Neurogenic bladder is impaired bladder function resulting from damage to the nerves that govern the urinary tract. Various nerves converge in the area of the bladder and serve to control the muscles of the urinary tract, which include the sphincter muscles that normally form a tight ring around the urethra to hold urine back until it is voluntarily released. A variety of factors can damage these nerves and cause urinary incontinence. In some cases spontaneous nerve impulses to the bladder trigger spastic, unexpected bladder contractions, resulting in accidental voiding of sometimes large amounts of urine.
In other types of neurogenic bladder conditions, the bladder may become flaccid and distended and cease to contract fully, resulting in only partial emptying and continual dribbling of small amounts of urine. Rashes may erupt in areas of skin irritated by urine. Stagnant urine in the bladder also increases the risks of bladder stone formation and urinary tract infections. Such infections, when severe, can lead to life-threatening kidney failure. In some patients there is partial loss of anal sphincter control as well. Neurogenic bladder can occur at any age, but it is especially common among the elderly.
What Causes Neurogenic Bladder?
- Spinal cord injuries resulting in paralysis
- Other disorders that may produce neurogenic bladder as they progress; these include syphilis, diabetes mellitus, brain or spinal cord tumors, stroke, ruptured or herniated intervertebral disk, and degenerative neurological diseases such as multiple sclerosis and amyotrophic lateral sclerosis (or Lou Gehrig’s disease).
- A congenital spinal cord abnormality (that is, one that is present at birth), such as spina bifida
- Long-term effects of alcoholism
Symptoms of Neurogenic Bladder
- Urinary incontinence, characterized by either the involuntary release of large volumes of urine or continuous dribbling of small amounts. Bed-wetting may occur.
- Frequent urination
- Persistent urge to urinate despite recent voiding; constant feeling that the bladder is not completely empty
- Pain or burning on urination
- Dribbling urine stream
- There are no known ways to prevent this condition.
Diagnosis of Neurogenic Bladder
- A thorough patient history is essential. It is useful to keep a 24-hour record of urination patterns, including the approximate volume of urine voided, how urgently you felt the need to urinate, and any factors that may aggravate incontinence. It is also important to report any medications you are taking.
- Physical examination will likely include a rectal, genital, and abdominal check to look for enlargement of the bladder or other abnormalities.
- A complete neurological exam is essential.
- X-rays or an ultrasound scan may be taken during urination (voiding cystography).
- Tests to measure urine output are conducted. To determine whether urine is retained after voiding, the doctor may insert a catheter into the bladder. To determine whether leakage occurs, a full-bladder stress test may be necessary: The bladder is filled to capacity via a catheter, and the patient is then asked to bend over, cough, or walk.
- Urine and blood samples may be taken in order to look for abnormalities, including infections and underlying disorders that might be causing or aggravating the condition.
- Urodynamics may be performed to test the function of the nerves and muscles of the bladder
- Spinal x-rays may be ordered.
How to Treat Neurogenic Bladder
- Patients suffering from bladder paralysis can be taught to insert a catheter several times a day to drain the bladder completely and to prevent urine retention that may lead to bladder stones and infections.
- A urinary catheter (drainage tube) can be used continuously by patients who have sudden, unexpected bladder contractions. Women usually fare better with such therapy; men are more prone to developing urinary tract infections and complications, including abscess formation.
- Various medications may help to improve bladder muscle control and to prevent involuntary muscle contractions. Muscle relaxants, antispasmodics and anticholinergic drugs (which block the neurotransmitter acetylcholine), such as propantheline, oxybutynin and imipramine, are helpful in some cases.
- A device that stimulates bladder contraction with electrical impulses may be used, although such therapy is considered experimental.
- Surgery may be performed to widen the sphincter to decrease resistance in the bladder outlet and thus maximize bladder emptying. In other cases the sphincter or lower pelvic muscles may be surgically tightened to improve bladder control. An artificial sphincter may also be permanently implanted.
- In very severe cases surgery may be done to reroute the flow of urine so that it empties into the intestine or into an externally worn receptacle.
When to Call a Doctor
- Call a doctor if you experience recurrent urinary incontinence or if you are unable to urinate. Don’t allow embarrassment to prevent you from seeking professional help.
Johns Hopkins Symptoms and Remedies: The Complete Home Medical Reference
Simeon Margolis, M.D., Ph.D., Medical Editor
Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50
Updated by Remedy Health Media