Neurogenic Bladder
Neurogenic Bladder
Comprehensive information on the causes, symptoms, and treatments of bladder dysfunction caused by nervous system abnormalities.
Symptoms and Causes
Neurogenic bladder is a bladder dysfunction resulting from damage to the nerves that control its function. Neurological injury alters the ability to empty the bladder or retain urine.
There are three main types of neurogenic bladder according to their characteristics:
- Underactive or flaccid bladder: lacks the ability to contract, causing the bladder to fill until it overflows (urinary incontinence).
- Overactive or spastic bladder: involuntary contractions occur, causing the patient to feel the urge to urinate even with a small amount of urine or when the bladder is empty.
- Mixed bladder: exhibits characteristics of both types, leading to irregular urinary control.
If neurogenic bladder is not properly treated, it can lead to severe complications. Early diagnosis and appropriate therapy allow disease management so that patients maintain a good quality of life, even though there is no definitive cure.
Symptoms
The most characteristic symptoms of neurogenic bladder are:
- Underactive bladder:
- Urine leakage
- Inability to sense when the bladder is full
- Difficulty initiating urination
- Urinary retention: inability to completely empty the bladder
- Men often present erectile dysfunction
- Overactive bladder:
- Increased urinary frequency
- Loss of sphincter control
- Urgency incontinence: sudden, compelling urge to urinate, even at night
- Mixed bladder:
- Urinary retention
- Urinary incontinence: inability to control urination
Causes
Neurogenic bladder can be caused by various underlying conditions, including:
- Central nervous system (CNS) disorders (brain and spinal cord): nerve signals controlling bladder activity are interrupted:
- Spinal cord injuries
- Amyotrophic lateral sclerosis (ALS): degenerative disease causing premature death of motor neurons, preventing transmission of orders to muscles
- Stroke: significant interruption or reduction of blood flow in the brain
- Dementia: loss of brain function
- Cerebral palsy: a group of motor disorders affecting movement and posture due to brain injury during embryonic development
- Brain tumors
- Hydrocephalus: accumulation of fluid in the brain
- Spina bifida: congenital malformation where the spinal column fails to close completely during embryogenesis
- Lumbar canal stenosis: narrowing of the spinal canal that can compress the spinal cord
- Hereditary spastic paraplegia: genetic conditions causing leg weakness, stiffness, and muscle spasms
- Multiple system atrophy: neurodegenerative disorder affecting movement, balance, and autonomic functions
- Peripheral nerve disorders: damage occurs in nerves throughout the body:
- Herniated disc: displacement of an intervertebral disc pressing on a nerve root
- Diabetic neuropathy: nerve damage from prolonged high blood glucose levels
- Alcoholic neuropathy: peripheral nerve damage from excessive alcohol consumption
- Vitamin B12 deficiency: essential for nerve health; insufficient levels can damage bladder-controlling nerves
- Sarcoidosis: granuloma formation affecting organs, potentially impairing bladder function when the nervous system is involved
- Guillain-Barré syndrome: autoimmune disorder causing weakness from nerve damage
- Combined CNS and peripheral nerve damage: affecting both the brain/spinal cord and other nerves:
- Multiple sclerosis: chronic autoimmune disease damaging the myelin sheath of nerves
- Syphilis: neurosyphilis can occur when bacteria reach the CNS, potentially causing blindness, paralysis, dementia, and damage to peripheral nerves regulating bladder function
- Parkinson's disease: neurodegenerative condition causing progressive neuronal death
Risk Factors
The risk of developing neurogenic bladder increases in individuals with any of the underlying conditions described above.
Complications
The most common complications of neurogenic bladder include:
- Recurrent urinary tract infections (UTIs)
- Kidney stones: solid masses formed from crystallized minerals in urine
- Kidney damage: excess pressure from retained urine can cause reflux and impair renal function
- Vesicoureteral reflux: urine flows backward into the ureters
- Renal failure: severe kidney damage results in inadequate renal function
Prevention
Neurogenic bladder cannot always be prevented, as the onset of causative diseases is not fully avoidable. To reduce the risk of certain diseases or complications, the following measures are recommended:
- Maintain a healthy lifestyle
- Drink approximately two liters of water per day
- Prevent constipation
- Maintain a healthy weight
- Avoid alcohol
- Do not smoke
- Adequately control diabetes
- Use protective measures and avoid high-risk activities to prevent spinal or brain injuries
Which Specialist Treats Neurogenic Bladder?
Neurogenic bladder is managed by the Urology specialty.
Diagnosis
Diagnosis of neurogenic bladder requires various studies. The most frequently used are:
- Medical history: detailed collection of patient history, lifestyle, and presenting symptoms
- Physical examination:
- Observe genital anatomy with the patient standing, both with full and empty bladder
- Genital, rectal, and pelvic inspection for abnormalities
- Neurological evaluation: mental status, reflexes, strength, and sensation
- Pelvic muscle assessment: posture observation, palpation of muscles externally, and internal evaluation via vaginal or rectal examination to assess strength, tone, and function
- Ultrasound: imaging of the urinary tract to detect abnormalities and determine post-void residual
- Urodynamic study: evaluates urinary sphincter, bladder, and urethra function
- Uroflowmetry: measures urine volume and voiding time to calculate urine flow rate
- Cystomanometry: evaluates bladder filling function using a transurethral catheter; intravesical and detrusor pressures are recorded with electrodes in the bladder and anus, plus a rectal catheter to measure intra-abdominal pressure
- Pressure-flow study: infusion stops when the patient feels urge; pressures and urinary flow are recorded during voiding
- Cystography: X-rays of bladder and urethra using contrast introduced via catheter
- Cystourethrography: similar to cystography, performed while voiding, often combined as a single study
- Cystoscopy: flexible catheter with camera and light is inserted through the urethra to examine bladder anatomy
- Electromyography (EMG): assesses electrical activity of muscles and nerves to detect neuromuscular disorders in sphincter and pelvic floor; involves inserting fine needles and surface electrodes to measure muscle signals at rest and contraction
- Somatosensory evoked potentials: measures brain electrical activity in response to tactile stimuli in extremities; electrodes record signals traveling from peripheral nerves to spinal cord and brain
Treatment
Treatment of neurogenic bladder is directed at the underlying disorder, so therapy is individualized. To address symptoms, patients are advised to follow a healthy diet and maintain high fluid intake to reduce infections and kidney stone formation. Additional interventions include:
- Medications: drugs to improve bladder function by relaxing muscles, reducing involuntary contractions, or enhancing emptying; commonly used are oral anticholinergics, beta-3 adrenergic agonists, or botulinum toxin injections to reduce muscle activity
- Bladder retraining: patient learns techniques or lifestyle modifications to improve bladder control, including:
- Maintaining a voiding diary and gradually spacing urinations
- Urgency suppression techniques: contracting pelvic floor, sitting, or paced breathing during sudden urges
- Pelvic floor rehabilitation: Kegel exercises
- Behavioral modifications: distributing fluid intake in small amounts throughout the day and limiting evening intake to reduce nocturia
- Intermittent catheterization: enables complete bladder emptying by inserting a catheter through the urethra whenever the patient feels the need
- Indwelling catheter: used in severe cases; connected to a collection bag
- Surgery: indicated when previous treatments are insufficient; procedures vary according to patient needs:
- Augmentation cystoplasty: increases bladder capacity, often using a segment of the patient’s intestine, to reduce internal pressure
- Neobladder: new bladder created from intestinal segment; can be orthotopic or diverted near the intestine
- Artificial sphincter: inflatable device to close urethra, manually operated via a pump in the scrotum or labia majora
- Urinary diversion: creates new pathways for urine to exit the body, usually via urostomy connected to an external bag
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