Neurogenic bladder

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

  • Alternative Names
    • Neurogenic detrusor overactivity; NDO; Neurogenic bladder sphincter dysfunction; NBSD

  • Causes
    • Several muscles and nerves must work together for the bladder to hold urine until you are 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:

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

      • Nerve damage (neuropathy)
      • Nerve damage due to long-term, heavy alcohol use
      • Nerve damage due to long-term diabetes
      • Vitamin B12 deficiency
      • Nerve damage from syphilis
      • Nerve damage due to pelvic surgery
      • Nerve damage from a herniated disk or spinal canal stenosis
  • Symptoms
    • The symptoms depend on the cause. They often include symptoms of urinary incontinence.

      Symptoms of overactive bladder may include:

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

      Symptoms of underactive bladder may include:

      • Full bladder and possibly urine leakage
      • Inability to tell when the bladder is full
      • Problems starting to urinate or emptying all the urine from the bladder (urinary retention)
  • Treatment
    • Medicines may help manage your symptoms. Your health care provider may suggest:

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

      Your provider may refer you to 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 may help 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).
      • 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
    • If you are having urinary incontinence, organizations are available for further information and support.

  • Possible Complications
    • Complications of neurogenic bladder may include:

      • Constant urine leakage that can cause skin to break down and lead to pressure sores
      • Kidney damage 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 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
    • Chapple CR, Osman NI. The underactive detrusor. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:chap 77.

      Goetz LL, Klausner AP, Cardenas DD. Bladder dysfunction. In: Cifu DX, ed. Braddom's Physical Medicine and Rehabilitation. 5th ed. Philadelphia, PA: Elsevier; 2016:chap 20.

      Panicker JN, DasGupta R, Batla A. Neurourology. In: Daroff RB, Jankovic J, Maziotta JC, Pomeroy SL, eds. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 47.