Neurogenic Bladder

Neurogenic bladder is a condition that affects the way your bladder stores and empties urine. It happens when there is damage to the nerves that control bladder function, which run between the brain, spinal cord, and bladder muscles.

When the nerve signals are disrupted, your bladder may become overactive, underactive, or fail to empty properly.

Neurogenic bladder often develops in people with:

• Spinal cord injuries
• Multiple sclerosis
• Stroke
• Parkinson’s disease
• Diabetes

It can result from any condition that damages the nervous system.

In a healthy bladder, nerves send signals between the brain and bladder to let you know when it’s time to urinate. They coordinate the process by signalling the bladder muscle to contract and your urinary sphincter to relax.

When this messaging system is disrupted, you may lose control over bladder function. This is known as neurogenic bladder.

Symptoms can vary widely. Depending on the type and extent of nerve damage, you might experience an overactive bladder, an underactive bladder, or a combination of both. Common signs and symptoms include:

• Urinary urgency, described as a sudden, strong need to urinate, even if little urine comes out
• Needing to urinate more than 8 times during the day
• Trouble starting urination
• A weak stream
• Feeling like you’re not fully emptying your bladder, or retaining urine
• Loss of bladder control that causes leaking or accidents
• Not being able to feel when your bladder is full
• Waking up multiple times at night to urinate
• Dribbling small amounts of urine, often due to a constantly overfilled bladder
• Recurrent urinary tract infections (UTIs)

Your doctor will start by asking about your symptoms, medical history, and any medications or conditions that could affect your bladder. You may be asked to keep a bladder diary to track:

• How often you urinate
• How much urine you pass
• When you leak urine
• Fluid intake
• Any symptoms you experience

A physical exam will likely be done to check the muscles and nerves in the pelvic region.

Additional tests may include:

• Urinalysis and urine culture to check for infection or signs of blood or protein in the urine
• Blood tests to look for signs of kidney damage or diabetes
• Post-void residual (PVR) test, which measures how much urine remains in your bladder after you urinate
• A series of tests, called urodynamic testing, that measure bladder pressure, volume, and function
• Ultrasound, CT scans, or MRI to view the kidneys, bladder, and spinal cord
• A cystoscopy, where a thin, flexible tube with a camera is inserted into the bladder to look for structural problems or inflammation

Treatment depends on the type and symptoms, with the goal to:

• Improve bladder control
• Prevent kidney damage
• Avoid infections

1. Bladder emptying techniques

• Intermittent catheterization. Many people with neurogenic bladder use a clean, flexible catheter several times a day to empty their bladder. This intervention reduces the risk of infection and keeps the bladder from overstretching.
• Indwelling catheters. In some cases, a catheter is left in place for continuous drainage, although it is less common due to increased infection risk.
• Double voiding. Urinating, then waiting a few minutes and trying again, can help ensure complete emptying.

2. Medications

Depending on your specific bladder function, medications may include:

• Anticholinergic medications, like oxybutynin or tolterodine, to help relax the bladder to reduce urgency and leakage.
• Beta-3 adrenergic agonists, like mirabegron, that increase bladder capacity without the typical anticholinergic side effects.
• Cholinergic agents, such as bethanechol, to stimulate bladder contractions in people with an underactive bladder.
• Antibiotics, which are used to treat infections when present, and sometimes as a preventive strategy in recurrent cases.

3. Advanced therapies

If medications and catheterization aren’t enough, other options include:

• Botulinum toxin (Botox) injections. These help to relax the bladder muscle.
• Sacral neuromodulation. This therapy involves implanting a device, like Axonics or InterStim, that sends electrical signals to regulate the nerves that control the bladder.
• Surgery. In severe cases, options like increasing the size of the bladder or creating a new way to pass urine by diverting it may be considered.

Alongside medical treatment, lifestyle changes can help you manage symptoms:

1. Going to the bathroom on a schedule and gradually increasing the time between trips can help improve control.
2. Pelvic floor exercises, also called Kegels, strengthen the muscles that control urination. This may help reduce leakage, and a physical therapist trained in pelvic health can help with proper technique.
3. Avoiding bladder irritants like caffeine, alcohol, artificial sweeteners, and spicy foods may reduce urgency or leakage.

Get medical care right away if you develop a sudden loss of bladder control, especially if it’s accompanied by back pain, leg weakness, or numbness. And, call your doctor if you have a neurogenic bladder and show signs of a UTI, such as:

• Burning or pain with urination
• Increased urgency or frequency
• Cloudy or foul-smelling urine
• Blood in your urine
• Fever or chills

1. Can neurogenic bladder cause kidney damage if untreated?

Yes. If your bladder doesn’t empty fully or pressure inside the bladder is too high, it can back up into the kidneys and cause swelling, called hydronephrosis. It can also lead to infections or long-term kidney damage. Regular monitoring and proper management are needed to protect kidney health.

2. Is neurogenic bladder curable?

Neurogenic bladder is usually a chronic condition, but it can often be well managed with the right combination of strategies. The treatment goal is to prevent complications and improve your daily urinary function and comfort.

All of our providers perform Neurogenic Bladder