Neurogenic Bladder

Neurogenic bladder is a loss of normal control of bladder function. This is caused by damaged nerves, which can be a result ofa variety of injuries and diseases.

The muscles and nerves of the urinary system work together to store urine and release urine at the right time. Nerves carry messages from the bladder to the brain and from the brain to the muscles of the bladder. In a neurogenic bladder, the nerves that are supposed to carry these messages do not work properly.There are 2 types of neurogenic bladder:

  • Overactive. The bladder is unable to control when or how much to urinate. Even when only a small amount of urine is in the bladder, there may be an urge to urinate that cannot be controlled. This can result in wetting accidents (urge incontinence).

  • Underactive. The bladder holds much more urine than normal. Small amounts of urine leak out as bladder pressure builds because there is not a sensation that the bladder is full. This can also result in wetting accidents.

CAUSES

Neurogenic bladder can be caused by many problems. These include:

  • Stroke.

  • Multiple sclerosis.

  • Infection.

  • Trauma and injuries to the spine, spinal cord, depending on the level in the back of the injury.

  • Diabetes.

  • Parkinson's Disease.

  • Brain and spinal cord tumors.

  • Birth defects that affect the brain or spinal cord.

  • Guillain-Barré syndrome.

  • Complications of surgery involving the spine, spinal cord, or pelvis.

SYMPTOMS

The following are the most common problems and symptoms of neurogenic bladder. However, each individual may experience symptoms differently.

  • Urinary tract infection symptoms:

  • Pain or burning when urinating.

  • Back or flank pain.

  • Cloudy or bloody urine.

  • Fever.

  • Kidney stone symptoms. Symptoms of kidney stones include:

  • Chills.

  • Shivering.

  • Feeling sick to your stomach (nausea) and/or vomiting.

  • Fever.

  • Loss of bladder control (urinary incontinence).

  • Small urine volume when emptying bladder (voiding).

  • Urinary frequency and urgency.

  • Dribbling urine.

  • Loss of sensation of bladder fullness.

  • Kidney failure.

  • Infection in the blood stream (sepsis).

DIAGNOSIS

When neurogenic bladder is suspected, both the nervous system and the bladder are examined. In addition to reviewing your complete medical history and having a physical exam, diagnostic procedures for neurogenic bladder may include:

  • X-rays of the spine.

  • Imaging tests of the kidneys, ureters, and bladder. These tests may include:

  • MRI.

  • CT scan.

  • Ultrasound.

  • Urodynamics or Cystometrogram (CMG). Thistests the nerves and muscles of the bladder. The test can show how much the bladder can hold and if it empties completely.

  • EMG of the sphincter . This is measure of the electrical activity of the sphincter muscle and this helps determine when the sphincter is contracting or squeezing down.

  • Video studies of the bladder and sphincter while you are urinating.

  • Cystoscopy . Looking inside the bladder with a telescope like instrument.

TREATMENT

Specific treatment for neurogenic bladder will be determined by your caregiver based on:

  • Your age, overall health, and medical history.

  • Severity of symptoms.

  • Cause of the nerve damage.

  • Type of bladder problem present.

  • Your tolerance for specific medications, procedures, or therapies.

  • Expectations for the course of the condition.

  • Your opinion or preference.

Treatment may include:

  • Antibiotic medicine.

  • Medications.

  • Insertion of a flexible tube (catheter) to empty the bladder.

  • Surgery to create an artificial sphincterto prevent urinary leakage.

  • Sacral nerve stimulation (SNS) to help stimulate the nerves in order to empty the bladder.

  • Sling surgery to hold the neck of the bladder and urethra in the proper position to prevent leakage.

  • Bladder augmentation.

  • Ileal loop surgery to connect a section of intestine to the ureters and positioned out to a opening on the abdomen. Urine comes out and can be collected into a plastic bag.

  • Perineal pads may be used to catch urine.

HOME CARE INSTRUCTIONS

  • Take all medications as prescribed by your caregiver.

  • Review your medications (both prescription and non-prescription) with your caregiver to make sure medications you are presently taking will not be harmful.

  • Periodic blood, urine, and imaging tests may be required. Follow your caregiver's advice regarding the timing of these.

  • Follow the catheter care instructions if you use a catheter.

  • Use disposiable underwear if you have bladder weakness.

SEEK MEDICAL CARE IF:

  • You have increasing fatigue or weakness.

  • You find there is less and less control of the urine stream despite treatment.

  • You develop a loss of appetite or nausea.

  • You begin to have trouble inserting the catheter.

  • Your urine appears somewhat dark, cloudy, or has an unusual smell.

SEEK IMMEDIATE MEDICAL CARE IF:

  • You develop worsening abdominal or back pain.

  • You cannot pass any urine.

  • Your urine becomes bloody.

  • You experience a lot of burning while urinating.

  • You have a fever.

  • You keep vomiting.

  • You have bleeding with catheter insertion.