Non-Neurogenic Voiding Dysfunction

Non-neurogenic voiding dysfunction is a condition that prevents you from completely emptying your urinary bladder. “Non-neurogenic” means that the condition doesn’t relate to a problem with your nervous system, while “voiding” and “dysfunction” mean that you’re not peeing as you should.

Anyone can have non-neurogenic voiding dysfunction. It usually relates to weak bladder muscles, a blockage in your urinary system or habits you develop over time. But it’s more common in potty-trained children between 4 and 6 and females over 40.

Approximately 1 in 5 children between the ages of 4 and 6 have daytime wetting due to non-neurogenic voiding dysfunction. More than 6% of females over 40 have non-neurogenic voiding dysfunction.

What are the symptoms of non-neurogenic voiding dysfunction?

Non-neurogenic voiding dysfunction examples include:

• Difficulty starting or straining to pee
• A weak pee stream or a pee stream that starts and stops
• Having to push with your abdominal (stomach) muscles or needing to push on your lower abdomen with your hands to pee
• Feeling like your bladder is never empty
• Constipation
• Peeing more than usual (frequent urination) or less than usual
• Leaking pee or peeing when you don’t mean to (urinary incontinence)
• Having a sudden, uncontrollable urge to pee (urge incontinence)
• Peeing more than once while you’re sleeping (nocturia)

Children may also display symptoms or behaviors such as:

• Daytime wetting
• Using holding maneuvers, such as crossing their legs, squatting or pressing their hands or the heel of their foot between their legs

What causes non-neurogenic voiding dysfunction?

Common causes of non-neurogenic voiding dysfunction include:

• Weak bladder muscles
• A blockage in your urinary system
• Overactive bladder
• An underactive bladder that doesn’t trigger an urge to pee
• Constipation
• Urinary tract infections (UTIs)
• Ignoring the need to pee until your bladder gets too full
• An enlarged prostate (benign prostatic hyperplasia)
• Prostate cancer

In children, dysfunctional elimination syndrome can also cause non-neurogenic voiding dysfunction. Dysfunctional elimination syndrome is when your bladder muscles and nerves don’t work together.

Complications of this condition

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

Any problems you have going pee can also have psychological consequences. Many people feel embarrassed, ashamed or insecure because they can’t control when and how they pee. You may also feel like you’re a burden on others if you have to stop activities to deal with non-neurogenic voiding dysfunction symptoms frequently. Serious complications may develop if you avoid socializing with others, including:

• Anxiety
• Depression

How doctors diagnose non-neurogenic voiding dysfunction

A healthcare provider can diagnose non-neurogenic voiding dysfunction. They’ll review your health history and perform a physical exam, which may include a pelvic exam or a digital rectal exam of your prostate.

Your provider may also ask that you keep a bladder diary to keep track of:

• How much you drink
• When you pee
• How much you pee
• When you have urinary leakage

They may also order additional tests to help confirm their non-neurogenic voiding dysfunction diagnosis.

Tests that are used

A healthcare provider may order one or more of the following tests:

• Prostate-specific antigen (PSA) test. A PSA test is a type of blood test that looks for high levels of prostate-specific antigens. An elevated PSA level may indicate that you have problems with your prostate.
• Pee test (urinalysis). A pee test can help determine if you have a UTI.
• Ultrasound. An ultrasound is an imaging test that helps a provider see how much pee remains in your bladder after you use the bathroom. Ultrasound results can help the provider see a voiding problem. An ultrasound can also look at your kidneys to see if they have been affected by the non-neurogenic voiding dysfunction.
• Urodynamic testing. These tests help measure how much pee your bladder holds and how well the muscles in your bladder, urethra and pelvis work together.
• Cystoscopy. A provider inserts a long, thin instrument with a camera at the end of it (cystoscope) into your urethra to check for problems with your urethra and bladder.

Non-neurogenic voiding dysfunction tests for children are usually less invasive. A provider may ask you to keep a bladder diary and only recommend a blood test, pee test, ultrasound and certain urodynamic tests.

How is it treated?

Non-neurogenic dysfunction voiding treatments vary according to the cause. Treatments may include:

Bladder training

You can retrain your bladder muscles to help them hold pee longer. You go to the bathroom at set times throughout the day to stop your bladder from getting too full, even if you don’t have to pee. A physical therapist or another provider who specializes in pelvic floor problems can help you with bladder training.

Pelvic floor therapy

A specialized physical therapist can teach you how to relax the muscles in your pelvic floor so you can pee more easily. They may place biofeedback sensors in your vagina or rectum to ensure you’re working the right muscles.

They may also teach you Kegel exercises to help strengthen your pelvic floor muscles. Strong pelvic floor muscles help prevent urinary incontinence and urge incontinence.

Medications

Medications that help improve voiding problems include:

• Alpha-blockers, such as tamsulosin (Flomax®)
• Urinary antispasmodics, including oxybutynin (Ditropan®) and tolterodine (Detrol®)

Botulinum toxin

A provider may inject botulinum toxin (Botox®) into your bladder to help relax the muscles and relieve urge incontinence.

Percutaneous tibial nerve stimulation (PTNS)

Sometimes, your nerves need a boost to encourage your bladder muscles. During PTNS, a provider will place an electrical conductor (electrode) near the tibial nerve in your ankle. They’ll then send mild electrical signals to the electrode, stimulating your tibial nerve. Your tibial nerve sends impulses to the sacral nerves in your pelvis. It prevents your sacral nerves from sending abnormal signals to your urinary sphincter muscles, bladder and pelvic floor muscles so you can regain control over your bladder.

Sacral nerve stimulation

A provider will surgically implant an electrode under the skin just above your butt (buttocks). The electrode sends mild electrical impulses to your sacral nerve through a thin wire (probe) under your skin. The impulses stimulate your bladder muscles to work.

Self-catheterization

You can insert a urinary catheter into your bladder at regular intervals to drain pee into a bag outside of your body. A provider will show you how to perform self-catheterization.

Surgery

If other treatment options don’t work, a provider may recommend bladder augmentation surgery (cystoplasty). This procedure makes your bladder larger so it can hold more pee.

What is the first-line treatment for non-neurogenic overactive bladder?

First-line treatments for non-neurogenic overactive bladder usually include:

• Cutting back on foods or drinks that cause bladder symptoms, including tea, coffee, alcohol and spicy or acidic foods and beverages
• Bladder training

If behavior changes don’t work, depending on the type of non-neurogenic voiding dysfunction, healthcare providers may recommend medications like:

• Anticholinergics
• Alpha-blockers
• Beta 3 receptor agonists

How is non-neurogenic voiding dysfunction treated in children?

For children, alpha-blockers and anticholinergic drugs help treat an overactive bladder. Some children can also learn to do pelvic floor exercises.

A healthcare provider may recommend bladder training, as well. For example, they may encourage your child to go to the bathroom at regular intervals and show them the best way to sit on the toilet (posture).

How soon after treatment will I feel better?

It depends on the treatment. Bladder training and pelvic floor training may start to work in a few weeks or months. Nerve stimulation usually starts to work after a few weeks. Medications should begin to work within a few days or weeks. A healthcare provider will give you a better idea of what to expect.

When should I see my healthcare provider?

Talk to a healthcare provider as soon as you first notice problems using the restroom, including:

• The inability to pee for an extended period
• Changes to your pee, including a strong or foul odor, a cloudy appearance or blood in your pee (hematuria)
• Pain when you pee (dysuria)
• Constipation symptoms that don’t go away
• Signs of an infection, including a fever, chills or headache

During your appointment, you may wish to ask:

• How do you know I have non-neurogenic voiding dysfunction?
• What’s causing my non-neurogenic voiding dysfunction?
• What treatment do you recommend for my non-neurogenic voiding dysfunction?
• What are the side effects of your recommended treatment?
• When should I expect to see results from your recommended treatment?
• What lifestyle changes do you recommend to ease my non-neurogenic voiding dysfunction symptoms?
• Should I look out for any signs of complications?
• Should I see a urologist?

What can I expect if I have non-neurogenic voiding dysfunction?

The outlook for non-neurogenic voiding dysfunction is good. Treatment helps improve bladder control for most people. A cystoplasty is rarely necessary to treat non-neurogenic voiding dysfunction.

Can this be prevented?

You can help prevent non-neurogenic voiding dysfunction by making changes to your lifestyle and eating patterns. These may include:

• Cutting back on foods and drinks that irritate your bladder. Caffeinated beverages, citrus fruits, spicy foods and alcohol can all irritate your bladder and cause problems peeing.
• Eating more fiber. Constipation can lead to non-neurogenic voiding dysfunction or make it worse. You can increase your fiber intake by eating lots of beans, fruits, veggies and whole-grain foods — such as whole-wheat bread, oatmeal, quinoa, brown rice and whole-grain pasta. Stool softeners (laxatives) can also treat constipation. Talk to a healthcare provider before you take laxatives or give them to a child.
• Maintaining a healthy weight for you. A body mass index (BMI) greater than 25 (having overweight) can put pressure on your bladder and cause it to leak.
• Quitting smoking. Nicotine, one of the main ingredients in tobacco products, can irritate your bladder muscles. People who smoke are also more likely to have a chronic cough, which puts pressure on your bladder.

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

Neurogenic voiding dysfunction (neurogenic bladder) is a condition that affects your nervous system. That means a problem with your brain, nerves or spinal cord affects your ability to control your bladder.