Neurogenic Bladder

Problems or abnormalities of the nervous system can affect the bladder and urination. This condition is called neurogenic bladder, which can result from numerous problems affecting the nervous system (the brain and/or spine), including congenital birth defects. Neurogenic bladder is a complex disorder. Patients with this condition benefit most by seeing a physician with experience in neuro-urology and complicated urologic cases.

People with nerve damage typically have little or no sense of when the bladder is full and often cannot control when urine is released from the bladder. For patients with spinal cord injury, for example, the signals from the bladder letting the brain know the bladder is full do not work. Thus, signals from the brain that let the bladder know it's time to empty also don't work.

Fortunately, we have some of the region’s foremost physicians specializing in neurogenic bladder, fellowship-trained in neuro-urology and diagnosing and treating this complex condition.

With neurogenic bladder, patients experience either:

• Overactive bladder - Patients have little or no control urinating, resulting in urinary incontinence and urine leakage. Individuals often experience a sudden urge to urinate or find they are urinating more frequently.
• Underactive bladder/urinary retention – The bladder loses the ability to empty properly, resulting in a buildup of urine that causes pressure in the bladder and subsequent urine leakage. Patients typically cannot completely empty their bladders.

Causes of Neurogenic Bladder

Multiple disorders, particularly conditions that affect the nervous system, can cause neurogenic bladder, including:

• Stroke
• Parkinson’s disease
• Multiple sclerosis
• Spinal cord injuries
• Spinal surgeries
• Central nervous system tumors
• Traumatic brain injuries
• Spinal congenital birth defects such as spina bifida

Symptoms of Neurogenic Bladder

Urinary incontinence, or the involuntary leakage of urine, as well as urinary retention and overflow incontinence, are the most common symptoms of neurogenic bladder. Other symptoms can include:

• Frequent urination
• Frequent urine leakage, but the individual cannot sense this
• Urinary urgency
• Weak urine stream
• Difficulty or straining to urinate

Diagnosis & Treatment for Neurogenic Bladder

Your physician will take a comprehensive medical history and perform a physical exam to diagnose neurogenic bladder. This typically includes performing studies on the bladder caused by nervous system disorders.

Your doctor will also order a series of diagnostic tests that thoroughly examine the bladder and overall function, including:

• Urodynamic studies, or bladder function tests, are complex studies that help to determine bladder over-activity, bladder muscle contractility, obstruction during voiding and relaxation of sphincter muscles, which allows leakage during activity.
• A cystoscopy uses a small cystoscope (telescope) to view inside the urethra and bladder
• Imaging studies of the kidneys, ureters, bladder, and urethra, and sometimes of the brain and spine may include CT scan, X-ray, ultrasound, or MRI

Our neuro-urologists understand the complexities of this condition and its relationship to other neurological conditions. Following comprehensive diagnostic testing, they will develop a treatment plan to help minimize the effects of your condition. This is to prevent additional medical complications from arising and determine the best course of action based on your dysfunction. The goal of any treatment program for neurogenic bladder is to preserve the kidneys and the bladder, which improves quality of life.

Conservative Treatments

Nonsurgical treatment options for neurogenic bladder include:

• Medication - medications used to treat overactive bladder, including anticholinergics or Beta-3 agonists as well as alpha blockers can help alleviate urinary symptoms. Certain antidepressants can help reduce muscle contractions and spasms.
• Timed voiding - usually done for people who have sensation and are able to empty the bladder.
• Clean Intermittent Catheterization (CIC) - Patients can learn how to insert catheters into the bladder to drain urine.
• Neuromodulation devices

Surgical Treatment

Surgical options to treat the condition include:

• Cystoscopy with Botox injections, one of the primary FDA-approved procedures for treating neurogenic bladder
• Artificial sphincters and sphincterotomy
• Superpubic tube insertion
• Bladder augmentation
• Urinary diversion
• Lifestyle and behavioral modification -
• Controlled, monitored fluid intake
• Adherence to physician recommendations for bladder management
• Pelvic floor muscle exercises, depending on severity of your condition