Injuries, surgeries, diseases and birth defects may affect the how the body’s nerves work … or don’t work! Some medical conditions that commonly affect how our nerves work include Spina bifida, Multiple sclerosis (MS), Type 1 and 2 Diabetes, spinal cord injuries (SCIs), Parkinson’s disease, and stroke. And each of these conditions may create a neurogenic bladder. A neurogenic bladder is a disorder of the lower urinary tract that is the result of damage to — or diseases of — the nervous system leading to a loss of voluntary control of your bladder.
Symptoms of Neurogenic Bladder
The typical symptoms experienced with a neurogenic bladder include urinary incontinence, frequency, and urgency, or conversely, difficulty emptying the bladder. The loss of bladder control may result in a phenomenon called “neurogenic detrusor overactivity.” This overactivity results in involuntary bladder contractions (squeezes) during the filling and storing phase of urine in your bladder.
Urinary Tract Infections
People with a neurogenic bladder are at increased risk and incidence of urinary tract infections (UTIs), urinary retention (your bladder does not empty completely), and bladder outlet obstruction (blockage). If neurogenic bladder is not treated properly, there is also a potential risk of sepsis (this is the body’s response to infection) and renal (kidney) failure.
When the Nerves are Damaged
Under normal conditions, the body’s nerves tell you when your bladder is full, and then empties the bladder of urine at an appropriate time and place (in other words, when you decide to pee) — all based on messages the brain receives from nerves.
However, when there is nerve damage, or a condition blocking the messages sent or received by the nerves, the messages between the brain and the bladder may not be sent and received correctly. In other words, conditions affecting nerves can cause the brain to not receive the message “your bladder is full,” or a condition may block the message sent by the brain to the bladder to tell it to either “hold on” or pee.
Diagnosis of Neurogenic Bladder
In order to know if a person has a neurogenic bladder, a healthcare professional must do a thorough evaluation to assess how their lower urinary tract is functioning. This may include many different kinds of tests that include a physical examination, a neurologic examination, urodynamic studies, post-void residential urine volume ((PVR), cystoscopy, and laboratory evaluations (urinalysis, serum blood urea nitrogen and serum creatinine). Only after a thorough examination will a healthcare professional be able to provide a proper diagnosis.
Treatment of Neurogenic Bladder
How neurogenic bladder is treated will depend on the cause of the problem. In the case of urine retention (when the bladder does not completely empty), treatment may involve medication to help promote better bladder emptying and timed voiding – urinating on a schedule — to promote more efficient urination. Some people may need to periodically insert a small, thin tube called an called an intermittent catheter through their urethra and into their bladder in order to empty the bladder. A healthcare professional will help you learn how to do this. A healthcare professional can also help a patient learn how to tell when their bladder is full and how to massage the lower abdomen to fully empty the bladder. If urinary leakage or incontinence is the main problem, medications, strengthening the pelvic floor muscles, or surgery may be of help. Possible treatments for urinary urgency and frequency of overactive bladder (OAB) may involve medications, PTNS, Botox injections, timed voiding, Kegel exercises, and surgery in some cases.
Early diagnosis and treatment for neurogenic bladder is important to prevent complications that are more serious. Please see your healthcare provider and once you are under their care, report any changes or concerns immediately.
Medical Reviewer: Christine Norton, PhD, MA, RN
Professor Norton is Professor of Nursing at King’s College London & Imperial College Healthcare NHS Trust, London. She is also Nurse Consultant, bowel control, at St. Mark’s Hospital in London. She has been working with people with incontinence for over 30 years in a variety of settings. She has an extensive research output on ways of helping people with faecal incontinence, as well as teaching both nationally and internationally. She is the author of the book Nursing for Continence, co-editor of the book Bowel Continence Nursing, and has authored or co-authored articles in such prestigious journals as The Lancet, Spinal Cord, British Journal of Surgery, Journal of Advanced Nursing, Nursing Times, American Journal of Nursing, Diseases of the Colon and Rectum, and many others. Professor Norton chaired the UK national guideline and international groups on managing faecal incontinence. Dr. Norton was one of the first continence nurse specialists in the UK and was the first Secretary of the Association for Continence Advice. Later she founded and was Director of the UK Continence Foundation. She was awarded a PhD by London University in 2001 for a study of biofeedback for faecal incontinence. She has co-founded and co-chaired the International Continence Society (ICS) Continence Promotion Committee, has represented nursing on the ICS Board, chairs the International Consultation on Incontinence (ICI) faecal incontinence committee, the Royal College of Nursing Gastroenterology & Stoma Care Forum and has served as an editor for the Cochrane Incontinence Group.