Neurogenic bladder

Answer 1

Definition

Neurogenic bladder is a urinary problem in which the bladder does not empty properly due to a neurological condition.

See also: Urinary incontinence

Causes, incidence, and risk factors

Several muscles and nerves must work together for your bladder to hold urine until you're ready to empty it. Nerve messages go back and forth between the brain and the muscles that control bladder emptying. If these nerves are damaged by illness or injury, the muscles may not be able to tighten or relax at the right time.

Disorders of the central nervous system commonly cause neurogenic bladder. This can include:

• Alzheimer's disease
• Meningomyelocele
• Brain or spinal cord tumors
• Multiple sclerosis
• Parkinson disease
• Spinal cord injury
• Stroke recovery

Damage or disorders of the peripheral nerves can also cause neurogenic bladder. This can include:

• Alcoholic neuropathy
• Diabetic neuropathy
• Nerve damage due to pelvic surgery
• Nerve damage from a herniated disc
• Vitamin B12 deficiency

Symptoms

The specific symptoms depend on the underlying neurological disorder, and may include:

Symptoms of overactive bladder:

• Having to urinate too often in small amounts
• Problems emptying all the urine from the bladder
• Loss of bladder control

Symptoms of underactive bladder:

• Bladder becomes too full and you may leak urine
• Problems starting to urinate or emptying all the urine from the bladder
• Unable to tell when the bladder is full
• Urinary retention

Treatment

Medications may help manage your symptoms. Your doctor may recommend:

• Medicines that relax the bladder (oxybutynin or propantheline) for overactive bladder
• Medicines that make certain nerves more active (bethanechol) for underactive bladder
• Medicines that treat infection (antibiotics) if the bladder problems lead to an infection

Your health care provider may also teach you some exercises to strengthen your pelvic floor muscles (Kegel exercises).

Learn to recognize the symptoms of urinary infections, such as burning when you urinate, fever, low Back pain on one side, and a more frequent need to urinate.

Some people with multiple sclerosis need to use a urinary catheter. This is a thin tube that is inserted into your bladder:

• You may need a catheter to be in place all the time (indwelling catheter)
• You may need a catheter to be placed in your bladder 4 to 6 times a day to keep your bladder from becoming too full (intermittent catheterization)

Sometimes surgery is needed. Surgeries for neurogenic bladder include:

• Artificial sphincter
• Electrical stimulation of the sacral nerve
• Sling surgery

Support Groups

See: Incontinence resources

Complications

• Chronic urine leakage can cause skin breakdown and pressure sores
• Kidney damage may occur if the bladder becomes too full, causing pressure to build up in the tubes leading to the kidneys and in the kidneys themselves
• Urinary tract infections

Calling your health care provider

Call you health care provider if you:

• Are unable to empty your bladder at all
• Have signs of a bladder infection (fever, burning when you urinate, frequent urination)
• Urinate small amounts, frequently

References

Holroyd-Leduc JM, Tannenbaum C, Thorpe KE, et al. What type of urinary incontinence does this woman have? JAMA. 2008;299(12):1446-56.

Shamliyan TA, Kane RL, Wyman J, et al. Systematic review: randomized, controlled trials of nonsurgical treatments for urinary incontinence in women. Ann Intern Med. 2008;148(6):459-73. Epub 2008 Feb 11.

Wein AJ. Lower urinary tract dysfunction in neurologic injury and disease. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 59.

Answer 2

Definition

Neurogenic bladder is a problem in which a person lacks bladder control due to a brain or nerve condition.

See also: Urinary incontinence

Causes, incidence, and risk factors

Several muscles and nerves must work together for your bladder to hold urine until you're ready to empty it. Nerve messages go back and forth between the brain and the muscles that control bladder emptying. If these nerves are damaged by illness or injury, the muscles may not be able to tighten or relax at the right time.

Disorders of the central nervous system commonly cause neurogenic bladder. This can include:

• Alzheimer's disease
• Birth defects of the spinal cord (meningomyelocele)
• Brain or spinal cord tumors
• Multiple sclerosis
• Parkinson disease
• Spinal cord injury
• Stroke recovery

Damage or disorders of the nerves that supply the bladder can also cause this condition. This can include:

• Alcoholic neuropathy (nerve damage due to long-term, heavy alcohol use)
• Diabetic neuropathy (nerve damage due to long-term Diabetes)
• Nerve damage due to pelvic surgery
• Nerve damage from a herniated disc

Symptoms

The specific symptoms depend on the cause, and may include:

Symptoms of overactive bladder:

• Having to urinate too often in small amounts
• Problems emptying all the urine from the bladder
• Loss of bladder control

Symptoms of underactive bladder:

• Bladder becomes too full and you may leak urine
• Problems starting to urinate or emptying all the urine from the bladder
• Unable to tell when the bladder is full
• Urinary retention

Treatment

Medications may help manage your symptoms. Your doctor may recommend:

• Medicines that relax the bladder (oxybutynin or propantheline)
• Medicines that make certain nerves more active (bethanechol)
• Botulinum toxin (Botox)

Your doctor may refer you someone who has been trained to help people manage bladder problems. Skills or techniques you may learn include:

• Exercises to strengthen your pelvic floor muscles (Kegel exercises)
• Keeping a diary of when you urinate, the amount, and if you leaked urine. This may help you learn when you should empty your bladder and when it may be best to be near a bathroom.

Learn to recognize the symptoms of urinary infections, such as burning when you urinate, fever, low back pain on one side, and a more frequent need to urinate.

Some people may need to use a urinary catheter. This is a thin tube that is inserted into your bladder:

• You may need a catheter to be in place all the time (indwelling catheter)
• You may need a catheter to be placed in your bladder 4 to 6 times a day to keep your bladder from becoming too full (intermittent catheterization)

Sometimes surgery is needed. Surgeries for neurogenic bladder include:

• Artificial sphincter
• Electrical device implanted near the bladder nerves, to stimulate the bladder muscles
• Sling surgery
• Creation of an opening (stoma) in which urine flows out of the into a special pouch (this is called urinary diversion)

Support Groups

See: Incontinence resources

Complications

• Chronic urine leakage can cause skin breakdown and pressure sores
• Kidney damage may occur if the bladder becomes too full, causing pressure to build up in the tubes leading to the kidneys and in the kidneys themselves
• Urinary tract infections

Calling your health care provider

Call you health care provider if you:

• Are unable to empty your bladder at all
• Have signs of a bladder infection (fever, burning when you urinate, frequent urination)
• Urinate small amounts, frequently

References

Wein AJ. Lower urinary tract dysfunction in neurologic injury and disease. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 59.

Reviewed By

Review Date: 04/30/2011

Kevin Sheth, MD, Department of Neurology, University of Maryland School of Medicine, Baltimore, MD. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine;David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.