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What is Neurogenic Bladder?

Millions of Americans have neurogenic bladder. Neurogenic bladder is the name given to a number of urinary conditions in people who lack bladder control due to a brain, spinal cord or nerve problem. This nerve damage can be the result of diseases such as multiple sclerosis (MS), Parkinson's disease or diabetes. It can also be caused by infection of the brain or spinal cord, heavy metal poisoning, stroke, spinal cord injury, or major pelvic surgery. People who are born with problems of the spinal cord, such as spina bifida, may also have this type of bladder problem. Nerves in the body control how the bladder stores or empties urine, and problems with these nerves cause overactive bladder (OAB), incontinence, and underactive bladder (UAB) or obstructive bladder, in which the flow of urine is blocked.

The Urinary System

The 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 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. The brain tells the bladder muscles to squeeze (or "contract"). This forces the urine out through your urethra, the tube that carries urine from your body. 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. Bladder muscles may be overactive and squeeze more often than normal and before the bladder is full with urine. Sometimes the muscles are too loose and let urine pass before you're ready to go to the bathroom (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. They also depend on the type of nerve damage the person has. Some people have symptoms of both overactive and underactive bladder. People with MS, stroke and herpes zoster are more likely to have both kinds of symptoms. Urinary Tract Infection People with overactive and underactive bladder can get repeated urinary tract infections. These are often the first symptom of neurogenic bladder. This repeated illness is caused by harmful bacteria, viruses or yeast growing in the urinary tract. Leaking Urine (incontinence) with Overactive Bladder In overactive bladder (often seen with strokes, brain disease and Parkinson's disease), the muscles squeeze more often than normal. Sometimes this squeezing causes urine to leak before you're ready to go to the bathroom (incontinence). With overactive bladder, you feel a sudden urge to go the bathroom that you can't ignore. This "gotta go" feeling makes you afraid you will leak urine if you don't get to a bathroom right away. You may or may not leak urine after feeling this urge to go. 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. Frequency in OAB Another OAB symptom is going to the bathroom many times during the day or night. (You may produce only small amounts of urine.) The number of times someone urinates differs from person to person. But many experts agree that going to the bathroom more than 8 times in 24 hours is "frequent urination." Urinary Retention/Obstruction with Underactive Bladder In people with an underactive bladder (often seen with diabetes, MS, polio, syphilis or major pelvic surgery), 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 are trying to empty your bladder. With UAB symptoms, you may only produce a "dribble" of urine. You may not be able to empty your bladder fully (urinary retention). Sometimes you may not be able to empty your bladder at all (obstructive bladder). How Can Neurogenic Bladder Affect Your Life? The symptoms of neurogenic bladder can seriously affect your quality of life. They may make it difficult for you to get through your day without interruptions. You may feel afraid to go out with friends, take vacations or do everyday things. You may be afraid you may not be able to find a bathroom when you need one. Some people begin to cancel activities and withdraw from their lives. Neurogenic bladder may affect your work and your relationships. You may feel tired, depressed, anxious and lonely. If you are experiencing incontinence, the leaking urine can sometimes cause skin problems or infections. What Should You Do If You Are Having Symptoms? It is important to talk with your health care provider and find out what is causing your symptoms. The symptoms of neurogenic bladder may seem like the symptoms of other illnesses and medical problems. Your health care provider can help rule out other issues. Sometimes neurogenic bladder symptoms can lead to more serious bladder problems. But there are a number of treatments available. You and your health care provider can decide which treatment is best for you.

Diagnosis

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Neurogenic bladder involves the nervous system and the bladder. Your health care provider will conduct different tests to determine the health of both. Medical History Your health care provider will ask you a number of questions to understand your medical history. This should include information about the symptoms you are having, how long you have had them, and how they are changing your life. A medical history will 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 should also ask you about your diet, and about how much and what kinds of liquids you drink during the day. Physical Exam Your health care provider will examine you to look for something that may be causing your symptoms. In women, the physical exam will likely include your abdomen, the organs in your pelvis and your rectum. In men, the physical exam will include your abdomen, prostate and rectum. Bladder Diary You may be asked to keep a bladder diary, where you will note how often you go to the bathroom and any time you leak urine. This will help your health care provider learn more about your day-to-day symptoms. Pad Test During this test, you will wear a pad that had been treated with a special dye. The pad changes color when you leak urine. Other Tests Urine culture : Your health care provider may ask you to leave a sample of your urine to test for infection or blood. : Your health care provider may ask you to leave a sample of your urine to test for infection or blood. Bladder scan : This type of ultrasound shows how much urine is still in the bladder after you go to the bathroom. : This type of ultrasound shows how much urine is still in the bladder after you go to the bathroom. Cystoscopy : During this test, the doctor inserts a narrow tube with a tiny lens into the bladder. This allows them to rule out other causes of your symptoms. : During this test, the doctor inserts a narrow tube with a tiny lens into the bladder. This allows them to rule out other causes of your symptoms. Urodynamic testing: These tests check how well your lower urinary tract stores and releases urine. There are several urodynamic tests you may be asked to take. You may be asked to urinate 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: Your health care provider may need to do additional imaging tests such as x-rays and CT scans 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

Neurogenic bladder is a serious condition, but when it is watched closely and treated the best way, patients can see large improvements intheir quality of life. Specific treatment for neurogenic bladder will be decided by your health care provider based on: