What Is Neurogenic Bladder?

Neurogenic bladder is the medical name for a loss of control over urination resulting from nerve or muscle damage. Your bladder is responsible for collecting, storing, and passing urine from the body but its activities are controlled by electrochemical signals from the brain. If these are inhibited in any way, urinary problems can arise – either excessive retention or overactive elimination. The causes of neurogenic bladder are numerous. They include any medical condition impacting the neurological or muscular operation of the bladder.

Neurogenic bladder is estimated to affect millions of Americans. The most extreme cases can lead to kidney failure and death. If you are concerned about neurogenic bladder, make an appointment with a member of the Baptist Health urology team for consultation and treatment.

What Are the Symptoms of Neurogenic Bladder?

The symptoms of neurogenic bladder include:

• Urine leakage at night or while clothed
• Regular urinary tract infections (UTIs)
• Decreased bladder control
• Straining during urination
• Weak urine streams
• Frequent trips to the bathroom
• Inability to feel a full bladder
• Inability to completely void the bladder

Neurogenic bladder symptoms are mostly associated with two opposite conditions: overactive or spastic bladder and underactive or flaccid bladder.

What Causes Neurogenic Bladder?

There are two broad categories of causes for neurogenic bladder. The first of these are medical conditions directly affecting the bladder muscles:

• Damaged spinal column nerves
• Alcoholism
• Pelvic surgery
• Diabetic nerve damage (diabetic neuropathy)

The second group of causes are brain disorders that obstruct proper neurological communication between the brain and the bladder:

• Birth defects, including spina bifida and sacral agenesis
• Cerebral palsy
• Brain or spinal cord tumors
• Strokes
• Parkinson’s disease
• Spinal cord injuries
• Multiple sclerosis (MS)
• Amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease)
• Alzheimer’s disease
• Other forms of dementia

How Is Neurogenic Bladder Diagnosed?

Diagnosis of a neurogenic bladder is accomplished by one or more of the following steps:

• Physical exam: Your physician will record your symptoms, compile a medical history, and examine you physically for evidence of a bladder condition.
• Urine test: A urine sample will be analyzed for evidence of blood or other novel intrusive elements.
• Bladder-capacity test: A urodynamic test measures both bladder volume and the rate at which it empties. 
• Visual inspection of the bladder: Your physician can insert a tiny camera, called a cystoscope, into your bladder, to inspect it for evidence of blockage, a kidney stone, or muscle damage.
• Imaging tests: X-ray, CT scan, magnetic resonance imaging (MRI), or ultrasound pictures can provide additional information relevant to diagnosis.
• Nerve and muscle tests: A electroencephalograph, or EEG, documents brain function. An electromyograph, or EMG, records your bladder’s nerve and muscle activity. Both  tests are useful when determining why the bladder is not properly regulating urine storage and disposal.
• Leakage measurement: You will be asked to wear a special garment that indicates urine leakage by changes in color.
• Urine diary: Another off-site exercise is a urine diary. You’ll keep track of when and how often you go to the bathroom and what difficulties, if any, you experience when doing so. You’ll maintain the diary for a prescribed period of time and then share the information with your physician on a return visit to his or her office.

How Is Neurogenic Bladder Treated?

There are several treatment options for improving bladder function:

• Medication: Anticholinergic drugs, including oxybutynin and tolterodine, obstruct the actions of acetylcholine, a chemical messenger produced by the central nervous system. This kind of drug therapy can be effective in controlling an overactive bladder.
• Botox injections: Botox is a neurotoxin used to reduce bladder contractions.
• Catheterization: Catheters are thin tubes inserted in the bladder, with the purpose of relieving urinary retention through the drainage of unpassed fluids.
• Augmentation cystoplasty: The bladder’s carrying capacity can be increased by the surgical attachment to it of sections of the sigmoid colon. The sigmoid colon is the bottommost section of the large intestine, adjacent to the rectum and anus.
• Ileal conduit: A stoma or opening is created to drain the bladder by means of a conduit. The conduit, which is constructed from a section of the small intestine, empties into a bag or similar device outside the body.

There are a number of lifestyle modifications that can assist a patient in the management of his or her neurogenic bladder. These include dietary changes, especially the elimination of alcohol and caffeine; weight loss; Kegel exercises for strengthening pelvic-floor muscles; and self-discipline with regard to controlling urinary urges by scheduling bathroom breaks.  

Because of the many causes involved, it may not be possible to cure neurogenic bladder. However, a combination of medical treatments and lifestyle changes can be effective in managing and improving this condition.

Learn More About Neurogenic Bladder from Baptist Health

For more information about neurogenic bladder diagnosis and treatment or to schedule an appointment with our physicians, please contact the Baptist Health urology team.