Neurogenic Bladder

Neurogenic bladder is the term for what happens when neurological (nervous system) conditions affect how your urinary bladder works. Your nervous system consists of your:

• Brain
• Nerves
• Spinal cord

Your nerves send electrical signals between your brain and every other part of your body. The electrical signals tell your body to function — to move, to breathe and even to pee.

Neurogenic bladder occurs when a problem with your brain, nerves or spinal cord causes you to lose control of your bladder. Another name for neurogenic bladder is neurogenic lower urinary tract dysfunction (NLUTD).

What are the types of neurogenic bladder?

There are two major types of bladder control problems that link to neurogenic bladder. They depend on the affected nerves and the nature of the damage. The types include:

• Overactive (spastic or hyper-reflexive) bladder
• Underactive (flaccid or hypotonic) bladder

What are neurogenic bladder symptoms?

The most common symptom of neurogenic bladder is being unable to control when you pee. Other neurogenic bladder symptoms depend on the type you have.

Overactive bladder symptoms may include:

• Difficulty starting to pee, a slow urine stream or dribbling (urinary hesitancy)
• Loss of bladder control (urinary incontinence)
• Peeing eight or more times daily (frequent urination)
• Sudden urges to pee immediately (urinary urgency)

Underactive bladder symptoms may include:

• Your bladder not emptying all the way or at all when you pee (urinary retention)
• Your bladder being too full, so you leak pee (overflow incontinence)
• Not being able to tell when your bladder is full

What causes neurogenic bladder?

Neurogenic bladder can be congenital (present at birth). Birth defects that may cause neurogenic bladder include:

• Caudal regression syndrome
• Cerebral palsy
• Spina bifida

Common neurological conditions that may cause neurologic bladder include:

• Central nervous system tumors
• Multiple sclerosis (MS)
• Parkinson’s disease
• Stroke

Other conditions that may cause neurogenic bladder include:

• Spinal cord injuries
• Traumatic injuries, such as a fall or automobile accident

Complications of neurogenic bladder

If you have neurogenic bladder, you’re at a higher risk for other conditions that affect your urinary system. These may include:

• Kidney damage (kidney disease)
• Kidney stones and other stones in your urinary system, like ureteral stones
• Pee flowing backward from your bladder to your kidneys (vesicoureteral reflux)
• Repeated urinary tract infections (UTIs)

Neurogenic bladder can also make you nervous to go out in public because you may worry about leaks or odors. This can cause feelings of anxiety, depression and loneliness. It’s important to recognize these feelings and reach out to a healthcare provider for help.

How doctors diagnose neurogenic bladder

A healthcare provider will review your medical history, ask questions about your symptoms and recommend a physical exam. If they suspect neurogenic bladder, they may recommend nervous system and bladder tests. These may include:

• Cystoscopy to look inside your urethra and bladder
• Imaging tests, including CT scans, MRIs, ultrasounds and X-rays
• Urodynamic testing to measure how much pee your bladder can hold, the pressure within your bladder, how well pee flows and how well your bladder empties when it’s full and you pee

During urodynamic testing, a provider may place special sensors near your urethra or rectum to make sure your muscles and nerves in those areas are working properly.

They’ll also likely refer you to a specialist.

What kind of doctor treats it?

A urologist who specializes in neurourology can help treat neurogenic bladder. A urologist is a medical doctor who specializes in diagnosing and treating conditions that affect your urinary system, as well as the male reproductive system and the female reproductive system. Neurourology is the study of neurological conditions that affect your urinary system.

Can you fix a neurogenic bladder?

No, you can’t cure neurogenic bladder. But treatments can help you manage your symptoms.

How is it treated?

Healthcare providers will work with you to decide on a treatment plan that’s appropriate for what’s causing neurogenic bladder. Some neurogenic bladder treatments include:

• Augmentation cystoplasty (bladder augmentation). This is a type of surgery that increases the size of your bladder so it can hold more pee.
• Botulinum toxin (Botox®). A healthcare provider injects Botox into your bladder or urinary sphincters to help the muscles relax. This may increase how much pee you can store and reduce symptoms of urgency, frequency and leakage.
• Continuous catheterization. You wear a thin, flexible tube (urinary catheter) at all times to drain pee. The catheter may enter through your urethra and into your bladder or enter through your lower abdominal wall.
• Drugs. Medications that help treat neurogenic bladder include oxybutynin, tolterodine, mirabegron, and solifenacin succinate.
• Self-catheterization (clean intermittent catheterization). A healthcare provider teaches you how to insert a urinary catheter through your urethra and into your bladder to drain pee so you can drain your bladder on your own schedule.
• Urinary reconstruction and diversion. A surgeon disconnects part of your small intestine or large intestine (some approaches use both), attaches it to one end of your ureters and attaches the other end to a surgical opening (stoma). The stoma drains into a plastic bag (ostomy bag) attached to the outside of your body.

What is the first-line treatment for neurogenic bladder?

While not a treatment, healthcare providers often first suggest absorbent underwear to help prevent wetness and odors while protecting your skin and clothing. Bed pans and rubber sheets can help protect mattresses and bed linens.

They may also recommend lifestyle changes. These may include avoiding certain foods or drinks that can irritate your bladder, like alcohol, caffeinated drinks like coffee and carbonated drinks like soda pop. If you have diabetes, monitoring your blood sugar (glucose) levels can help. Treating constipation can also help.

How do you train a neurogenic bladder?

Bladder training is a nonsurgical treatment that may help treat neurogenic bladder. You may need to keep a bladder diary in which you record:

• Any leaks and what you were doing before you leaked
• How much you pee
• What you drink
• When you pee

This information helps you establish a pattern of when you should try to pee throughout the day.

Kegel exercises can also help you strengthen your pelvic floor muscles so you have more control over when you pee.

Can Flomax® help?

In some cases, long-term use of tamsulosin (Flomax®) may help treat neurogenic bladder.

When should I see my healthcare provider?

If you’re already in treatment for a type of disorder that affects your nervous system, chances are that healthcare providers will already know how to address the issue of neurogenic bladder. Still, it’s important to be honest with providers about issues you face. Make sure to speak to a provider if you have new or worsening symptoms. This includes symptoms that may indicate an infection, like pain or a fever.

What is the prognosis for neurogenic bladder?

Many people worry about neurogenic bladder because there isn’t a cure. Sometimes, your symptoms may improve. But other times, they get worse. However, you can manage your symptoms. Many people can manage symptoms with lifestyle changes, medications and catheterization. Most people don’t need surgery to treat it. A healthcare provider will give you a better idea of what to expect according to the type of neurogenic bladder you have and its cause.