Neurogenic Bladder Adult
Neurogenic bladder is a problem with how the bladder works. It may empty too often or at the wrong time. This is called incontinence . The bladder may also not be able to fully empty all of the urine. The urine may then build up and move back up into the kidney.
Poor flow of urine can lead to infections and kidney damage. Treatment can decrease the risk of these problems.
|Bladder With Nerves|
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Nerves control the action of the bladder. Signals move from the bladder to the brain, and the brain to the bladder. Neurogenic bladder is a problem with any part of this process. It may be the result of:
- Spinal cord injury
- Tumors of the brain or on the spinal cord in the pelvis
- Infection of the brain or spinal cord
Medical conditions affecting the brain or nerves, such as:
- Spina bifida
- Multiple sclerosis
- Cerebral palsy
You will be asked about your symptoms and past health. An exam will be done. You may be asked to keep a diary. Keep track of how often you drain your bladder, feel urges, and any waking at night to pass urine. The doctor may need tests to rule out other possible causes.
Tests may include:
- Urinalysis—to look for signs of infection or kidney changes
- Blood tests—to look for signs of infection
Problems with the structure of the urinary tract can cause symptoms. Images of the kidneys, ureters, and bladder can be taken with:
- CT scan
- MRI scan
To see how well the bladder is working, you may also have:
- Bladder function tests
- Urodynamics—how well urine flows
The goal of treatment is to empty your bladder on a routine basis. This should help to ease symptoms. The right plan will depend on your specific needs.
Treatment options include:
Early steps may include:
- Bladder training—set a schedule to empty your bladder.
- Pelvic floor exercises—to make muscles around the bladder stronger. Biofeedback may be added.
- Painless electrical stimulation—to help retrain the bladder muscles.
A thin tube can be placed into the bladder. It will allow urine to leave the bladder. You can learn to do this yourself or your care team may do it for you.
Medicines that may be considered include:
- Anticholinergic drugs (antimuscarinics)—to help relax bladder muscles
- Alpha-blockers—may be used along with anticholinergic drugs
- Botulinum toxin injections—to help bladder muscle relax
Surgery may be an option for severe cases. It may be considered when all other treatments fail. Surgery options include:
- Remove part of the muscle that holds the bladder closed (men only)—urine then flows out into a tube attached to the penis.
- Create an opening in the belly and connect urinary tract to it. This will allow urine to pass out of the body and into an attached bag.
- Make the bladder larger with tissue from the bowel.
- Replace the bladder. A new pouch is made from areas of the bowel or other tissue.
- Insert a stent. This small tube can help to prop open the bladder neck. It will allow urine to flow more freely.
- Urethral sling (women only)—device is placed to help lift the urethra. It will slow flow of urine and stop leakage.
- Sacral neuromodulation—a device is placed into the pelvis. It can deliver impulses to the nerves that send signals from bladder to brain. It can reduce the number of signals telling the bladder to contract.
Percutaneous Tibial Nerve Stimulation (PTNS)
The bladder can send wrong signals to the brain. PTNS can override signals from the bladder and decrease symptoms.
A small needle electrode is inserted at the ankle. Small electrical impulses are passed through the needle to nearby tibial nerve. The impulses travel up to nerves in the pelvis that control the bladder. The new impulses block incorrect bladder signals to the brain.
This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.
Edits to original content made by Denver Health.
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a (Neurogenic Incontinence—Adult)
National Association for Continence https://www.nafc.org
Urology Care Foundation http://www.urologyhealth.org
Canadian/American Spinal Research Organizations https://www.csro.com
HealthLink BC https://www.healthlinkbc.ca
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Neurogenic bladder. Urology Care Foundation website. Available at: http://www.urologyhealth.org/urologic-conditions/neurogenic-bladder?article=9. Accessed December 11, 2018.
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