Neurogenic Bladder

The bladder, located in the pelvis, is a hollow, muscular, balloon shaped organ that stores urine. The kidneys make urine when they filter the blood. Urine flows from the kidneys through a pair of thin tubes, the ureters, to the bladder, where it is stored until a person urinates. During urination, muscles in the wall of the bladder contract, forcing urine out of the bladder and into a tube called the urethra. At the same time, the sphincter muscles that surround the urethra relax.

Nerves carry messages from the bladder to the brain, telling the brain that the bladder is full. Then the brain sends messages back to the muscles of the bladder, telling them either to tighten or release. For the urinary system to work right, these muscles and nerves must work together to hold urine in the bladder and then release it at the right time.

In a neurogenic bladder the message-carrying nerves do not work properly. The result is that the bladder can be overactive, that is, it contracts too quickly or frequently, leading to urinary frequency, incontinence (inability to control urination) or urine leakage. Or the bladder can be unable to contract and/or empty completely. If it becomes too full, urine may back up into the kidneys. The extra pressure can cause damage to the tiny blood vessels in the kidney. Or urine that stays too long may lead to an infection in the bladder or ureters.

Symptoms of Neurogenic Bladder

In addition to the problems mentioned above, other symptoms of neurogenic bladder are:

• A dribbling urinary stream
• Urinary urgency
• Inability to urinate or straining during urination
• Painful urination (dysuria)
• Urinary tract infection (UTI) caused by urine being held too long in the bladder; UTI with fever is a sign of potential severe kidney infection (pyelonephritis) that can cause permanent kidney damage
• Urinary tract stones caused by the stoppage of urine flow and/or infection
• Vesicoureteral reflux (VUR) or backup of urine from the bladder to the kidney(s) (a way of releasing pressure in the bladder when it doesn’t empty itself); this can be dangerous if a person as a UTI because the infected urine is sent back to kidneys, which can cause kidney infection

Causes of Neurogenic Bladder

Neurogenic bladder is a result of damage to nerves and nerve pathways. Common causes of this are:

• Accidents that injure the brain or spinal cord
• Heavy metal poisoning
• Diabetes
• Acute infections are among the ways nerves and nerve pathways can be damaged
• Birth defects, including spina bifida and other spinal cord and nerve problems

Diagnosis of Neurogenic Bladder

Diagnosis of neurogenic bladder usually involves testing both the nervous system (including the brain) and the bladder itself. Diagnostic tests may include:

• X-rays of the skull and spine
• EEG (electroencephalogram): wires are taped to the forehead to sense any brain dysfunction (similar to an electrocardiogram test of the heart)
• Bladder muscle and nerve tests, including x-rays of the bladder and ureters and filling the bladder to check its capacity and ability to empty completely

Treatment for Neurogenic Bladder

Treatment for neurogenic bladder depends on the type of problem (overactive or underactive bladder) and cause of the nerve damage. Options include:

For overactive bladder, incontinence, urine leakage:

• Medications that help the bladder stay relaxed (so it doesn’t contract and empty itself at the wrong time or leak urine)
• Antibiotics for treatment of UTI
• Surgical replacement of the sphincter muscle (which holds urine in by squeezing the urethra shut)
• In extreme cases, surgery to increase bladder size, construct an alternate tube for emptying the bladder, or make other changes to the urinary system

For inability to urinate, urinary retention:

• Use of a catheter (a thin tube that is slid through the urethra, up to the bladder) to regularly empty the bladder
• Endoscopic surgery to improve urine flow
  • Endoscopic surgery uses an endoscope, a very thin, tubular medical instrument that can be inserted into the body for diagnostic exams and surgical procedures
  • Endoscopic surgery is considered minimally invasive because it does not require a major incision or long recovery period