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Neurogenic Bladder

What is neurogenic bladder?

Neurogenic bladder is the loss of normal bladder function caused by damage to part of the nervous system. The damage can cause the bladder to be underactive, in which it is unable to contract and unable to empty completely, or it can be overactive, in which it contracts too quickly or frequently.

What are some risk factors for neurogenic bladder?

Risk factors for neurogenic bladder include various birth defects, which adversely affect the spinal cord and function of the bladder, including spina bifida and other spinal cord abnormalities. Tumors within the spinal cord or pelvis may also disrupt normal nervous tissue function and place an individual at risk. Traumatic spinal cord injury is also a major risk factor for development of neurogenic bladder.

What are the symptoms of neurogenic bladder?

Inability to control urination, also known as urinary incontinence, is perhaps the most common symptom associated with the neurogenic bladder. This may be caused by abnormalities in bladder capacity or malfunction of control mechanisms such as the bladder neck and/or external urethral sphincter muscle that are important for the bladder's storage function.

Symptoms including a dribbling urinary stream, straining during urination or inability to urinate may also be associated with neurogenic bladder. Urinary retention may result either from loss of bladder muscle contracting performance or loss of appropriate coordination between the bladder muscle and the external urethral sphincter muscle.

Irritating symptoms, such as urinary frequency and urgency, may be evidence of bladder hyperactivity. Other irritating symptoms may include painful urination (dysuria), which may be a result of a urinary tract infection (UTI) caused by urine being held too long in the bladder. UTI with fever is a sign of potential severe kidney infection (pyelonephritis) and is a more worrisome situation as it may result in permanent damage of the kidney(s).

Stones may also form in the urinary tract of individuals with a neurogenic bladder caused by the stoppage of urine flow and/or infection.

Abnormal backup of urine from the bladder to the kidney(s), also known as vesicoureteral reflux (VUR), may develop as a means of releasing high pressure within the bladder. A UTI is of particular concern as VUR may place the patient at significant risk for a severe kidney infection by transporting infected bladder urine directly to the kidney(s).

How is neurogenic bladder diagnosed?

When neurogenic bladder is suspected, both the nervous system (including the brain) and the bladder itself are tested. In addition to complete medical history and physical examination, diagnostic procedures may include:

  • X-rays of the skull and spine
  • an electroencephalogram (EEG) to identify brain dysfunction
  • imaging tests of the bladder and ureters
  • function tests that involve filling the bladder to see how much it can hold and if it empties completely

How is neurogenic bladder treated?

Medication for treatment of overactive bladder may improve or relieve irritating symptoms and/or incontinence. Antibiotics are important for treatment and prevention of urinary tract infections (UTIs), especially in patients with vesicoureteral reflux. Other medications may improve bladder control by increasing outlet resistance at the bladder neck.

Clean intermittent catheterization (CIC) was developed by Dr. Jack Lapides in the early 1970s as a means of emptying the bladder in the case of a bladder muscle that is unable to contract or in patients with loss of appropriate coordination between the bladder muscle and the  external urethral sphincter muscle.

Surgical cutting of the external urethral sphincter with the use of an endoscope passed through the urethra may allow free flow of urine into an appropriate receptacle and eliminate the need for CIC in order to empty the bladder. Also, endoscopic injection of paralytic agents directly into the external urethral sphincter muscle is another technique that provides temporary relief.

Permanent stents can also be used in the bladder neck for effective urinary transportation.
At times, however, damage to bladder anatomy and function is so severe that capacity needs to be improved with bladder augmentation (increasing bladder size with various tissues), vesicoureteral reflux needs to be corrected and/or an alternate tube for emptying the bladder may need to be surgically constructed.

What can be expected after treatment for neurogenic bladder?

A person can expect extensive follow-up evaluation of bladder and kidney function. This may involve repeated X-rays, ultrasound, blood tests and bladder function tests.

Although some characteristics of the neurogenic bladder may improve or resolve, most issues typically require constant attention and reevaluation.

Proactive management of patients with a neurogenic bladder may decrease the risk of damage to the bladder and kidney(s) and, therefore, potentially limit the need for future intervention. This has been shown in management of neurogenic bladder patients with spina bifida.

Frequently asked questions:

What is the likelihood that my child with spina bifida will develop neurogenic bladder? 
The risk of neurogenic bladder is significant in this population and, therefore, careful and frequent evaluation of bladder function is recommended.

What are expected limitations for a patient with neurogenic bladder?
Limits are typically a function of the cause of neurogenic bladder (such as spinal cord injury, for example), rather than the neurogenic bladder itself.

Can the effects of a neurogenic bladder be prevented? 
Some effects of neurogenic bladder are preventable with aggressive management with medication and at times appropriate surgical reconstruction. 
Reviewed December, 2002

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Neurology Medical Center of South Orange County California serves patients in all South Orange County Communities including
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