Neurogenic bladder is a bladder malfunction caused by an injury or disorder of the brain, spinal cord, or nerves. The condition can lead to voiding difficulties, such as urinating too often or at the wrong time, or being unable to completely empty the bladder. Left untreated, neurogenic bladder can result in kidney damage.
Neurogenic Bladder Causes
In order for the bladder to store and expel urine normally, both the nerves that control the bladder and the brain have to work together in a coordinated manner so that the messages sent between the two organs are received. Injuries or disorders that affect the brain, spinal cord, or nerves can interfere with the nerve signals and lead to the individual not being able to contract or relax their bladder at the right time. They include:
- Birth (congential) defects, such as spina bifida or cerebral palsy
- Multiple sclerosis
- Spinal cord, head, or pelvic injuries
- Brain or spinal cord tumors
- Herniation of the vertebral disk
- Diabetes
- Stroke
- Alzheimer's disease
- Attention deficit hyperactivity disorder and other learning disabilities
- Parkinson's disease
- Alcoholic neuropathy (due to heavy alcohol use)
Neurogenic Bladder Symptoms
The symptoms of neurogenic bladder vary depending upon the underlying condition, but include:
- Loss of bladder control (urinary incontinence)
- Inability to empty the bladder completely (urinary retention)
- Straining or dribbling during urination
- Painful urination
- Overflow of urine from a full bladder
- Inability to sense the fullness of the bladder
Many of these symptoms resemble other urological conditions or medical problems, so it is important that persons presenting with these signs consult their doctor to obtain a diagnosis and appropriate treatment.
Left untreated, neurogenic bladder can lead to other problems, such as recurrent urinary tract infections, kidney stones, hydronephrosis, vesicoureteral reflux, pyelonephritis, or kidney damage.
Neurogenic Bladder Diagnosis
To diagnose neurogenic bladder, the physician will review the patient's medical history, including the symptoms that they have been experiencing. A physical exam will be then performed. The doctor might also ask the patient to use a voiding diary to keep track of how often they urinate. This can provide useful information about their condition.
Other tests that may be done to make a diagnosis, include:
- Urine tests and urine culture: urine sample is examined for signs of infection or inflammation in the body
- Blood tests:checks to see if the kidneys are functioning properly
- Imaging tests of the urinary tract: A CT scan, ultrasound, x-ray, or magnetic resonance imaging (MRI) can all be used to create images of the structures inside the body. They can provide information about blockages or other problems with the bladder, ureters, or kidneys.
- Imaging tests of the skull and spine: looks for injuries or other conditions that may affect bladder control
- Urodynamic test (also known as cystometrogram or CMG): A catheter is inserted into the urethra and guided up to the bladder. Fluid (often saline) is then passed through the catheter in order to fill the bladder. This is done to see how much the bladder can hold and whether it empties completely.
- Electromypography: A needle electrode is inserted into the bladder muscle through the skin. It picks up electrical signals the bladder gives off and transmits them to a monitor.
Neurogenic Bladder Treatments
There are several ways to treat neurogenic bladder, depending upon the underlying cause and the severity of the symptoms. This includes behavioral therapy to retrain the bladder, medication, pelvic floor exercises, catheterization to drain urine, and surgery.
References
Rackley RR, Appell RA. (1997). Evaluation and medical management of female urinary incontinence. Cleve Clin J Med. 64(2):83-92.
Wein AJ, Dmochowski RR. (2011). Neuromuscular dysfunction of the lower urinary tract. Campbell-Walsh Urology. 10th ed.
