Non-Neurogenic Voiding Dysfunction

What is non-neurogenic voiding dysfunction?

People with non-neurogenic voiding dysfunction can’t fully empty their bladders. As a result, you may feel as though your urinary stream is slow or difficult to start, and takes longer than normal. You may pee more often than is typical, leak urine, or feel strong urges to use the bathroom. Children may wet their pants during the day.

What is the difference between non-neurogenic and neurogenic voiding dysfunction?

Neurogenic voiding dysfunction, also called neurogenic bladder, is a nervous system disorder in which brain, nerve or spinal cord problems affect bladder control.

Non-neurogenic voiding dysfunction has no neurologic (nervous system) cause and is usually related to a weak bladder muscle, a blockage in the flow of urine, or habits that have developed over time.

How common is non-neurogenic voiding dysfunction?

Non-neurogenic voiding dysfunction affects children and adults. It can affect all genders but is more common in women. More than 6% of women over 40 have non-neurogenic voiding dysfunction.

Approximately 1 in 5 children ages 4 to 6 experience daytime wetting due to the condition.

What causes non-neurogenic voiding dysfunction?

Your bladder is part of the urinary system. It’s a hollow muscular organ that holds urine until you pee. People with non-neurogenic voiding dysfunction have difficulty fully emptying their bladder due to either a weak bladder muscle, a blockage in the flow of urine, or behavioral problems or habits that develop over time.

Behavioral problems or habits may lead to non-neurogenic voiding dysfunction. These factors may also play a role:

• Constipation.
• Dysfunctional elimination syndrome in children (bladder muscles and nerves don’t work together).
• Infections, such as urinary tract infections (UTIs).
• Ignoring the urge to urinate until the bladder becomes too full.
• Overactive bladder.
• Underactive bladder that doesn’t trigger an urge to pee.
• Blockage in the flow of urine.

What are the symptoms of non-neurogenic voiding dysfunction?

Children and adults with non-neurogenic voiding dysfunction may experience:

• Taking a while for urination to start, straining to pee, slow urine stream or flow that starts and stops.
• Having to push with the stomach muscles, or push on the lower abdomen with the hands, in order to urinate.
• Feeling like the bladder is never fully empty.
• Constipation.
• Frequent urination (more than six times a day in children, or more than what is considered to feel normal in adults), infrequent urination (fewer than three times a day) or leaking urine (urinary incontinence).
• Holding behaviors, such as crossing legs or squatting (mostly in children).
• Nocturia (urinating more than once per night).
• Strong, sudden need (urge) to urinate.
• Wetting during the day (mostly in children).

How is non-neurogenic voiding dysfunction diagnosed in adults?

Your healthcare provider will take your history and perform a physical exam. For women, this may include a pelvic exam. Men may have an exam to check for an enlarged prostate or other prostate problems. Your provider may ask you to keep a bladder diary to track daily urinating habits.

You may get one or more of these tests:

• Blood test: Men may have a blood test to check for high levels of prostate-specific antigens (PSAs). An elevated PSA can indicate prostate problems.
• Urinalysis: A urinalysis checks for infections, such as a UTI.
• Cystoscopy: Your provider inserts a cystoscope, hollow tube with a lens, through the urethra (tube that carries urine out of the body). Your provider views the inside of the bladder to check for problems.
• Ultrasound: A bladder or renal (kidney) ultrasonography test assesses the amount of urine left in the bladder after you pee. Test results can show a voiding problem.
• Urodynamic testing: Urodynamic tests measure how much urine the bladder holds, and how well the muscles in the bladder, urethra, and pelvis work together.

How is non-neurogenic voiding dysfunction diagnosed in children?

Your child’s healthcare provider will perform a physical exam and assess symptoms. You may need to keep a bladder diary. This record tracks your child’s bathroom habits and accidents.

Your child may get a blood test, urinalysis, ultrasound or certain urodynamic tests. It’s rare for a child to need more invasive diagnostic tests.

What are the complications of non-neurogenic voiding dysfunction?

When you can’t empty your bladder, bacteria in the remaining urine can cause an infection, such as a UTI. You or your child may be more prone kidney stones or bladder stones. If the problem is severe, it can lead to kidney damage.

How is non-neurogenic voiding dysfunction managed or treated in adults?

Treatments for non-neurogenic voiding dysfunction in adults vary depending on the underlying cause. Treatments include:

• Bladder training: You can retrain the muscles in your bladder to help them hold urine longer or urinate more easily. You can work on this with a physical therapist or other provider who specializes in pelvic floor problems.
• Pelvic floor therapy: A specialized physical therapist can teach you to relax the muscles in your pelvic floor to urinate more easily. Your provider may place biofeedback sensors inside the vagina or rectum. The sensors ensure you are working the right muscles.
• Medications: Several medications improve voiding problems. Alpha blockers such as tamsulosin (Flomax®) may help. Or you may try drugs for overactive bladder, such as oxybutynin (Ditropan®) and tolterodine (Detrol®) if you have bad urinary urgency or leakage.
• Botulin toxin (Botox®) injections: Your provider may inject botulin toxins into the bladder to relax muscles, if you also have urge incontinence (strong urge to pee).
• Percutaneous tibial nerve stimulation (PTNS): PTNS takes place in your provider’s office. Your provider places an electrode near the tibial nerve in the ankle. A stimulator device sends mild electrical signals to the sacral nerve in the pelvis. This nerve controls urinary sphincter muscles, the bladder and pelvic floor muscles and this therapy can help regain control over your bladder
• Sacral nerve stimulation: Your provider surgically implants a small device (neurotransmitter) under the skin just above your buttocks (butt). The device sends mild electrical impulses to the sacral nerve through a wire under the skin. This device can help reduce urinary urgency and leakage, and can help empty the bladder more effectively.
• Self-catheterization: You may use a catheter (thin hollow tube) to drain urine from the bladder throughout the day. Your provider will show you how to perform self-catheterization.

How is non-neurogenic voiding dysfunction managed or treated in children?

Like adults, children can benefit from alpha blockers and drugs for overactive bladders. Some children learn to do pelvic floor exercises.

Your healthcare provider may also recommend bladder training. A provider helps you work with your child to change voiding-related behaviors.

For instance, your child may need to use the bathroom every three hours during the day. Good posture on the toilet can help, too. Changing bathroom behaviors can retrain the bladder and make the bladder muscle stronger.

How can I prevent non-neurogenic voiding dysfunction?

Lifestyle and dietary changes can lower your risk of voiding dysfunction. You can improve bladder function with these techniques:

• Cut back on foods that irritate the bladder. These include caffeinated beverages, citrus fruits and juices, spicy foods and acidic (tomato-based) foods and drinks. Adults should minimize alcohol consumption.
• Get more fiber in your diet. Constipation can lead to voiding dysfunction or make the problem worse. You can increase the amount of fiber in your diet by choosing whole-grain products, beans and fresh fruits and vegetables. You may also use a stool softener (laxative). Check with your child’s doctor before giving laxatives to a child.
• Maintain a healthy weight. Excess weight can squeeze the bladder, causing urine to leak. Weight control can help.
• Stop smoking. Nicotine irritates the bladder muscle. Plus, smokers are more likely to have a chronic cough that puts pressure on the bladder. You can take steps to quit smoking.

What is the prognosis (outlook) for people who have non-neurogenic voiding dysfunction?

Treatment improves bladder control for most people. Rarely, someone with non-neurogenic voiding dysfunction needs surgery to expand the bladder.

When should I call the doctor?

You should call your healthcare provider if you experience:

• The inability to urinate for a prolonged period of time.
• Changes in urine, such as strong odor or cloudy appearance.
• Painful urination (dysuria) or blood in urine.
• Severe constipation.
• Signs of infection, such as fever.

What questions should I ask my doctor?

You may want to ask your healthcare provider:

• Why do I or my child have non-neurogenic voiding dysfunction?
• What is the best treatment for me or my child?
• What are the treatment side effects?
• What lifestyle changes should my family make?
• Should I look out for signs of complications?

A note from Cleveland Clinic

Non-neurogenic voiding dysfunction can cause life-disrupting symptoms. Children who wet their pants may be embarrassed and have lower self-esteem. Adults with difficulty urinating or who find themselves racing to the bathroom and leaking urine have a significantly lower quality of life. Don’t be shy about talking to your healthcare provider about this problem. Many treatments can help you or your child.