Neurogenic Bladder (Neurogenic Incontinence)
Neurogenic bladder is abnormal bladder function caused by a nerve problem. The bladder may empty too often or at the wrong time (incontinence). Or the bladder may be unable to completely empty the urine (urinary retention). In this case, urine may leak out of the overfilled bladder.
Contact your doctor if you think you may have this condition. The sooner it is treated, the lower the chance of developing more serious conditions, such as a urinary tract infection.
Neurogenic bladder is caused by problems with the nerves carrying messages between the bladder and the brain. The nerve problems may be caused by:
- Spinal cord injury
- Tumors of the brain or spinal cord in the pelvic area
- Infection of the brain or spinal cord
- Medical conditions affecting the nerves, such as:
- Spina bifida
- Multiple sclerosis
The following medical conditions increase your chances of developing neurogenic bladder. If you have any of these risk factors, tell your doctor.
- Nerve or spinal cord conditions present since birth (such as spina bifida)
Symptoms may include:
- Urinary incontinence
- Dribbling urine stream
- Straining during urination
- Inability to urinate (urinary retention)
- Overflow of urine from a full bladder
- Painful urination
Your doctor will ask about your symptoms and medical history, and perform a physical exam. You will be asked to keep a diary of how often you empty your bladder and other urinary habits. If your doctor thinks that your symptoms may be caused by a nerve problem, you will have some of the tests described below. You may also be referred to a urologist or a urogynecologist for further evaluation and treatment.
Tests may include the following:
- Urinalysis– test of the urine to look for evidence of infection or kidney problems
- Blood Tests–to look for evidence of kidney problems
- Bladder Function Tests–to measure how well the muscles of the bladder respond to filling and emptying
- Imaging tests of the kidneys, ureters, and bladder, such as:
- X-rays (usually with contrast material injected into a vein)
- Ultrasound–a test that uses sound waves to examine the kidneys, ureters, and/or bladder
- Computed tomography (CT) scan–use of x-rays and computers to make detailed images of the kidneys, ureters, and/or bladder
- Images of the brain and/or spinal cord–most often with magnetic resonance imaging (MRI), which uses powerful magnets and radio waves to create images of the brain and/or spinal cord
- Electromyograph (EMG)–to test the function of the nerves and muscles of the bladder
Treatment focuses on relieving symptoms by emptying your bladder regularly.
Treatment options include:
- Bladder training–setting a regular schedule for emptying your bladder and drinking less fluid
- Exercises to strengthen muscles around the bladder that help control urine flow
- Painless electrical stimulation to aid the function of bladder muscles
Drugs to relax bladder muscles may relieve symptoms and improve bladder function.
A thin tube, called a catheter, can be inserted to empty the bladder. You can learn to do this yourself or a trained healthcare professional may do it for you.
Surgery may be an option for severe cases when all other treatments fail. Surgical procedures include:
- Removing part of the muscle that holds the bladder closed. This allows urine to flow out into a collection tube attached to the penis (for men only).
- Inserting a tube into an opening in the abdomen. This allows urine to flow out into a collection bag.
- Using tissue from the bowel to make the bladder larger.
- Replacing the bladder with a pouch made from sections of the bowel or other tissue.
- Inserting a small tube-like device, called a stent, into the bladder neck. This allows urine to flow out.
While most cases of neurogenic bladder cannot be prevented, people with diabetes may be able to delay or avoid the problem by carefully controlling their blood sugar levels over the long-term. Also, wearing seat belts and avoiding activities that increase the risk of spinal cord injuries will prevent neurogenic bladder from this cause.