Neurogenic Bladder

What is a neurogenic bladder?

A neurogenic bladder is a loss of normal control of your bladder 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 tell the brain when the bladder is full. The nerves carry messages from the brain to the muscles of the bladder. They tell the muscles either to tighten and hold the urine, or to release the urine when you urinate. If you have a neurogenic bladder, the nerves that carry these messages do not work properly.

Examples of causes of this problem are:

• injuries, birth defects, or tumors that affect the brain or spinal cord
• dementia, such as Alzheimer’s disease
• diabetes
• polio
• Parkinson's disease
• multiple sclerosis
• infection
• stroke
• heavy metal poisoning (such as by lead, mercury, or arsenic).

What are the symptoms?

Because of this problem, you may not be able to empty your bladder completely. Urine that is held too long 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 hurt the kidneys.

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 you urinate
• pain in the lower pelvis, stomach, or side or lower back
• change in the amount you urinate (either more or less)
• chills
• fever.

How is it diagnosed?

Your healthcare 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. The tests may include:

• X-rays, CT scan, or MRI scan of the skull and spine
• X-rays of the kidneys, bladder, and ureters
• EEG, a test that uses wires taped to your forehead to check the brain’s electrical activity
• 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 this problem depends on:

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

Medicine may help control your symptoms. If you have an overactive bladder, your healthcare 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 may include:

• Insertion of a catheter to empty the bladder. A catheter is a thin, flexible tube inserted through the urethra and into the bladder to drain the bladder. There are different ways a catheter may be used:
  • A catheter may be used to empty the bladder continuously into a collection bag. This type of catheter is called an indwelling or continuous catheter. This type of catheter can be a nuisance because you must always have the collection bag with you. It can be hard to hide the catheter and the collection bag.
  • Another way to use a catheter is to insert it 4 to 6 times a day to empty the bladder. This is called intermittent catheterization. It allows more mobility than an indwelling catheter and a more normal social life. There is also much less risk that the catheter will cause infection.
• Surgery to create an artificial sphincter muscle to help you control urination. An artificial cuff is placed around the neck of the bladder. The 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 is used to stimulate the nerves to empty the bladder.
• Sling surgery. The surgeon creates an internal support to hold the neck of the bladder in the right position and prevent leakage. The sling may be made from your own tissue or from synthetic materials.

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 healthcare provider's advice on how much fluid you should drink.

Carefully follow your instructions for self-catheterization. This will help to prevent urine accidents and, most importantly, infections.

Contact your healthcare 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 101.5°F (38.6°C) or higher
  • worsening pain for several hours in the abdomen, back, or bladder area
• You cannot empty your bladder at all.

For more information, contact:

National Kidney Foundation
1-800-622-9010
Web site: http://www.kidney.org