Neurogenic Bladder

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KEY POINTS

• A neurogenic bladder is loss of normal control of your bladder caused by damaged nerves.
• Treatment depends on your symptoms, the cause of the nerve damage, your age, health, and medical history. Treatment may include medicine, a catheter to empty your bladder, a bladder pacemaker, or surgery.
• Follow the full course of treatment prescribed by your healthcare provider. Don't try to control urine leakage by cutting back on fluids. It won't help and may be harmful.

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What is a neurogenic bladder?

A neurogenic bladder is loss of normal control of your bladder caused by damaged nerves. Nerves tell your brain when your bladder is full. The nerves also carry messages from the brain to tell your bladder muscles to hold urine or to release urine. If you have a neurogenic bladder, the nerves that carry these messages do not work properly.

This can cause 2 kinds of problems:

• If you have an overactive bladder, you have sudden, strong urges to urinate very often.
• If you have an underactive bladder, your bladder gets very full before you feel the need to urinate. Because you cannot feel when your bladder is full, you leak small amounts of urine as pressure in the full bladder builds up.

If you don’t empty your bladder completely, urine is held too long and may lead to infections of the urinary tract. The urinary tract includes your:

• Kidneys, which make urine
• Ureters, which are the tubes that carry urine from the kidneys to the bladder
• Bladder, which stores urine
• Urethra, which is the tube that drains urine from the bladder

What is the cause?

Nerve damage may be caused by:

• Injuries, birth defects, or tumors that affect the brain or spinal cord
• Alzheimer’s disease
• Diabetes
• Parkinson's disease
• Multiple sclerosis
• Infection
• Stroke
• Lead, mercury, or arsenic poisoning

What are the symptoms?

Symptoms may include:

• Leaking or dribbling urine
• A frequent and urgent need to urinate
• Pain or burning when you urinate
• Trouble starting a stream of urine
• Crampy pain or discomfort in your lower belly, low back, or your side
• Change in amount of urine, either more or less
• Fever and chills
• Sweating
• Headache

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. Tests may include:

• Urine tests
• Post-void residual test to measure the amount of urine left in your bladder after you urinate. It is done by inserting a catheter into your bladder or by using an ultrasound, which uses sound waves to measure the amount of urine in your bladder.
• X-rays
• EEG (electroencephalogram), which measures and records the electrical activity in the brain
• CMG (cystometrogram), which uses liquid sent through a small, flexible tube put into your bladder to see how much it can hold and how well your bladder empties
• CT scan, which uses X-rays and a computer to show detailed pictures of the urinary tract, brain and spine
• MRI, which uses a strong magnetic field and radio waves to show detailed pictures of the urinary tract, brain and spine

How is it treated?

Treatment depends on:

• The type of symptoms you have and how severe they are
• The cause of the nerve damage
• Your age, health, and medical history

Medicine may help control your symptoms. If you have an overactive bladder, your healthcare provider may prescribe drugs that relax the bladder. If you have an underactive bladder, you may be given medicine to tell the nerves to empty the bladder. You may need to take antibiotics to prevent infections.

Long-term treatment may include:

• Insertion of a catheter each time you need to empty your bladder. A catheter is a thin, flexible tube inserted through the urethra and into the bladder to drain urine from the bladder. There are different ways a catheter may be used:
  • A catheter may be used to empty the bladder continuously into a collection bag. You must always have the collection bag with you.
  • Another way to use a catheter is to insert it several times a day to empty the bladder. After you put in the catheter, urine drains into a drainage bag, toilet, bedpan or urinal.
  • Men may be able to use a condom-type catheter. This is a special condom that fits over the penis and is attached to a tube that collects urine and drains it down into a bag.
• Surgery to place a cuff around the neck of your bladder. The cuff can be inflated to prevent urinary leakage, and then deflated when it is time to empty your bladder. You will still need intermittent catheterization to completely empty your bladder.
• Sacral nerve stimulation (SNS). SNS is a kind of "bladder pacemaker." It uses a small device that is implanted under the skin near your tailbone. The device sends mild electrical impulses through a small wire to tell the nerves to empty the bladder.
• Sling surgery. The surgeon creates a sling inside your body to support and raise the urethra in a position that helps improve bladder control. The sling may be made from your own tissue or from man-made materials.

How can I take care of myself?

Follow the full course of treatment prescribed by your healthcare provider. Ask your provider:

• How and when you will get your test results
• How long it will take to recover
• If there are activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

• Follow your healthcare provider's advice about how much fluid you should drink.
  • Limiting fluids may actually be harmful. Drinking too little can irritate your bladder and increase the risk of infection.
  • Cut back on fluids a couple hours before bedtime or if you are going to a place where there are no restrooms.
• Try cutting back on fluids that can irritate your bladder such as:
  • Alcohol
  • Coffee and tea and other drinks that have caffeine
  • Carbonated drinks
  • Sugar-free products, such as diet sodas, that contain the artificial sweetener aspartame
• Drink a glass of cranberry juice each day. The juice should be real cranberry juice, not a cranberry-flavored drink.
• If you have trouble controlling your bladder:
  • Follow a schedule to empty your bladder every 3 to 4 hours. Do this even if you don’t feel like you need to.
  • If you feel like you need to urinate, use the toilet. Don’t ignore the feeling and try to "hold it.”
  • Use absorbent pads if needed. Be sure to change the pads when they get damp and keep your skin clean and dry.
  • Do Kegel exercises to strengthen weak pelvic muscles. Your provider can teach you how to do these exercises.

If you are using a catheter, carefully follow your healthcare provider’s instructions for using it. This will help to prevent urine accidents and infections.

You can get more information from:

• National Kidney Foundation
  800-622-9010
  https://www.kidney.org/