Neurogenic bladder refers to a loss of bladder control due to complications with the brain, spinal cord, or nerves that control the bladder. It can be caused by a head or spinal cord injury, or other conditions such as multiple sclerosis, diabetes or stroke. Treatment for neurogenic bladder depends upon the underlying cause, but includes behavioral therapy to improve bladder control, catheterization to drain urine from the bladder, medication to relax or reduce bladder activity and surgery to reconstruct the bladder.
Behavioral Therapy for Neurogenic Bladder
In some cases, behavioral therapy can help patients regain control of the bladder. This includes:
- Bladder training: This involves sticking to a fixed voiding schedule that is prepared by the patient and their health care provider. The schedule should be followed regardless of whether the patient has an urge to urinate or not. The goal of the training is to increase the volume of fluids the bladder can store, as well as the amount of time between emptying the bladder. The interval between voiding is expanded in 15 to 30 minute growths until the patient is comfortable holding their urine for several hours. Sometimes drinking less fluid will be recommended.
- Biofeedback: Electrodes are placed on the skin and a monitor is positioned to help the patient feel and visualize the activity of their urinary tract and other bodily functions. This technique is often combined with pelvic floor exercises. After several biofeedback sessions, the patient may learn to control the muscles that control urination.
- Pelvic floor muscle exercises: Pelvic floor exercises, also known as Kegel exercises, work to strengthen the muscles and connective tissue that support the pelvic organs so that the individual can better control the flow of urine. With practice, patients learn to relax and contract the muscles that control urination. These exercises can significantly minimize leakage or allow the patient to more completely empty their bladder.
- Voiding diary to track urination times and amounts, as well as any leakage. This can help people learn to recognize when they need to empty their bladder.
Medical Therapy and Devices for Neurogenic Bladder
Besides behavioral therapy, there are medications and devices used to treat neurogenic bladder, including:
- Anticholinergic drugs: Several medications are available that may help people with frequent or urgent urination, or leakage due to neurogenic bladder. Anticholinergic drugs act by relaxing the muscles of the bladder, and decreasing the urgency or leakage due to overactivity or spasms of the bladder. The drugs have many side-effects, such as drowsiness, blurred vision, heart palpitations and facial redness. Patients may need to try several drugs before finding one that works well.
- Antispasmodic drugs: Antispadmodic medications also work by relaxing the muscles of the bladder. This can increase the capacity of the bladder and decrease the need to urinate frequently. These drugs have similar side effects to anticholinergic medications and may interfere with activities that require physical coordination and mental alertness, such as driving or operating heavy machinery.
- Antidepressant drugs: Certain antidepressant drugs (tricyclics) can be used to treat bladder problems, although they are not approved by the Food and Drug Administration for these uses. The drugs work by relaxing the muscles of the bladder and can be used to treat frequent urination (urge incontinence).
- Botulinum toxin (botox) injections: Botox can be used to paralyze the muscles of the bladder in order to control an overactive neurogenic bladder. This may decrease the activity of the bladder’s muscles and reduce the amount of leakage caused by bladder spasms. The effect of the Botox lasts only six to eight months, and the drug must be readministered at that time.
- Urinary Catheter: A thin tube (catheter) can be inserted through the urethra in order to drain urine from the bladder. The urinary catheter may be left in place (indwelling catheter) or inserted four to six times a day (intermittent catheterization). Some people are comfortable doing this on their own, while others require it to be done by a healthcare professional. Complications that can occur from catheterization, include infection, urinary tract injury, bladder spasms and an allergic reaction to the tube.
Surgery for Neurogenic Bladder
Surgery for neurogenic bladder is generally only done in severe cases, when all other treatments fail.
- Artificial sphincter: The urinary sphincter is a muscle that holds the urine in the bladder. When the sphincter no longer works well—such as with stress incontinence or after prostate surgery—an artificial sphincter may be surgically implanted to keep urine from leaking out of the bladder. A pump is used to inflate the artificial sphincter. The cuff of this device is then deflated to allow urine to flow out of the bladder.
- Sling surgery: In bladder neck sling surgery, a piece of tissue or synthetic mesh is placed under the urethra, the tube that carries urine from the bladder. This increases the resistance in the urethra and can help prevent urine leakage (incontinence).
- Bladder augmentation: If a neurogenic bladder is severely contracted, it can lead to frequent urination. During bladder augmentation surgery (enterocystoplasty), a section of the bowel is used to increase the size of the bladder and allow it to store more urine. After surgery, patients will need to drain urine from the bladder with a catheter, either on their own or with the help of a healthcare professional.
- Urinary diversion: In cases where bladder augmentation is not possible, urinary diversion surgery may be done to bypass the bladder. There are many types of urinary diversions, but includes creating a new pouch inside the body from a piece of the bowel, or redirecting the flow of urine to a small, permanent hole in the skin of the belly.
Neurogenic Bladder Treatment Outcomes
The success of any treatment for neurogenic bladder depends upon the underlying problem and how severe it is.
- Behavioral therapy: Exercises to strengthen the pelvic floor muscles can improve the control of urination in 56 to 95 percent of cases. Pelvic floor exercises, along with biofeedback, are successful in 54 to 87 percent of cases. Bladder training improves urine control in 75 percent of cases, with only 12 percent completely cured of urinary incontinence.
- Medication: The success of medical treatments depends upon the drug and dosage that is administered. Anticholinergic drugs were successful in treating incontinence in 13 to 90 percent of cases, and some antispasmodic drugs have been shown to cure incontinence in up to 50 percent of cases, although at times they may reduce symptoms in up to 90 percent of cases.
- Surgery: Bladder augmentation has been shown to be an effective way to increase the bladder's ability to store urine. However, one study found that 41 percent of patients had at least one complication after the procedure. Use of an artificial urinary sphincter has been found to improve symptoms of incontinence in up to 95 percent of cases, with total control of urination in 86 percent of cases.
Staskin DR, Comiter CV. (2011). Surgical procedures for sphincteric incontinence in the male: artificial genitourinary sphincter and perineal sling. Campbell-Walsh Urology. 10th ed.
Wein AJ, Dmochowski RR. (2011). Neuromuscular dysfunction of the lower urinary tract. Campbell-Walsh Urology. 10th ed.