Neurogenic Bladder Adult

Definition

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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Causes

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
  • Diabetes
  • Stroke
  • Multiple sclerosis
  • Cerebral palsy

Risk Factors

Factors that increase your chance of neurogenic bladder include:

• Nerve or spinal cord conditions present since birth, such as spina bifida or spinal cord tumor
• Diabetes
• Stroke
• Other causes of brain injury such as infection or trauma

Symptoms

Symptoms of neurogenic bladder may include:

• Urinary incontinence
• Dribbling urine stream
• Straining while passing urine
• Not being able to pass enough urine (urinary retention)
• Overflow of urine from a full bladder
• Passing urine is painful
• Urinary tract infections that keep coming back

Diagnosis

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:

• X-rays
• Ultrasound
• CT scan
• MRI scan

To see how well the bladder is working, you may also have:

• Bladder function tests
• Urodynamics—how well urine flows

Treatment

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:

Training

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.

Catheters

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.

Medications

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

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.

Prevention

Most cases of neurogenic bladder cannot be prevented. People with diabetes may be able to delay or avoid the problem with good control of blood sugar levels.