When neurological (nervous system) conditions affect the bladder, it is called neurogenic bladder. There are two major types of bladder control problems that are associated with a neurogenic bladder. Depending on the nerves involved and nature of the damage, the bladder becomes either overactive (spastic or hyper-reflexive) or underactive (flaccid or hypotonic).
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What is the bladder?
The bladder is a hollow organ located in the pelvis, or lower abdomen. The bladder has two important functions:
- It stores urine.
- It removes urine from the body through a complex communication circuit in the spinal cord and brain.
Urinary incontinence occurs when a person cannot control the flow of urine. The storage of urine can be a problem if the bladder is unable to empty fully or if it begins to empty itself before the person reaches the bathroom (a condition known as overactive bladder). Leakage can occur if the bladder cannot empty (overflow incontinence), if the sphincter controlling urination doesn’t work (stress incontinence), or if bladder spasms cause the bladder to shrink before the person reaches the toilet (urge incontinence).
What causes neurogenic bladder?
Neurogenic bladder can be congenital (present at birth). Birth defects that can cause neurogenic bladder include:
- Spina bifida (myelomeningocele): This disorder occurs when the fetus' spine does not completely develop during the first month of pregnancy. Babies born with myelomeningocele often have paralysis or weakness that affects how the bladder works.
- Sacral agenesis: This is a condition in which parts of the lower spine are missing.
- Cerebral palsy: Cerebral palsy is a group of chronic (long-term) disorders that weaken a person's ability to control body movement and posture. These disorders result from injury to the motor areas of the brain. The problem causing cerebral palsy may occur while the infant is still in the womb or after birth. Cerebral palsy is not always found during a child's first year of life.
Various medical conditions can cause neurogenic bladder, including the following:
- Stroke
- Parkinson's disease
- Multiple sclerosis
- Spinal cord injuries
- Spinal surgeries
- Erectile dysfunction
- Trauma/accidents
- Central nervous system tumors
- Heavy metal poisoning
What are the symptoms of neurogenic bladder?
The most common symptom of neurogenic bladder is being unable to control urination. Other symptoms include:
- A weak or dribbling urinary stream
- Frequent urination (urinating eight or more times daily)
- Urgency (a feeling or need to urinate immediately)
- Painful urination, which may mean there is a urinary tract infection
How is neurogenic bladder diagnosed?
A doctor will do an exam and may order several tests of the nervous system and the bladder to diagnose neurogenic bladder: These include:
- Urodynamic studies: These bladder function tests measure how much urine the bladder can hold, the pressure within the bladder, how well urine flows, and how well the bladder empties when it is full. Special sensors may be placed on the skin near the urethra (the tube through which urine passes) or rectum to see if the muscles and nerves in those parts of the body are working properly.
- Cystoscopy: The doctor may perform this procedure to examine the inside of the bladder and urethra with the use of a small telescope (cystoscope).
- X-rays
- Computed tomography (CT)
- Magnetic resonance imaging (MRI)
How is neurogenic bladder treated?
The main treatments for neurogenic bladder are the following:
- Clean intermittent catheterization (CIC): Catheters are thin, flexible tubes that can be inserted through the urethra and into the bladder to drain urine.
- Drugs: Medications are prescribed to improve your bladder function. Specific medications for neurogenic bladder depend on if your bladder is overactive (you can’t hold urine, you often feel the urge to urinate) or underactive (you won’t release urine even when your bladder is full) or both.
- Injections of botulinum A toxin (Botox®): A doctor injects Botox into the bladder or urinary sphincters.
- Bladder augmentation (augmentation cystoplasty): This is a surgery in which segments of the intestine (sigmoid colon) are removed and attached to the walls of the bladder. This reduces the bladder's internal pressure and increases its ability to store urine.
- Ileal conduit: Part of the small bowel is used to make a urine stoma. This stoma drains to a bag attached to the outside of the body.
- Lifestyle changes: These might include avoiding certain foods or drinks that can irritate the bladder. These include certain caffeinated drinks like coffee, carbonated beverages, spicy foods, and citrus fruit. Losing weight can ease stress on the bladder. A behavioral treatment called delayed voiding may help some people with urine control.
Absorbent undergarments, pads, panty shields, panty liners, and adult diapers can help prevent wetness and odors while protecting skin and clothing. Bed pads can protect sheets and mattresses.
