Urology Health - What is Neurogenic Bladder?

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What is Neurogenic Bladder?

Neurogenic Bladder, also known as Neurogenic Lower Urinary Tract Dysfunction, is when a person lacks bladder control due to brain, spinal cord or nerve problems. Several muscles and nerves must work together for your bladder to hold urine until you are ready to empty. Nerve messages go back and forth between the brain and the muscles that control when the bladder empties. If these nerves are harmed by illness or injury, the muscles may not be able to tighten or relax at the right time. In people with neurogenic bladder, the nerves and muscles do not work together well. The bladder may not fill or empty in the right way.

Millions of people have neurogenic bladder. This includes people with Multiple Sclerosis (MS), Parkinson’s disease and spina bifida. It also could include people who have had a stroke, spinal cord injury, major pelvic surgery, diabetes or other illnesses.

The Urinary System

The urethra, bladder and kidneys are part of the urinary system. These are the organs that make, store, and pass urine. When the urinary system is working well, the kidneys make urine and move it into the bladder. The bladder is a balloon-shaped organ that serves as a storage unit for urine. It is held in place by pelvic muscles in the lower part of your belly. When the bladder empties, urine passes through the urethra, the tube that carries urine from your body.

When it is not full of urine, the bladder is relaxed. Nerve signals in your brain let you know that your bladder is getting full. Then you feel the need to urinate. When you have found a bathroom and are ready to urinate, the brain tells the bladder muscles to squeeze (or "contract"). This forces the urine out through your urethra. Your urethra has muscles called sphincters. They help keep the urethra closed so urine doesn't leak before you're ready to go to the bathroom. These sphincters open up when the bladder contracts

Causes

Several muscles and nerves must work together for your bladder to hold urine until you are ready to empty it. Nerve messages go back and forth between the brain and the muscles that control bladder emptying. If these nerves are damaged by illness or injury, the muscles may not be able to tighten or relax at the right time.

In people with neurogenic bladder, the nerves and muscles don't work together very well. As a result, the bladder may not fill or empty correctly. With overactive bladder (OAB), muscles may be overactive and squeeze more often than normal and before the bladder is full with urine. Sometimes the sphincter muscles are not strong enough and let urine pass before you're ready to go to the bathroom, this is called incontinence.

In other people the bladder muscle may be underactive. It will not squeeze when it is filled with urine and won't empty fully or at all. The sphincter muscles around the urethra also may not work the right way. They may remain tight when you are trying to empty your bladder. Some people experience both overactive and underactive bladder.

Symptoms

The symptoms of neurogenic bladder differ from person to person. Symptoms also depend on the type of nerve damage causing the problem. Symptoms may include:

Urinary Tract Infection

A urinary tract infection (UTI) is often the first sign of neurogenic bladder. People with overactive and underactive bladder can get repeated urinary tract infections. This repeated illness is caused by harmful bacteria, viruses or yeast growing in the urinary tract.

Leaking Urine

Urine leaks may happen as bladder muscles may be overactive and squeeze more often than normal. Sometimes this squeezing causes urine to leak before you are ready to pass urine. This is called urinary incontinence. You may leak just a few drops of urine. Sometimes you may gush a large amount of urine. Sometimes urine will leak while you sleep.

Passing Urine Often

Passing urine often may happen with OAB – this is when you feel a sudden urge to pass urine. After this feeling, some people leak urine—a few drops or a gushing amount. One more symptom is passing urine frequently – more than 8 times in 24 hours.

Urine Dribbles

With underactive bladder symptoms, you may only dribble a bit of urine. You may not be able to empty your bladder fully or may not be able to empty your bladder at all (urinary retention). This may happen to people with diabetes, MS, polio, syphilis or who had major pelvic surgery as the bladder muscle may not squeeze when it needs to. The sphincter muscles around the urethra also may not work the right way. They may stay tight when you try to empty your bladder.

Diagnosis

Since neurogenic bladder involves the nervous system and the bladder, your doctor may run many tests to determine the health of both. Talking to your doctor about your symptoms can be a vital first step.

Medical History

Your doctor may ask you for your medical history and your daily habits. This may include information about the symptoms you are having, how long you have had them, and how they are changing your life. A medical history may also include information about your past and current health problems. You should have a list of the over-the-counter and prescription drugs you usually take. Your health care provider may also ask you about your diet and about how much and what kinds of liquids you drink during the day.

Bladder Diary

Sometimes doctors may suggest you use an assessment tool or keep a bladder diary to help diagnose your condition. You may be asked to keep a bladder diary assessment tool, where you will note how often you go to the bathroom and any time you leak urine. This may help your health care provider learn more about your day-to-day symptoms.

Pad Test

You may also be asked to do a pad test. In this, you wear a pad that has been treated with a special dye and the pad changes color when you leak urine.

Physical Exams

Physical exams may be needed as well. For women, the doctor may look at your belly, pelvis and rectum. For men, the belly, rectum and prostate may be checked.

Other Tests

Other tests may include a urine test to look for infection or urodynamic testing to measure how your urinary tract is working. An x-ray or scan may also to help diagnose you.

  • Urine cultures test your urine for infection or blood.
  • Bladder scans are a type of ultrasound which shows how much urine is still in the bladder after you pass urine.
  • Cystoscopy is a test where the doctor inserts a narrow tube with a tiny lens through the urethra and into the bladder.
  • Urodynamic testing checks how well your lower urinary tract stores and releases urine. There are several urodynamic tests you may be asked to do. You may be asked to pass urine into a special funnel to see how much urine you produce and how long it takes. You may have a catheter inserted in your bladder to drain your bladder or to add water to it and check the resulting pressure.
  • Imaging tests such as x-rays, ultrasound and/or CT scans may also be used to diagnose your condition. You may also be referred to a specialist for an exam that may include imaging of the spine and brain.

Treatment

The goals of treatment are to control your symptoms and prevent damage to your kidneys. Treatments are focused on improving your quality of life. When neurogenic bladder is watched closely and treated, patients can see large improvements in their quality of life.

Treatment for neurogenic bladder will be decided by your health care provider based on:

  • your age, overall health and medical history
  • the cause of the nerve damage
  • the types of symptoms
  • the severity of symptoms
  • your tolerance for certain drugs, procedures or therapies
  • their expectations for the course of the condition

Some ways to manage neurogenic bladder may include lifestyle changes or medical treatments.

Lifestyle Changes

For those with less nerve damage a good first step may be lifestyle changes, or sometimes called behavioral treatments. These are changes people can make in their daily life to control symptoms. Some lifestyle changes for neurogenic bladder are:

  • Scheduled voiding: Instead of going when you first feel the urge, you try to hold it and pass urine at set times, this can lengthen the amount of time you can hold your urine. In some cases, your doctor may ask you to try to go to the bathroom even if you do not feel the need, to try to empty your bladder at routine times.
  • Limit certain foods and drinks: Some foods and drinks have been found as irritants to the bladder. Some people have found spicy foods, coffee, tea and colas to be bothersome. It may be of great value to try to notice how food and drinks affect you and your symptoms.
  • Double voiding: This can be helpful for those who really have a hard time getting their bladder empty, or have the steady feeling to void after already passing urine. With double voiding, after passing urine, you wait a few seconds to a minute and then relax and try again to empty the last bits of urine from your bladder.
  • Delayed voiding: If you have OAB symptoms, you start by delaying urination a few minutes. You slowly increase the time to a few hours. This helps you learn how to put off voiding, even when you feel an urge.
  • Pelvic floor exercises: These may help you relax your bladder muscle when it starts squeezing or can increase the strength of your sphincter muscles. Your nurse or doctor can tell you about these exercises in more detail or you may be referred to a specialized physical therapist.

Medical Treatments

When lifestyle changes do not help enough, your doctor may ask you to try some other choices, such as prescription drugs or catheters.

    • OAB drugs: These can help to relax overactive bladder muscles. These may be taken by mouth, or delivered through the skin with a gel or a patch.
    • Catheters: This is often a treatment used for underactive bladder. This small tube is inserted into your urethra to help your bladder empty fully. There are two types:
      • Clean intermittent catheterization (CIC) is the type you put in yourself many times a day to empty your bladder. Depending on your symptoms, your health care provider may ask you to do this 3 to 4 times a day, leaving it in only long enough to empty your bladder. Sometimes clean intermittent catheterization can help improve how your bladder works after several weeks or months. Intermittent catheters may be hard for some people with hand coordination problems.
      • Continuous catheterization stays in place to drain urine at all times. The catheter can be placed through the urethra or can be surgically placed through a small incision in the lower belly directly into the bladder (called a suprapubic tube). The catheter needs to be changed every 4-6 weeks.
    • Botulinum toxin (Botox ®) which are shots injected into the bladder muscle. This drug may help keep your bladder from contracting too often. Over time, this treatment wears off. It may need to be repeated in 6 months or a year.
    • Sacral neuromodulation (SNS) therapy is used for patients with overactive bladder when other drugs or lifestyle changes don't help. The sacral nerves carry signals between your spinal cord and the bladder. Changing these signals can improve overactive bladder symptoms. The surgeon places a thin wire close to the sacral nerves. Then the wire is connected to a small battery placed under your skin. It delivers harmless electrical impulses to the bladder to stop the "bad" signals that can cause overactive bladder.
    • Percutaneous tibial nerve stimulation (PTNS) uses a needle inserted into a nerve in your leg called the tibial nerve. The needle is connected to a device that sends electrical impulses. The impulses travel to the tibial nerve, and then to the sacral nerve. This is done in your health care provider's office. Most patients receive 12 weekly treatments and them monthly treatments.
  • Surgery is used to help some patients. Some surgeries may include:
      • Artifical sphincter: This device helps treat severe urinary incontinence when the urethral sphincter muscle isn't working correctly. Surgery is required to place the sphincter cuff around the urethra while a pump is placed under the skin in the scrotum or labia. The pump is used to open the sphincter and allow you to pass urine.
    • Urinary diversion surgery: In this procedure the surgeon creates an opening called a stoma on the belly. Depending on the surgery, a catheter can be passed through the stoma to empty the bladder or an external collection pouch is placed over the stoma to catch the urine.
    • Bladder augmentation (augmentation cystoplasty): Part of the intestine is removed and attached to the walls of the bladder. This increases the size of the bladder and helps it store more urine.
    • Sphincter resection: The weak portion of the urethral sphincter muscle is removed. In some cases sphincterotomy is performed, in which the entire muscle may be cut.

Updated September 2021


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