Patient education: Neurogenic bladder in adults (The Basics)

What is neurogenic bladder? — This is the name for problems with bladder control that happen in people with conditions affecting the brain or spinal cord. Neurogenic bladder most often happens in people who have a spinal cord injury. Conditions like multiple sclerosis, a stroke, and many other disorders can also cause neurogenic bladder.

For normal control of the bladder, nerves carry signals between the brain, the bladder, and the muscles that control bladder filling and emptying (figure 1). In many conditions that affect the brain or spinal cord, these nerves do not work normally.

What are the symptoms of neurogenic bladder? — People with this condition might have 1 or more of the following:

●Urinate small amounts more often than usual – They might feel a strong urge to urinate but then pass only a small amount of urine.

●Have problems starting to urinate or emptying their bladder – Some people notice that they only "dribble" urine rather than having a normal urine stream.

●Lose bladder control and leak urine – This is called "incontinence."

●Trouble knowing if their bladder is full

●Repeated urinary tract infections ("UTIs") – UTIs are caused by bacteria growing in the bladder or urinary tract.

Are there tests for neurogenic bladder? — Yes. Your doctor or nurse will ask about your symptoms and do an exam. They might also ask you to keep a diary of your urinary habits, such as how often you empty your bladder.

For other tests, your doctor will likely refer you to another doctor who specializes in bladder problems, such as a urologist or gynecologist. Tests you might need include:

●Urine test

●Blood test

●Bladder function tests – These are also called "urodynamics." For these tests, the doctor puts a thin tube (called a "catheter") into your urethra and fills your bladder with fluid. They measure how much your bladder can hold. You then release the fluid so that the doctor can see if your bladder can empty all of the way.

●Imaging tests – These tests create pictures of the inside of the body. They can include X-rays, an ultrasound, a CT scan, and an MRI.

Should I see a doctor or nurse? — Yes. Your doctor or nurse can help figure out what is causing your bladder problems. They can also recommend treatments that can relieve your symptoms.

See your doctor or nurse right away if:

●You have new loss of bladder control, especially if you also have back pain or leg weakness.

●You have neurogenic bladder and get symptoms of a UTI, such as:

•Pain or a burning feeling when you urinate

•Needing to urinate often

•Needing to urinate right away or in a hurry

•Blood in the urine

•Fever

How is neurogenic bladder treated? — Your doctor or nurse might recommend things you can do on your own. These might help you better control your bladder:

●Bladder retraining – You go to the bathroom at scheduled times. For instance, you might decide that you will go every hour. You make yourself go every hour, even if you don't feel like you need to. You try to wait until a whole hour has passed if you need to go sooner. Then, once you get used to going every hour, increase the amount of time you wait between bathroom visits. Over time, you might be able to "retrain" your bladder to wait 3 or 4 hours between bathroom visits.

●Pelvic floor muscle training – This involves learning exercises to strengthen and relax your pelvic muscles. These include the muscles that control the flow of urine and bowel movements. These exercises can help, but people often do them wrong. Ask your doctor or nurse how to do them right.

Other treatments might include:

●Prescription medicines – Some of these relax the bladder, such as oxybutynin (brand name: Ditropan) or propantheline (brand name: Pro-Banthine). Others can make certain nerves more active, such as bethanechol (brand name: Urecholine). You might also need antibiotics if you get a UTI.

●Bladder catheter – If you cannot empty your bladder completely, you might need to put a thin, flexible tube (called a "catheter") in your urethra a few times a day. The catheter helps you empty your bladder and avoid infection and other problems. In rare cases, a permanent catheter is needed.

If your problems are more serious and medicines and a catheter do not help enough, you might need other treatments to control your bladder. These can include nerve stimulators, botulinum toxin (Botox) injections, and surgery.

More on this topic

Patient education: Urinary incontinence in females (The Basics)
Patient education: Pelvic floor muscle exercises (The Basics)
Patient education: Bladder spasm (The Basics)
Patient education: Lowering the risk of a catheter-associated urinary tract infection (The Basics)
Patient education: How to remove a urinary catheter (The Basics)
Patient education: Suprapubic catheter placement (The Basics)
Patient education: Autonomic dysreflexia (The Basics)

Patient education: Urinary incontinence in women (Beyond the Basics)
Patient education: Urinary incontinence treatments for women (Beyond the Basics)