Neurogenic bladder is a form of impaired bladder function affecting millions of Americans. It is caused by neurological disorders or damage to the nerves serving the urinary tract. Depending on the nature of the condition and the nerves involved, the urinary bladder may become either underactive or overactive.
Definition & Facts
The bladder is a hollow, balloon-shaped organ situated in the lower abdomen. It serves as a reservoir for storing urine that is produced by the kidneys. When the bladder becomes full, a complex nerve system in the brain and spinal cord sends messages to the bladder to empty through the process of urination.
These messages tell the bladder to contract, which forces urine through the urethra. Muscles called sphincters help keep the urethra closed so that urine does not leak out before it is time to go to the bathroom. Congenital disorders or acquired medical conditions causing nervous system damage can disrupt the messages and make it impossible for the person to control bladder function, resulting in urinary incontinence.
Symptoms & Complaints
- Frequent urinary tract infections or kidney stones
- Incontinence or frequent dribbling of urine
- Needing to urinate frequently
- Feeling a constant sense of urinary urgency
- An inability to tell that the bladder is full
- Only voiding a small amount when urinating.
The exact symptoms a person experiences vary depending on the specific type of nerve damage involved. Individuals suffering from strokes, Parkinson’s disease, or other neurological diseases, often experience an overactive bladder. The person may complain of a sudden urge to urinate and may have difficulty making it to the bathroom in time. They may also have the frequent need to urinate, sometimes more than eight times a day, but can only void a small amount each time.
An underactive bladder is most common in people with multiple sclerosis, diabetes mellitus, polio, or who have undergone major pelvic surgery. The bladder muscle and urethra sphincters do not contract and relax as they should to allow the urine to pass into the urethra. As a result, the individual may not be able to empty their bladder completely.
The most common causes of congenital neurogenic bladder are birth defects, including spina bifida, sacral agenesis, and cerebral palsy. Spina bifida and sacral agenesis both involve an incomplete development of the spine, which can affect bladder function.
Cerebral palsy is a disorder affecting the portion of the brain responsible for motor control and function and can occur in utero or after birth. A number of medical conditions can cause the bladder to become neurogenic, including
- Parkinson’s disease
- Multiple sclerosis
- Ruptured or herniated intervertebral discs
- Spinal cord surgery
- Spinal cord injuries resulting from accidents or trauma
- Erectile dysfunction
- Tumors affecting the central nervous system
Diagnosis & Tests
To diagnose a neurogenic bladder, the doctor will begin with a medical history and chronology of symptoms. This is followed by a physical examination focused on the abdominal and pelvic organs and the rectum. Men will also undergo a prostate exam. A urine test may be used to screen for infection, the presence of blood in the urine (hematuria), and other abnormalities.
A post-void bladder scan may be used to determine how much urine is retained in the bladder after urination. The doctor may also perform a cystoscopy to rule out other conditions affecting bladder function. This involves inserting a small tube with an attached camera into the bladder.
Bladder function tests called urodynamic studies may be used to measure the pressure inside the bladder, the amount of urine that the bladder can hold, the flow of urine, and the amount of retained urine. These tests utilize a number of different techniques, including attaching sensors near the urethra or rectum to measure muscle and nerve function and using catheters to measure bladder pressure.
X-rays, computed tomography (CT) scans, magnetic resonance imaging (MRI)s, and medial ultrasounds may be used to identify abnormalities of the brain, spinal cord, and urinary tract that may lead to neurogenic bladder.
Treatment & Therapy
The treatment of neurogenic bladder depends on the patient’s overall health, the underlying cause of the condition, and the type and severity of symptoms. Anticholinergic medications, including oxybutynin and tolterodine, are often used to treat overactive bladder. These medications block the neurotransmitter acetylcholine and inhibit the nerve impulses responsible for involuntary smooth muscle movement in the GI tract and other parts of the body. Botulinum A toxin injections into the bladder or urinary sphincters may help treat overactive bladder symptoms in patients who cannot tolerate or who did not respond to anticholinergic medications.
Some patients may require surgery to maximize bladder emptying or improve bladder control. Segments of the colon may be used to augment the size of the bladder. This helps reduce the pressure inside the bladder and increases the amount of urine that it can hold. Surgery may also be used to widen or tighten the urinary sphincters to allow urine to pass more freely or to improve bladder control. It is also possible to permanently implant an artificial urinary sphincter.
Severe cases may require a procedure known as an ileal conduit urinary diversion. This is a surgical procedure that reroutes urine to an external storage receptacle. A small section of bowel is used to create an opening in the abdomen called a stoma. This opening allows the urine to drain into a bag on the outside of the body.
Prevention & Prophylaxis
Absorbent undergarments can help reduce odor and wetness and protect clothing and skin from leaks. Bed pads can be used to protect bedding and furniture. It is important for individuals with incontinence to keep the perineal area clean and dry to protect against skin rashes and sores on the skin.