Neurogenic Bladder Adult

Causes

Nerve signals go back and forth between the brain and the muscles that control the bladder. Neurogenic bladder is a problem with this process. It may be the result of:

• A spinal cord injury
• Tumors of the brain or on the spinal cord in the pelvis
• Infection of the brain or spinal cord
• Health problems that affect the brain or nerves, such as:
  • Spina bifida
  • Diabetes
  • Stroke
  • Multiple sclerosis
  • Cerebral palsy

Risk Factors

Things that may raise the risk of neurogenic bladder are:

• Nerve or spinal cord problems 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:

• Problems controlling the flow of urine (pee)
• Dribbling urine flow
• Straining while passing urine
• Not being able to pass enough urine
• Overflow of urine from a full bladder
• Pain when passing urine

Diagnosis

The doctor will ask about symptoms and past health. A physical exam will be done. The doctor may need tests to rule out other causes.

Tests may include:

• Urinalysis—to look for signs of infection or kidney changes
• Blood tests—to look for signs of infection

Pictures may be taken of the kidneys, ureters, and bladder. This can be done with:

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

Tests may also be done to see how well the bladder is working. This can be done with:

• Bladder function tests
• Urodynamics to find out how well urine flows

Treatment

The goal of treatment is to help the bladder empty on a routine basis. This should ease symptoms. The right plan will depend on a person's needs.

Treatment options may be:

Training

Early steps may include:

• Bladder training—to set a schedule to empty the bladder
• Pelvic floor exercises—to make muscles around the bladder stronger
• Painless electrical stimulation—to help retrain the bladder muscles

Catheters

A thin tube may be placed into the bladder to allow urine to exit.

Medications

Medicines may be given to help the bladder muscles relax, such as:

• Anticholinergic drugs
• Alpha-blockers—may be used along with anticholinergic drugs
• Botulinum toxin injections

Surgery

People who are not helped by other methods may need surgery. Options are:

• Removing part of the muscle in men that holds the bladder closed to allow urine to flow into a tube attached to the penis
• Creating an opening in the belly and connecting the urinary tract to it to allow urine to pass out of the body and into an attached bag
• Making the bladder larger with tissue from the bowel
• Replacing the bladder with a new pouch made from areas of the bowel or other tissue
• Inserting a small tube to prop open the bladder neck and allow urine to flow more freely
• Placing a device to help lift the urethra (in females) to slow the flow of urine and stop leakage
• Placing a sacral neuromodulation device in the pelvis to deliver impulses to the nerves that send signals from the bladder to the brain to lower 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 the 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

People with diabetes may be able to lower the risk of neurogenic bladder by managing their condition.