Neurogenic Bladder

What is a neurogenic bladder?

A neurogenic bladder is a loss of normal control of bladder function caused by damaged nerves. There are 2 kinds of neurogenic bladder problems: overactive and underactive.

If you have an overactive bladder, you are not able to control when or how much you urinate.

If you have an underactive bladder, it holds much more urine than normal. Because you cannot feel when the bladder is full, you leak small amounts of urine as bladder pressure builds.

How does it occur?

Nerves and the muscles of the urinary system work together to hold urine in the bladder and then release it when you go to the bathroom. Nerves tell the brain when the bladder is full. The nerves carry messages from the brain to the muscles of the bladder, telling the muscles either to tighten or to release. In a neurogenic bladder, the nerves that carry these messages do not work properly.

Neurogenic bladder may be caused by:

• injuries or birth defects that affect the brain or spinal cord
• diabetes
• polio
• Parkinson's disease
• multiple sclerosis
• infection
• strokes
• heavy metal poisoning.

With an overactive or underactive bladder, you may not be able to empty your bladder completely. Urine that is held too long before being eliminated may lead to infections of the bladder or ureters. (The ureters are the tubes that carry urine from each kidney to the bladder). Urine may back up into the kidneys and damage them.

What are the symptoms?

Common symptoms of neurogenic bladder and the infections it can cause are:

• leaking or dribbling urine
• a frequent and urgent need to urinate
• pain or burning when urinating
• pain in the lower pelvis, stomach, lower back, or side
• change in the amount you urinate, either more or less
• chills
• fever.

How is it diagnosed?

Your health care provider will ask about your symptoms and will examine you. A sample of your urine may be tested. Your provider may test your nervous system (including the brain) and your bladder. These tests may include:

• x-rays, CT scan, or MRI scan of the skull and spine
• x-rays of the bladder and ureters
• EEG, a test that uses wires taped to your forehead to check the brain for seizures
• CMG (cystometrogram), a test that involves filling the bladder to see how much it can hold and then emptying the bladder to see if the bladder empties completely.

How is it treated?

Treatment of a neurogenic bladder depends on:

• the type of bladder problems that you have
• the cause of the nerve damage
• your age, overall health, and medical history
• how severe your symptoms are.

Medicine may help control your symptoms. If you have an overactive bladder, your health care provider may prescribe drugs that relax the bladder, such as propantheline (Pro-Banthine) and oxybutynin (Ditropan). If you have an underactive bladder, you may be given a drug that stimulates a certain type of nerves. An example of such a drug is bethanechol (Urecholine). You may need to take antibiotics to prevent infections.

Long-term treatment for neurogenic bladder may include:

• Insertion of a catheter (thin tube) to empty the bladder. A small rubber catheter may be inserted 4 to 6 times a day to empty the bladder. This is called intermittent catheterization. A continuous catheter is another option. Continuous catheters are also called indwelling catheters. They empty the bladder continuously into a collection bag.
• Surgery to create an artificial sphincter. For this procedure, an artificial cuff is placed around the neck of the bladder. This cuff can be inflated to prevent urinary leakage and deflated when it is time to empty the bladder. You will still need intermittent catheterization to completely empty the bladder.
• Sacral nerve stimulation (SNS). For SNS, a small wire is inserted through the skin in the area around the tailbone. The wire allows the nerves to be stimulated to empty the bladder.
• Sling surgery. The surgeon creates a new support system, either from your own tissues or by using synthetic materials, to hold the neck of the bladder in the proper position and prevent leakage.

How long do the effects last?

In most cases you will need treatment for the rest of your life.

How can I take care of myself?

Follow your health care provider's advice on how much fluid you should drink.

Carefully follow your instructions for self-catheterization. This will help to prevent infections.

Contact your health care provider right away if:

• You have symptoms such as:
  • sweating, headache, and dizziness that do not go away after you empty your bladder
  • fever of 101°F or higher
  • worsening pain for several hours in the back or bladder area
• You cannot empty your bladder at all.

For more information, contact:

American Foundation for Urologic Disease
1128 North Charles Street
Baltimore, MD 21201
(800) 242-2383
Web site: http://www.afud.org

National Kidney Foundation
30 East 33rd Street
New York, NY 10016
(800) 622-9010
Web site: http://www.kidney.org