NuDigest: Understanding Neurogenic Bladder

Neurogenic bladder describes a number of urinary conditions caused by the malfunction of or trauma to the brain and the central nervous system. It occurs when the bladder is unable to relax or contract.

Millions of Americans live with neurogenic bladder. When the communication between the nervous system and bladder are disrupted by nerve damage, the ability of the bladder to fill and empty in a coordinated fashion is disrupted and may result in incontinence. The nerve damage can be caused by spinal cord injury; spina bifida; stroke; infection of the brain or spinal cord; or diseases such as diabetes, multiple sclerosis (MS) or Parkinson’s disease.

Neurogenic bladder presents in two ways: overactive bladder (OAB), or underactive bladder (UAB). Overactive bladder is the sudden and urgent spasms of the bladder muscles, regardless of the amount of urine in the bladder. This condition causes a frequent feeling of needing to urinate and may cause the involuntary loss of urine. With underactive bladder, the flow of urine is blocked by the bladder muscles not squeezing when they need to, producing a “dribble” of urine or preventing the emptying of the bladder leading to urinary retention. Some people may experience symptoms of both overactive and underactive bladder. It is most common in people with MS or stroke.

The symptoms of neurogenic bladder differ from person to person and depend on the type of nerve damage. Individuals with neurogenic bladder are more prone to urinary tract infections (UTIs); this is often the first symptom of neurogenic bladder. Other symptoms include: hematuria, pain, abnormal renal ultrasound and change in renal function.

Complications of neurogenic bladder include constant urine leakage that can cause skin breakdown leading to pressure sores; and kidney damage.

Proper treatment for neurogenic bladder is critical. Many individuals with more severe nerve damage are often prescribed clean intermittent self-catheterization (CIC) or continuous catheterization by way of an indwelling catheter. Clean intermittent self-catheterization is often preferred to indwelling catheterization, which has a high risk of recurrent UTIs. CIC is when an individual inserts a catheter (a straw like tube) into the bladder through the urethra. It is left in long enough to drain the bladder, then removed and disposed and is performed several times per day. Suprapubic catheterization may be used if patients cannot self-catheterize. Intermittent catheters, which are used to mitigate neurogenic bladder, are covered under most insurance policies.

Drugs may be prescribed for control of OAB and UAB symptoms. Surgery is a last resort treatments. For patients with less serious nerve damage, lifestyle changes are often the first treatments and may include scheduled voiding, diet changes, pelvic exercises or delayed voiding.

Neurogenic bladder is a serious condition, but when treated, patients experience improvements in their quality of life.

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