Neurogenic Bladder Dysfunction 

Neurogenic bladder dysfunction is a dysfunction of the urinary bladder due to disease of the central nervous system or peripheral nerves involved in the control of urination. 

There are two major types of bladder control problems that are associated with a neurogenic bladder. Depending on the nerves involved and nature of the damage, the bladder becomes either overactive (spastic or hyper-reflexive) or underactive (flaccid or hypotonic).

  • People with neurogenic overactive bladders have little to no control over urinating. With a spastic bladder, a person will feel a sudden urge to urinate or sense the need to go to the bathroom more often than necessary. The bladder contractions can be so strong that they have urge incontinence (the involuntary or accidental release of urine).

  • Neurogenic underactive bladders behave in the opposite way. The flaccid bladder loses the ability to contract and empty properly so it fills beyond it's normal capacity. At a certain point, the pressure of urine in the bladder overcomes the urethral sphincter muscle’s ability to retain it, and urine starts to dribble out.


What causes a Neurogenic Bladder?

Any condition that impairs the nervous system signaling to and from the bladder can create a neurogenic bladder.

It is often associated with spinal cord diseases, such as Multiple Sclerosis, spinal tumors, back injuries, herniated disks, and congenital spinal abnormalities including spina bifida. It may also be caused by brain tumors or other diseases of the central nervous system, like Alzheimer's, Parkinson's, Stroke (cerebrovascular accident (CVA) or TIA . Peripheral nerve diseases such as, Diabetes, Alcoholism and Vitamin B12 deficiency can also affect the bladder. 
Pregnancy can even affect bladder function by the compression, stretching and trauma of the nervous system during delivery.It is also a common complication of major surgery in the pelvis.


What are the symptoms of Neurogenic Bladder?

  • The most common symptom of neurogenic bladder is being unable to control urination. 

  • A weak or dribbling urinary stream, or intermittent urine stream that stops and starts.

  • Hesitancy, the inability to urinate or the need to strain excessively to urinate. 

  • Frequent urination, often seen along with urgency, a feeling or need to urinate immediately.

  • Urinary incontinence from urgency leak or overflow. 

  • Painful bladder from either being too full constantly or from a urinary tract infection. Neurogenic bladders tend to have stagnant retained urine and are prone to recurrent UTIs.


How is a Neurogenic Bladder diagnosed?

The doctor will perform a physical examination and ask details about your medical history, especially about any neurological problems such as back injury, stroke, or other neurologic diseases.

Your doctor may then order several tests of the nervous system and the bladder to diagnose a neurogenic bladder :

  • Urodynamic studies are bladder function tests that that are conducted to measure bladder capacity, bladder pressures, map the the flow of urine, and monitor bladder emptying.

  • A cystoscopy may be performed to examine the inside of the bladder and urethra with a small fiberoptic telescope called a cystoscope

  • The brain, spine, and urinary tract may be examined with X-rays, ultrasound, CT scans, or magnetic resonance imaging (MRI).

  • You may be referred to a neurologist for consultation.


How is a Neurogenic Bladder treated?

The types of treatment for a neurogenic bladder are very similar to those for and overactive bladder. The correct treatment is determined by symptoms, type, and extent of nerve damage, and a thorough evaluation and discussion with the individual patient.

  • Physical-psychological therapy:
    Physical-psychological therapy, combines will power and exercise. Kegel exercises, that strengthen the pelvic muscles allow better control  and are incorporated into daily life. Timed and double voiding also aims to keep bladder volumes low which then decreases the risk of incontinent episodes. 

  • Neuromodulation: Urgent PC or Interstim Therapy
    In neuromodulation or electrical-stimulatory therapy, electrodes and a small stimulator are placed near the tibial, pudendal or sacral nerves. The stimulator delivers electrical impulses that imitate those that are delivered by a normal nervous system. These devices have been approved by the U.S. Drug Administration to treat incontinence and urinary retention in patients in whom other therapies have failed.

  • Drug therapy
    There are certain drugs that reduce bladder muscle spasms, and other drugs that produce bladder contractions.

    • Antispasmodic drugs prevent excessive bladder contractions. They work by relaxing the smooth muscle of the bladder.
    • Antidepressants such as amitryptiline (Elavil) also help to reduce contractions by relaxing the smooth muscle of the bladder.
    • Estrogen Cream may be used by post-menopausal women to help treat mild to moderate stress incontinence. 

  • Intermittent self-catheterization
Catheters are devices that can be inserted through the urethra and into the bladder to drain urine. Patients can learn to insert the catheter themselves. This treatment is called Clean Intermittent Catheterization (CIC).

Sometimes an indwelling catheter called a Foley is left in the bladder for an extended period of time. Catheters prevent bladder distention by continually draining urine into a contained collecting unit.  

  • Surgery
    • Artificial sphincters consist of a cuff that fits around the bladder neck, a pressure-regulating balloon, and a pump that inflates the cuff. The balloon is placed beneath the abdominal muscles. The pump is placed in the labia in women and in the scrotum for men. (Other locations include beneath the skin of the abdominal wall or thigh.) Activating the pump sends fluid from the cuff to the balloon, allowing the sphincter muscle to relax and urine to pass. The cuff automatically re-inflates in three to five minutes.
    • Urinary diversion creates a stoma or opening through which urine drains  into a collection pouch.
    • Bladder augmentation (augmentation cystoplasty)--Segments of the intestine (sigmoid colon) are removed and attached to the walls of the bladder. This reduces the bladder’s internal pressure and increases its capacity to store urine.
    • Urethral stents, which are similar to an internal catheter, can be inserted through the sphincter muscle to expand it and allow urine to be drained.



Although following through with treatment and management plans for a neurogenic bladder may appear to create a burden, decreasing back pressure on the kidneys and preventing urinary tract infection will ultimately prevent kidney damage. If a neurogenic bladder is not treated, over years it can lead to renal disease and progress to kidney failure. Patients with a neurogenic bladder should be managed by both a urologist, and if necessary, a nephrologist for their lifetime.