Neurogenic Bladder

Neurogenic bladder is bladder dysfunction (flaccid or spastic) caused by neurologic damage. Symptoms can include overflow incontinence, frequency, urgency, urge incontinence, and retention.

What is Neurogenic Bladder

Neurogenic bladder is the name given to a number of urinary conditions in people who lack bladder control due to a brain, spinal cord or nerve problem. This nerve damage can be the result of diseases such as multiple sclerosis (MS), Parkinson’s disease or diabetes. It can also be caused by infection of the brain or spinal cord, heavy metal poisoning, stroke, spinal cord injury, or major pelvic surgery. People who are born with problems of the spinal cord, such as spina bifida, may also have this type of bladder problem. Nerves in the body control how the bladder stores or empties urine, and problems with these nerves cause overactive bladder (OAB), incontinence, and underactive bladder (UAB) or obstructive bladder, in which the flow of urine is blocked.

Symptoms

The symptoms of neurogenic bladder differ from person to person. They also depend on the type of nerve damage the person has. Some people have symptoms of both overactive and underactive bladder.

Urinary Tract Infection

People with overactive and underactive bladder can get repeated urinary tract infections. These are often the first symptom of neurogenic bladder.

Leaking Urine (incontinence) with Overactive Bladder

In overactive bladder, the muscles squeeze more often than normal. Sometimes this squeezing causes urine to leak before you’re ready to go to the bathroom (incontinence). With overactive bladder, you feel a sudden urge to go the bathroom that you can’t ignore.  You may or may not leak urine after feeling this urge to go. You may leak just a few drops of urine. Sometimes you may gush a large amount of urine. Sometimes urine will leak while you sleep.

Frequency in OAB

Another OAB symptom is going to the bathroom many times during the day or night. (You may produce only small amounts of urine.) The number of times someone urinates differs from person to person. But many experts agree that going to the bathroom more than 8 times in 24 hours is “frequent urination.”

Urinary Retention/Obstruction with Underactive Bladder

In people with an underactive bladder (often seen with diabetes, MS, polio, syphilis or major pelvic surgery), the bladder muscle may not squeeze when it needs to. The sphincter muscles around the urethra also may not work the right way. They may stay tight when you are trying to empty your bladder. With UAB symptoms, you may only produce a “dribble” of urine. You may not be able to empty your bladder fully (urinary retention). Sometimes you may not be able to empty your bladder at all (obstructive bladder).

How Can Neurogenic Bladder Affect Your Life?

The symptoms of neurogenic bladder can seriously affect your quality of life. They may make it difficult for you to get through your day without interruptions. You may feel afraid to go out with friends, take vacations or do everyday things.

Sometimes neurogenic bladder symptoms can lead to more serious bladder problems. But there are a number of treatments available. You and your health care provider can decide which treatment is best for you.

Diagnosis

Bladder Diary

You may be asked to keep a bladder diary, where you will note how often you go to the bathroom and any time you leak urine. This will help your health care provider learn more about your day-to-day symptoms.

Other Tests

 

Urine culture

Your health care provider may ask you to leave a sample of your urine to test for infection or blood.

Bladder scan

This type of ultrasound shows how much urine is still in the bladder after you go to the bathroom.

Cystoscopy

During this test, the doctor inserts a narrow tube with a tiny lens into the bladder. This allows them to rule out other causes of your symptoms.

Urodynamic testing

These tests check how well your lower urinary tract stores and releases urine. There are several urodynamic tests you may be asked to take. You may be asked to urinate into a special funnel to see how much urine you produce and how long it takes. You may have a catheter inserted in your bladder to drain your bladder or to add water to it and check the resulting pressure.

Imaging

You may need to do additional imaging tests such as x-rays and CT scans to diagnose your condition. You may also be referred to a specialist for an exam that may include imaging of the spine and brain.

Treatment

Neurogenic bladder is a serious condition, but when it is watched closely and treated the best way, patients can see large improvements in their quality of life.

    • Overactive Bladder Treatment
    • Underactive Bladder Treatment

OAB is a very common problem for men and women. It is also the most common type of bladder problem in people who have multiple sclerosis. The most common symptom of OAB is the sudden and unexpected urge to urinate that you can’t control. To manage your OAB symptoms you may be offered the treatment options listed below.

Lifestyle Changes
For many patients with less serious nerve damage, the first treatments used are often lifestyle changes. These are changes you can make in your daily life to control your symptoms.

Delayed voiding: You start by delaying urination a few minutes. You slowly increase the time to a few hours. This helps you learn how to put off voiding, even when you feel an urge.

Scheduled voiding: With this method, you follow a daily schedule of going to the bathroom. Instead of going when you feel the urge, you go to the bathroom at set times during the day. Depending on how often you go to the bathroom now, your health care provider may ask you to urinate every 2 to 4 hours, whether you feel you have to go or not.

Bladder diary: Writing down when you make trips to the bathroom for a few days can help you and your health care provider understand your symptoms better. A bladder diary may help show you some things that make your symptoms worse. For example, are your symptoms worse after eating or drinking a certain kind of food? Are they worse when you don’t drink enough liquids?

Dietary changes: Weight loss and limiting your intake of “bladder irritating” foods and drinks may be helpful. You may be asked to try avoiding coffee, tea, alcohol, soda, other fizzy drinks, citrus fruit and spicy foods. Some patients may see an improvement in their condition while using lifestyle treatment options. However, many may need additional treatments before seeing relief.

Medications
Drugs may be used if lifestyle changes don’t help enough. Some medications for OAB symptoms relax overactive bladder muscles, Others can help stop your bladder from contracting

Injections with botulinum toxin (Botox®) are used to help patients who have overactive bladder because of a brain or spinal cord disease or injury. When injected into the bladder muscle, this drug may help keep it from contracting too often. Over time, this treatment wears off in some people. It may need to be repeated periodically.

Neuromodulation Therapy
This therapy is the name given to a group of treatments that deliver electricity or drugs to nerves.

Sacral Neuromodulation: This is used for patients with overactive bladder when drugs or lifestyle changes don’t help. The sacral nerves carry signals between your spinal cord and the bladder. Changing these signals can improve overactive bladder symptoms. The surgeon places a thin wire close to the sacral nerves. Then the wire is connected to a small, battery operated device placed under your skin. It delivers harmless electrical impulses to the bladder to stop the “bad” signals that can cause overactive bladder.

Percutaneous Tibial Nerve Stimulation: In this type of neuromodulation a needle is inserted into a nerve in your leg called the tibial nerve. The needle is connected to a device that sends electrical impulses. The impulses travel to the tibial nerve, and then to the sacral nerve. This is done in your health care provider’s office. Most patients receive 12 treatments for the best results.

Underactive bladder is a condition in which you aren’t able to empty your bladder completely or are unable to urinate at all. You may hesitate before urine flows, or you may have to push urine out. Your urine may only come out in dribbles. Treatment options for underactive bladder symptoms are listed below.

Scheduled voiding: With this method, you follow a daily schedule of going to the bathroom. Instead of going when you feel the urge, you go to the bathroom at set times during the day. Depending on how often you go to the bathroom now, your health care provider may ask you to urinate every 2 to 4 hours, whether you feel you have to go or not.

Double voiding: After urinating, wait a few minutes and then try again to empty your bladder.

Bladder diary: Writing down when you make trips to the bathroom for a few days can help you and your health care provider understand your symptoms better. A bladder diary may help show you some things that make your symptoms worse. For example, are your symptoms worse after eating or drinking a certain kind of food? Are they worse when you don’t drink enough liquids?

Dietary changes: Weight loss and limiting intake of “bladder irritating” foods and drinks may be helpful. You may be asked to try avoiding coffee, tea, alcohol, soda, other fizzy drinks, citrus fruit and spicy foods. Some patients with underactive bladder may see an improvement in their condition while using lifestyle treatment options.

Medications
Drugs may be used if lifestyle changes don’t help enough. There are several prescription drugs that can be used to help improve bladder emptying with urinary retention. Sometimes behavioral therapy will be used along with drugs.

Catheters
Using a catheter can help you empty your bladder. A catheter is a thin, straw-like tube that is inserted into the urethra when you need to drain urine.

  • Clean intermittent catheterization (CIC): This is something you can learn to do yourself. Depending on your symptoms, you may do this 3 to 4 times a day, leaving it in only long enough to empty your bladder. Sometimes clean intermittent catheterization can help improve how your bladder works after several weeks or months. However, CIC can be hard for some people whose nerve damage or other health issues cause hand coordination problems.
  • Continuous catheterization: Some patients may have a different kind of catheter inserted to drain urine at all times.

Surgery

Surgery is used to help some patients with more serious types of underactive bladder.

Artificial sphincter: This device helps treat severe urinary incontinence when the real sphincter muscle isn’t working correctly. Surgery is required to place the sphincter cuff around the around the urethra while a pump is placed under the skin in the scrotum or labia. The pump is used to open the sphincter and allow you to pass urine.

Urinary diversion surgery: In this procedure the surgeon creates an opening called a stoma. Urine moves through the stoma to a collection pouch.

Bladder augmentation (augmentation cystoplasty): Part of the large intestine is removed and attached to the walls of the bladder. This increases the size of the bladder and helps it store more urine.

Sphincter resection: The weak portion of the urethral sphincter muscle is removed. In some cases sphincterotomy is performed, in which the entire muscle may be cut.

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