Neurogenic bladder is when either nerves or the brain cannot communicate effectively with the muscles in the bladder. When this happens, a person may find it difficult to control urination.

Up to 70–84% of people with spinal cord injuries may experience neurogenic bladder at some point in their lives. If a person does not receive treatment for it, they could be at risk of certain infections, such as urinary tract infections (UTIs).

This article will look at the types and symptoms of neurogenic bladder, as well as its causes and treatment options.

A doctor wearing blue scrubs looking at MRI scan images of someone's brain, in order to diagnose the cause of neurogenic bladder.Share on Pinterest
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Neurogenic bladder occurs when a person’s nerves, spinal cord, or brain have problems sending electrical signals to the bladder. This causes difficulty with urination.

There are two broad types of neurogenic bladder: overactive and underactive. An overactive bladder may leak urine, whereas an underactive bladder may struggle to release urine.

The causes of neurogenic bladder relate to problems with the nervous system. Because the nerves in the spinal cord cannot communicate well with the muscles in the bladder wall, the brain does not know when the bladder is full or empty.

If the muscles are overactive, they contract too much and squeeze the bladder when it is not full. Alternatively, if the muscles are underactive, they do not contract, and a person cannot urinate.

The symptoms of neurogenic bladder vary depending on whether someone has an overactive or underactive bladder.

The symptoms of an overactive bladder can include:

  • frequently urinating in very small amounts
  • feeling the urge to urinate a lot
  • lack of bladder control
  • urinary incontinence

The symptoms of an underactive bladder may include:

  • having a bladder that is frequently full
  • not being able to tell when the bladder is full
  • difficulty urinating
  • overflow leakage

Some people may experience symptoms of both types of neurogenic bladder, depending on the type of nerve damage they have.

People with either type of neurogenic bladder are more likely to experience UTIs. In fact, this is often the first symptom of the condition.

The symptoms of a UTI may include:

  • pain or burning when urinating
  • cloudy urine
  • blood in the urine
  • fever

Nerve dysfunction is what causes neurogenic bladder. This means that any condition or trauma that affects the nervous system may cause problems with bladder control.

Some examples of conditions that may cause neurogenic bladder include:

Undergoing major pelvic surgery can also cause neurogenic bladder of the underactive type.

For a doctor to diagnose neurogenic bladder, they will need to take a detailed look at a person’s brain, spinal cord, and bladder. They will also review the person’s medical history, looking at the onset and duration of the symptoms, any medications they take, and any coexisting conditions they have that could be playing a role.

As part of the diagnostic process, a person will likely need to keep a bladder diary in which they record how many times they go to the bathroom and how many leaks they experience.

The person may also need to undergo a pad test, which involves wearing a pad that contains a special dye. If a person experiences leaking, the pad will show how much.

Some other tests a doctor could request include:

  • X-rays of the spine and skull
  • CT scans
  • urine culture
  • ultrasound of the bladder
  • cystoscopy
  • urodynamic testing, which measures how well the body stores and releases urine

There is currently no cure for neurogenic bladder.

However, treatment can improve the symptoms and have a significant impact on a person’s quality of life. It can also prevent certain complications, such as UTIs or kidney damage.

Treatment will differ depending on whether the person has an overactive or underactive bladder.

Some other considerations that doctors take into account when treating neurogenic bladder include:

  • the person’s age
  • their overall health
  • their medical history
  • any preexisting conditions they have
  • their symptoms, including their type and severity
  • their tolerance for certain medications or procedures

Lifestyle changes

Depending on the severity of a person’s symptoms, treating an underactive or overactive bladder usually begins with making lifestyle changes. These include:

  • Quick flicks: When a person gets the urge to urinate, they can try squeezing and relaxing their pelvic floor muscles as quickly as they can. They should do this until they no longer want to urinate.
  • Dietary changes: Soda, caffeine, spicy foods, and alcohol can irritate the bladder, so a person may want to reduce their consumption of these items to ease the symptoms.
  • Delayed voiding: This involves a person delaying urination for a few minutes to begin with, then slowly building up the delay. Eventually, they may be able to go a few hours without urination.
  • Scheduled voiding: This involves a person using the bathroom according to a daily schedule, such as every 2–4 hours, depending on how often they need to urinate.
  • Double voiding: To double void, a person who is having difficulty urinating can try again after waiting a few minutes.

Additional overactive bladder treatment

If making the above lifestyle changes does not work to relieve overactive bladder, a doctor may recommend other treatments, such as:

  • Drug treatment: In some cases, a doctor may inject botulinum toxin (Botox) into the bladder muscle to stop it from contracting as much. Botox can wear off after a period of time, so a person may need to have injections every 6–12 months.
  • Sacral neuromodulation: This treatment stimulates the nerves with electricity, especially the sacral nerve, which relays signals from the spinal cord to the bladder.
  • Percutaneous tibial nerve stimulation: During this treatment, a doctor inserts a needle into the tibial nerve, which is in the leg. They then stimulate this nerve with electrical impulses. These impulses travel to the sacral nerve. A person usually needs to receive 12 sessions of this treatment.

Additional underactive bladder treatment

If a person does not notice any improvements in their underactive bladder symptoms after making the above lifestyle changes, a doctor may recommend medication or a catheter. A catheter is a device that drains urine for someone through a thin plastic tube.

There are two different types of catheterization that a person can try: clean intermittent catheterization (CIC) and continuous catheterization.

CIC involves inserting a sterile catheter into the bladder through the urethra and leaving the catheter in for only as long as it takes to drain the bladder. A person can then remove the catheter and wait another 6–8 hours to do this again.

Over time, CIC can sometimes improve bladder function. However, this option is not always suitable for people with nerve damage that affects hand function.

Continuous catheterization continuously drains urine. That said, these catheters do need replacing every so often to prevent infection.

Other treatment options for an underactive bladder include adding an artificial sphincter to the urinary tract. This opens to enable a person to urinate.

A doctor may also be able to remove weak muscle in the sphincter to reduce the person’s symptoms.

A person should speak with a doctor if they are having difficulty urinating or are urinating too much. This is especially important if they have diabetes or Parkinson’s disease.

Frequent UTIs are often the first symptom of neurogenic bladder, so a person should keep this in mind when they are discussing their symptoms with a doctor.

It may also help to keep a bladder diary to record leaks and bathroom visits.

When the nervous system or brain cannot communicate with the bladder, a person can develop neurogenic bladder. This means that the muscles in the bladder wall do not contract and relax properly, causing problems with urination.

Treatment differs depending on whether a person has an overactive or underactive bladder. However, making lifestyle changes often makes a significant difference to a person’s quality of life.