptoms vary depending on the location and severity of the nerve dysfunction. If you are not being medically treated for neurogenic bladder, your symptoms may be more pronounced. Symptoms of neurogenic bladder include:
- Urinary retention (i.e., you cannot fully empty your bladder)
- Frequent or recurrent urinary tract infections (UTI)
- Urinary incontinence (i.e., loss of bladder control)
- Bladder spasms that cause involuntary emptying of the bladder
- Small urine volume when urinating, or difficulty urinating at all
- Increased urinary frequency and urgency
- Loss of feeling of the bladder, including the inability to tell if the bladder is full
The symptoms of neurogenic bladder can be similar to symptoms from other conditions of the urinary tract. If you are having urinary symptoms, talk to your healthcare provider for an accurate diagnosis.
Diagnosis
In many cases, neurogenic bladder is caused by a known neurological condition. If your healthcare provider suspects that you have neurogenic bladder, they may order some or all of the following tests:
- Imaging tests of the skull or spine
- Imaging tests of the bladder and ureters
- Cystoscopy – a helpful procedure where a thin, flexible tube with a camera is inserted through the urethra to examine the urinary tract and check for problems
- Urodynamics or other tests that evaluate the bladder’s ability to fill and empty
Neurogenic bladder does not necessarily behave in the same way for each person – presentation depends on which nerves are involved. Therefore, tests can be helpful in determining the exact nature of your bladder dysfunction and help your healthcare provider select the most appropriate treatment for your unique situation.
Treatment
The goal of neurogenic bladder treatment is to allow your bladder to expand enough to hold urine and empty at the appropriate times, maintain a normal level of pressure in the urinary tract, and reduce the occurrence and severity of complications such as urinary tract infection and kidney damage. Treatment options vary, but may include:
- A catheterization program, where you manually empty your bladder using catheters to prevent it from overfilling and reduce the occurrence of leaks
- Oral medications that decrease bladder spasms and relax the bladder muscle, allowing it to fill and hold urine more effectively
- Botox injections decrease bladder spasms and relax the bladder muscle, allowing it to fill and hold urine more effectively
- Surgery to create a larger bladder (bladder augmentation) if your bladder has become too small or stiff to hold much urine
- Antimicrobial agents to reduce the amount of bacteria in your urine and lessen your risk of infection
- Placement of electrical implants that stimulate or slow down bladder activity to improve function
- Placement of inflatable cuffs or other implanted devices that help the bladder hold urine and prevent urinary leakage
A urologist is an important ally in neurogenic bladder management, as they specialize in the urinary tract. They can help diagnose and develop a treatment plan that addresses your symptoms, maximizes your quality of life, and keeps your urinary tract healthy. If you have been diagnosed with neurogenic bladder, consider establishing care at a urology practice for ongoing management.
Special Considerations
There are some complications that can occur from neurogenic bladder. Here are some more common ones to watch out for:
- Autonomic dysreflexia
Autonomic dysreflexia is an overreaction of the nervous system in response to painful or uncomfortable stimuli. It is common after a spinal cord injury, especially when the damage occurred above the T6 level vertebra. Although less common, individuals with multiple sclerosis, cerebral palsy, or spina bifida may also experience this condition. When these individuals experience uncomfortable or painful stimuli below the point of injury, they may experience sweating, flushing, headache, extreme elevations in blood pressure, or changes in heart rate that can be life-threatening if not rapidly addressed. The best way to stop autonomic dysreflexia is to remove the uncomfortable stimuli as soon as possible.
Autonomic dysreflexia can be caused by not adhering to a catheterization schedule and allowing the bladder to overfill, or by discomfort from urinary tract infections. If experiencing autonomic dysreflexia, try emptying your bladder first to see if this is the cause. If it persists, consider getting evaluated for Urinary tract infections (UTI). If you experience this often from routine bladder or bowel care, talk to your healthcare provider about medications or other interventions that may help.
- Urinary tract infections (UTI)
Because neurogenic bladders do not expand and contract normally, there is an increased risk of UTI. Retained urine, changes to the bladder tissues, and the need to catheterize the bladder all contribute to this risk. Signs of urinary tract infection include cloudy or strong-smelling urine, fever, chills, feelings of illness or fatigue, increased discomfort when urinating or self-cathing, urinary frequency or urgency, and kidney pain If you cannot feel your bladder, you may have to be aware of general symptoms such as a need to cath more often, fever, or autonomic dysreflexia.
UTI risk may increase if urine is held too long before it is removed from the body. Emptying your bladder at regular intervals and maintaining steady fluid intake to “keep things moving” may help reduce your risk of UTI. Talk to your doctor about any changes to your catheterization schedule or fluid intake to make sure it is safe for you.
- Changes to bladder size and structure
Neurogenic bladder can impact the size of your bladder and your bladder’s ability to stretch or contract. If your bladder becomes too stiff or small, you may have difficulties holding much urine. This can cause more urinary incontinence. It can also increase the pressure in your urinary tract, potentially damaging your kidneys. Talk to your doctor if you notice that your bladder is not holding as much urine as it used to, or if you are getting frequent kidney infections. You may benefit from medications or surgical interventions to improve your bladder’s size and structure.
- Urinary incontinence
Neurogenic bladder can cause problems with involuntary bladder emptying or urine leakage. This can impact your quality of life. In some cases, medications, procedures, or lifestyle changes can help reduce urinary incontinence. Adhering to a catheterization schedule to keep your bladder from overfilling may reduce urinary leakage. If you experience occasional leaks of urine, there are absorbent products such as absorbent pads or external catheters that may help keep you dry and clean. If you are experiencing urinary incontinence on your bladder management program, talk to your urologist. There may be treatments that can help.
- Stones and other kidney problems
Individuals with neurogenic bladder are at increased risk of kidney and bladder stones and kidney problems caused by too much pressure in the urinary tract. A yearly ultrasound to screen the kidneys and bladder is recommended. This screening can catch stones or problems with urine backing up in the kidneys so it can be addressed. You can have this non-invasive screening done at a urology office.
- Urethral trauma
People who use catheters to manage neurogenic bladder may be at increased risk of physical damage to the urethra from catheter insertion. False passages occur when a hole opens in the urethra. Urethral stricture is caused by scarring in the urethra that narrows the passageway. These complications can cause pain, increase your risk of UTI, and make catheter insertion difficult. If you are experiencing difficult catheterization, talk to your doctor. Traumatic catheter insertion can increase your risk of a false passage or urethral stricture. Try to relax your muscles, take deep breaths, and be gentle when inserting the catheter. If you experience pain or difficulty during insertion, don’t force it and talk to your doctor right away. There are other options or techniques that can decrease the trauma during catheter insertion. For example, a coude tip catheter can help with insertion if you have an enlarged prostate, or a hydrophilic catheter may help ease insertion due to its special coating that makes them very slippery during insertion.
Conclusion
Neurogenic bladder is a manageable condition with lifestyle changes and medications. Complications can often be prevented with the right treatment and oversight. Even if you have not noticed any complications, a yearly follow-up with your urologist is recommended for screenings and assessments to make sure you are doing well with your current management plan.
Catheterization is often the mainstay of successful neurogenic bladder management. Catheters are not all the same. Some have special coatings that can decrease your risk of urethral trauma, while others are fully enclosed systems, where the risk of bacterial contamination is significantly lower. Catheter shape, size, and packaging style can be customized to your preference and abilities. At ABC Medical, we are product experts. Give us a call and talk with our knowledgeable staff or on-staff nurse practitioner to learn more about what product would best meet your needs.
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Disclaimer: This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. For medical advice, please speak with your healthcare provider.
References
Allen KJ, Leslie SW. Autonomic Dysreflexia. [Updated 2023 May 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482434/
Leslie SW, Tadi P, Tayyeb M. Neurogenic Bladder and Neurogenic Lower Urinary Tract Dysfunction. [Updated 2023 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560617/
Neurogenic Bladder. John Hopkins Medicine. N.D. Accessed July 2, 2024. https://www.hopkinsmedicine.org/health/conditions-and-diseases/neurogenic-bladder
