Neurogenic Bladder

Neurogenic bladder is a condition that can develop in men and women in which the nerves that govern the urinary system and signal when urine should be held in or released from the bladder do not function properly, and patients lose bladder control. The bladder can become either overactive or underactive, depending on the origin of the problem.

People can develop neurogenic bladder following trauma such as a spinal cord injury or diseases that affect the nervous system, diabetes, acute infections, genetic nerve problems, or heavy metal poisoning.

Neurogenic bladder can cause urine leakage, urine retention, damage to the tiny blood vessels in the kidney, and infection of the bladder or ureters.

People with overactive bladders (OAB, often seen with strokes, brain diseases, and Parkinson's disease) may have frequency, urgency, incontinence, and incomplete emptying. Their bladder capacity may decrease because it is seldom filled to capacity. If the bladder is not emptied completely, the residual urine may lead to increased risks of urinary tract infections.

Patients with underactive bladders (common in diabetes, polio, syphilis, multiple sclerosis, and prior radical pelvic surgery) have the opposite characteristics. The nerves that tell the brain the bladder is full and it is time to urinate are disrupted, so their bladders continue to fill but patients are unable to urinate. At a certain point the pressure of urine in the bladder overcomes the sphincter muscle's ability to retain it and urine leaks out (much like an overflowing bathtub).

Symptoms of Neurogenic Bladder

Symptoms of neurogenic bladder can include:

• Urinary tract infections
• Kidney stones
• Urinary incontinence
• Small urine volume during voiding
• Urinary frequency and urgency; dribbling urine
• Loss of sensation of bladder fullness

Diagnosis of Neurogenic Bladder

Neurogenic bladder involves the nervous system and the bladder, and doctors conduct a variety of tests to determine the status of both. Tests include

• Urodynamic studies to measure bladder pressure, the ability of the bladder to hold urine, bladder capacity, urine flows, and bladder emptying
• Cystoscopy, a test in which a telescope is used to examine the bladder and urethra.  Cystoscopy is used to rule out kidney stones or bladder damage.
• Nervous system evaluation, performed by neurologists, who evaluate the nervous system in people with neurogenic bladder using imaging tests like MRI and CT scans.

Treatment for Neurogenic Bladder

Neurogenic bladder is a serious condition, but when it is monitored closely and treated properly patients can experience significant improvements in their quality of life. Our doctors routinely participate in the management of neurogenic bladder with the goal of preserving patients' kidney function and keeping them dry. Using state of the art equipment and technology, we provide patients with excellent care and monitor them over the long term.

• Bladder Retraining: In patients with OAB, the bladder muscles become conditioned to empty on a routine basis. Bladder retraining is a non-invasive way to retrain these muscles and help patients hold urine better. Kegel exercises (squeezing the pelvic floor muscles) can help to inhibit the urge to void when it is difficult to postpone. Pelvic floor muscle therapy is sometimes combined with biofeedback, during which a healthcare professional helps patients learn how to postpone or inhibit the feeling of urgency and desire to void.
• Medication: Several medications that are effective, covered by insurance, and typically well tolerated work very well at alleviating symptoms of OAB. A combination of behavioral measures and medication works better than either alone. There are not specific medications for patients with an underactive bladder resulting from nerve damage.
• Interstim: A therapy called Interstim is typically reserved for patients who are not helped by behavioral therapy and medications. Interstim is a small pacemaker that sends impulses to the sacral nerve, which controls the bladder. The success rates for this procedure are impressive.
• Catheterization: Catheterization, the insertion of a thin tube through the urethra and into the bladder, is a way for patients with underactive bladder to drain their bladder. The therapy is termed Clean Intermittent Catheterization (CIC). Another type of catheter, an indwelling Foley catheter, is placed in the bladder for extended periods, and prevents bladder distension by continually draining urine into a bedside collector.
• Surgical Treatment of Neurogenic Bladder: These treatments include the following:
  • For patients whose bladder and sphincter muscle do not work cooperatively, surgeons can open the sphincter and remove a portion of the muscle using a procedure called sphincter resection.
  • Artificial sphincters are mechanical devices for patients with severe incontinence related to activities such as coughing, running, sneezing, and lifting. These devices have a cuff that fits around the urethra, which is normally full and prevents urine from coming out. The fluid in the cuff can be emptied into another part of the device, allowing the sphincter muscle to relax and urine to pass. 
  • Urinary diversion and bladder augmentation are procedures that divert the urine or enlarge the bladder to help protect the kidneys and keep patients continent.