Patient education: Neurogenic bladder in adults (The Basics)

What is neurogenic bladder? — 

This means problems with bladder control that happen in people with conditions affecting the brain, spinal cord, or nerves. Neurogenic bladder most often happens in people who have a spinal cord injury. 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? — 

Symptoms can include:

●Urgency – You might feel a strong urge to urinate, but then only pass a small amount of urine.

●Frequent urination – You might feel like you need to urinate 8 or more times per day.

●Problems starting to urinate or emptying the bladder – You might only "dribble" urine rather than having a normal urine stream. You might not fully empty your bladder.

●Urinary incontinence – This is when you lose bladder control and leak urine.

●Trouble knowing if your bladder is full

●Repeated urinary tract infections ("UTIs") – These 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. They will want to know what medicines you take, including over-the-counter and prescription medicines. They might also ask you to keep a diary of your urinary habits, such as how often you empty your bladder.

Your doctor or nurse will also do an exam. This often includes a pelvic exam for females or a rectal exam for males.

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

Tests might include:

●Urine tests

●Blood tests

●Bladder function tests, also called "urodynamics" – 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 the doctor can see if your bladder can empty all the way.

●Imaging tests, including X-rays, ultrasound, CT scan, and MRI – These create pictures of the inside of the body.

●Cystoscopy – The doctor inserts a thin, flexible tube called a "cystoscope" into your urethra. Then, they guide it into your bladder. The cystoscope has a camera on the end. This lets the doctor see the inside of your bladder. Sometimes, they also take a sample of tissue (called a "biopsy") to look at under a microscope.

These tests can help your doctor figure out the cause of your symptoms.

How is neurogenic bladder treated? — 

Treatments might include:

●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, you might need a permanent catheter.

●Prescription medicines – Some relax the bladder, such as oxybutynin (brand name: Ditropan) and 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.

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

What can I do on my own? — 

Your doctor or nurse might recommend doing things to help you better control your bladder. These might include:

●Bladder training – You go to the bathroom at scheduled times. For instance, you might decide you will go every hour. You make yourself go every hour, even if you don't think 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 how much time you wait between bathroom visits. Over time, you might be able to "train" your bladder to wait 3 or 4 hours between bathroom visits.

●Pelvic floor muscle exercises – The "pelvic floor" is the name for the muscles that support the organs in the pelvis. These muscles also help control the flow of urine and bowel movements. You can learn ways to strengthen and relax these muscles. Your doctor or nurse might also suggest working with a physical therapist who has special training in pelvic floor issues. They can check your muscle strength and teach you specific exercises.

It can also help to cut down on any foods or drinks that make your symptoms worse. Alcohol and caffeine might irritate your bladder.

When should I call the doctor? — 

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

●Neurogenic bladder, and get symptoms of a UTI, such as:

•Pain or a burning feeling when urinating

•Needing to urinate more often

•Needing to urinate right away or in a hurry

•Blood in your urine

•Cloudy urine

•Fever

More on this topic

Patient education: Urinary incontinence in females (The Basics)
Patient education: Urinary incontinence in males (The Basics)
Patient education: Treatments for urgency incontinence in females (The Basics)
Patient education: Bladder spasm (The Basics)
Patient education: Urinary tract infections in adults (The Basics)
Patient education: Cystoscopy (The Basics)
Patient education: How to use a catheter to empty the bladder in females (The Basics)
Patient education: How to use a catheter to empty the bladder in males (The Basics)
Patient education: Botulinum toxin injections (The Basics)
Patient education: Bladder training (The Basics)
Patient education: Pelvic floor muscle exercises (The Basics)

Patient education: Urinary incontinence in women (Beyond the Basics)
Patient education: Urinary incontinence treatments for women (Beyond the Basics)
Patient education: Urinary tract infections in adults (Beyond the Basics)
Patient education: Pelvic floor muscle exercises (Beyond the Basics)