Neurogenic Bladder Adult

Definition

Neurogenic bladder is abnormal bladder function caused by a nerve or brain problem. The bladder may empty too often or at the wrong time (incontinence) or the bladder may be unable to completely empty the urine (urinary retention). In this case, urine may leak out of the overfilled bladder and back up into the kidney.

Contact your doctor if you think you may have this condition. The sooner it is treated, the lower the chance of developing other serious conditions, such as a urinary tract infection, hydronephrosis, or kidney damage.

Bladder With Nerves, Female

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Causes

Neurogenic bladder is caused by problems with the nerves carrying messages between the bladder and the brain or the brain itself. The nerve problems may be caused by:

• Spinal cord injury
• Tumors of the brain or spinal cord in the pelvic area
• 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 developing 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 during urination
• Inability to urinate (urinary retention)
• Overflow of urine from a full bladder
• Painful urination
• Recurring urinary tract infections

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. You may be asked to keep a diary of how often you empty your bladder and other urinary habits. If your doctor thinks that your symptoms may be caused by a nerve problem, you may have some of the tests below. You may also be referred to an urologist for further evaluation and treatment.

Your bodily fluids may be tested. This can be done with:

• Urinalysis
• Blood tests

Images may be taken of your kidneys, ureters, and bladder. This can be done with:

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

Other tests may be done, including:

• Bladder function tests
• Urodynamics

Treatment

Treatment focuses on relieving symptoms by emptying your bladder regularly.

Treatment options include:

Behavioral Therapy

• Bladder training—setting a regular schedule to empty your bladder
• Exercises to strengthen muscles around the bladder that help control urine flow
• Painless electrical stimulation to help the function of bladder muscles

Catheters

A thin tube, called a catheter, can be inserted to empty the bladder. You can learn to do this yourself or a trained healthcare professional may do it for you.

Medications

Your doctor may recommend anticholinergic drugs (antimuscarinics) or botulinum toxin injections to help control symptoms.

Surgery

Surgery may be an option for severe cases when all other treatments fail. Surgical procedures include:

• Removing part of the muscle that holds the bladder closed—This allows urine to flow out into a collection tube attached to the penis (for men only).
• Inserting a tube into an opening in the abdomen—This allows urine to flow out into a collection bag.
• Using tissue from the bowel to make the bladder larger
• Replacing the bladder with a pouch made from sections of the bowel or other tissue
• Inserting a small tube-like device, called a stent, into the bladder neck to allow urine to flow out.

Prevention

While most cases of neurogenic bladder cannot be prevented, people with diabetes may be able to delay or avoid the problem by carefully controlling their blood sugar levels over the long-term. Also, wearing seat belts and avoiding activities that increase the risk of spinal cord injuries will prevent neurogenic bladder from this cause.