Neurogenic Bladder

What is Neurogenic Bladder?

Neurogenic bladder is bladder dysfunction caused by nerve damage to the brain or to the region of the spinal cord that controls urination.

It often results from injury to the spinal cord, congenital disorders such as spina bifida, or nervous system disorders such as multiple sclerosis or Parkinson’s disease.

Neurogenic Bladder Symptoms

Symptoms for neurogenic bladder include:

• Urinary incontinence (leakage)
• Underactive or overactive bladder
• Urinary retention
• Increased urinary frequency
• Urinary tract infections (UTIs)
• Disruptions in social, work, and home life

Neurogenic Bladder Causes

The primary cause of neurogenic bladder is damage to the brain or spinal cord, particularly to the nerves that control and regulate urination. This damage may be caused by congenital disorders, neurological disorders, heavy metal poisoning, stroke, infection, and traumatic injury.

Neurogenic Bladder Diagnosis

To diagnose Neurogenic Bladder, the physician will begin by ruling out other problems that may be causing the symptoms.

First, the physician will perform a pelvic exam, to rule out malformations of the genitals and abdomen. Next, the physician may order a urine culture to rule out infection.

The physician may also request that the patient keep a bladder diary, to track the frequency of bathroom visits and any leaks that may occur. The physician may also request a pad test, in which the patient wears a pad treated with a special dye that changes color if a urine leak is absorbed.

If results are inconclusive and problems persist, the physician may proceed by ordering a cystoscopy, a procedure in which a lighted scope is inserted through the urethra via a catheter for the purpose of examining the bladder.

Additional tests may include a bladder scan, which is an ultrasound that reveals unexpelled urine in the bladder upon urination; urogenic testing, to assess the speed and volume of urination; and additional imaging tests such as an x-ray or CT scan to identify potential nerve damage.

Neurogenic Bladder Treatment

Neurogenic Bladder isn’t irreversible, but there are a number of treatment options, including:

• Dietary Changes: Individuals suffering from Neurogenic Bladder may benefit from avoiding food and beverages that may irritate the bladder, including spicy and acidic foods, carbonated beverages, caffeine, and alcohol. Increased water consumption may dilute irritants in the bladder.
• Bladder Training: Bladder training is conducted by timing urination at half hour intervals, and then gradually extending the length of the intervals to condition the individual’s urge to urinate. Relaxation and distraction techniques are employed to help overcome urinary urgency and help the individual wait until the next scheduled interval.
• Prescription medication injections: Injections of botulinum toxin (Botox) may help prevent bladder contractions in cases of overactive bladder
• Catheterization: The insertion of a tube into the urethra to aid in the draining of urine.
• Clean intermittent catheterization (CIC), in which the bladder is emptied several times a day by the patient or a healthcare professional.
• Continuous catheterization, in which the bladder is continuously drained by a catheter placed through the urethra or an abdominal wall.
• Physical Therapy: Low-impact exercises and stretches that target the affected area may help improve urinary function. One effective exercise is known as “quick flicks,” which consist of several sequential contractions and releases of the muscles in the pelvic floor.
• Transcutaneous Electrical Nerve Stimulation: Mild electronic pulses delivered by wires places on the pubic area or lower back increase blood flow to the bladder, relieving pain and reducing feelings of urgency.
• Percutaneous Tibial Nerve Stimulation: A needle is inserted into the tibial nerve near the thigh and is connected to a device that sends electrical impulses to the pelvic nerves.
• Sacral Nerve Stimulation Therapy: Small wires are implanted near the sacral nerve and deliver electronic pulses to the bladder, reducing feelings of urgency.
• Surgery: Generally explored as a last resort due to the potential of serious complications, surgery to modify or augment the bladder or sphincter muscles may improve quality of life for patients suffering from Neurogenic Bladder:
  • Artificial sphincter: In cases of internal sphincter malfunction, an artificial sphincter may be implanted to improve urinary function.
  • Urinary diversion surgery: Urinary diversion is a procedure in which the physician creates an artificial opening, called a stoma, for urine to pass through.
  • Bladder augmentation: Bladder augmentation modifies the size and capacity of the bladder by patching the bladder with a piece of the large intestine.
  • Sphincter resection or sphincterotomy: The weak section of the internal sphincter or the entire sphincter is removed to allow for the passage of urine.