Neurogenic bladder is a condition in which the nerves that control bladder function are damaged or impaired, leading to problems with storing and releasing urine. This condition occurs when the communication between the brain, spinal cord, and bladder is disrupted due to neurological injury or disease. As a result, the bladder may become overactive (spastic) or underactive (flaccid), causing symptoms such as urinary incontinence, retention, or incomplete emptying.
Neurogenic bladder is caused by damage or dysfunction of the nervous system. Common causes include:
Spinal cord injuries: Trauma or damage to the spinal cord can disrupt nerve signals to the bladder.
Neurological diseases:
Multiple sclerosis (MS)
Parkinson’s disease
Stroke
Alzheimer’s disease
Congenital conditions:
Spina bifida
Cerebral palsy
Infections or tumors: Affecting the brain or spinal cord.
Diabetes: Can cause nerve damage (diabetic neuropathy) that affects bladder control.
Pelvic surgery: Damage to nerves during surgery can lead to neurogenic bladder.
The symptoms depend on whether the bladder is overactive (spastic) or underactive (flaccid):
Overactive Bladder (Spastic):
Frequent urination (more than 8 times a day).
Sudden, strong urges to urinate (urgency).
Involuntary leakage of urine (urge incontinence).
Nocturia (frequent urination at night).
Underactive Bladder (Flaccid):
Difficulty starting urination.
Weak urine stream.
Inability to fully empty the bladder (urinary retention).
Overflow incontinence (leakage due to an overfull bladder).
Other Symptoms:
Recurrent urinary tract infections (UTIs).
Kidney damage (due to chronic retention or high bladder pressure).
Bladder stones.
To diagnose neurogenic bladder, a healthcare provider may:
Review the patient’s medical history and symptoms.
Perform a physical examination.
Conduct diagnostic tests, such as:
Urinalysis: To check for infections or blood in the urine.
Bladder diary: To track urination patterns.
Urodynamic testing: To measure bladder pressure, capacity, and flow.
Imaging tests: Such as ultrasound, MRI, or CT scans to assess the bladder and kidneys.
Cystoscopy: To examine the bladder and urethra for abnormalities.
Treatment aims to protect kidney function, prevent complications, and improve quality of life. Options include:
Lifestyle and Behavioral Changes:
Scheduled voiding (timed urination).
Bladder training to improve control.
Dietary modifications (e.g., reducing caffeine and alcohol).
Medications:
For overactive bladder: Anticholinergics (e.g., oxybutynin) or beta-3 agonists (e.g., mirabegron) to relax bladder muscles.
For underactive bladder: Medications to improve bladder emptying (e.g., bethanechol).
Catheterization:
Intermittent catheterization: To empty the bladder regularly.
Indwelling catheter: A permanent catheter for severe cases.
Medical Devices:
Percutaneous tibial nerve stimulation (PTNS): To improve bladder control.
Sacral neuromodulation: A device implanted to regulate bladder nerve activity.
Surgery:
Bladder augmentation: To increase bladder capacity.
Urinary diversion: To redirect urine flow when the bladder cannot function properly.
Sphincter implants: To control urine leakage.
Management of Complications:
Treating UTIs with antibiotics.
Monitoring kidney function to prevent damage.
If left untreated, neurogenic bladder can lead to serious complications, including:
Chronic kidney disease or kidney failure.
Recurrent urinary tract infections.
Bladder stones.
Urinary incontinence affecting quality of life.
If you have a neurological condition or injury and experience bladder-related symptoms, consult a healthcare provider. Early diagnosis and treatment can help prevent complications and improve bladder function.
Neurogenic bladder requires ongoing management, often involving a team of specialists, including urologists, neurologists, and physical therapists. With proper care, many people with neurogenic bladder can maintain a good quality of life.
