What Is Neurogenic Bladder?
Neurogenic bladder is when a problem in your brain, spinal cord, or central nervous system makes you lose control of your bladder. You may pee too much or too little. You could have symptoms of both overactive bladder (OAB) and underactive bladder (UAB). You may not be able to fully empty it.
It’s normal to have some stress and anxiety if you can’t control when you urinate. Talk to your doctor about what’s going on as soon as possible so you can start a treatment to help manage your symptoms.
Neurogenic Bladder Symptoms
Your symptoms will depend on what’s causing the condition. But if you have neurogenic bladder, you may have one or more of the following:
Urge incontinence. Nerves and muscles work together to keep urine in your bladder. But if you have symptoms of OAB, you may feel like you need to pee even if your bladder isn’t full. Even if you try to hold your urine in, the urge may come on so fast and strong that you can’t get to the bathroom in time.
Obstructive bladder. If you have UAB, your urinary muscles may squeeze together when they should loosen. As a result, they may be too tight to let urine pass.
Overflow incontinence. With UAB, your brain may not get the signal that your bladder is full and it’s time to pee. Your bladder may stretch and hold large amounts of urine. You may not be able to empty it all the way (urinary retention). When this happens, you’ll leak urine when your bladder overflows.
Frequent urinary tract infections (UTIs). You may get frequent UTIs when bacteria or other germs grow in your urinary tract. UTIs may be the first sign that your bladder isn’t working the right way. People with symptoms of OAB or UAB can get them.
Kidney stones. You’re more likely to form kidney stones (hard masses made of minerals like calcium) if urine stays in your bladder for a long time or your pee becomes concentrated. You may get a certain type of kidney stone called a struvite stone from UTIs.
Erectile dysfunction. Men or people assigned male at birth who have neurogenic bladder can have problems with sexual function, including infertility. You may have trouble getting an erection, having an orgasm, or ejaculating. This may happen because of injury to the nerves that go between your penis and your brain or because of psychological factors.
Neurogenic Bladder Causes and Risk Factors
An illness or injury can affect the nerves and muscles in your urinary system. This includes your bladder and urethra. Conditions that might lead to neurogenic bladder include:
- Multiple sclerosis (MS)
- Parkinson’s disease
- Stroke
- ALS (Lou Gehrig’s disease)
- Alzheimer’s disease or other dementias
- Brain or spinal cord tumors
Some people have it when they’re born or shortly afterward. This can happen with:
- Spina bifida
- Sacral agenesis (parts of the lower spine missing)
- Cerebral palsy
Neurogenic bladder may also happen with nerve damage (neuropathy) from:
- Infection or tumor in your brain or spinal cord
- Poison from heavy metals
- Spinal cord injury
- Pelvic surgery
- Diabetes
- A herniated disk
Neurogenic Bladder Diagnosis
Your doctor will want to know your symptoms and medical history. You may need to see a specialist, such as a urologist. They may do one or all of these things:
Have you keep a bladder diary. Keep track of how often you go to the bathroom and at what time of day. Write down how much pee comes out and if you have any leaks. Also, note what you eat and drink. You may notice a pattern that can help your doctor find the best treatment.
Measure urine leakage. A special pad turns a different color if you leak urine onto it.
Test your urine. A urinalysis can show if you have an infection or blood in your pee.
Look inside your bladder. Doctors can put a tiny camera into your bladder to see if there's a tumor, kidney stone, or other blockage (cystoscopy).
Urodynamic tests. This measures how much urine your bladder can hold and how long it takes to empty.
Imaging tests. These can include an ultrasound, X-ray, MRI, or CT scan. They may also put a dye into your bladder (cystography).
Electroencephalography (EEG) and electromyography (EMG). An EEG checks to see if there's a problem in your brain, while an EMG checks the nerves and muscles in your bladder.
Neurogenic Bladder Complications
Without treatment, neurogenic bladder can affect your quality of life or cause other health problems.
Neurogenic bladder complications can include:
- Backward flow of urine from your bladder up to your kidneys (vesicoureteral reflux)
- Swelling in one or both of your kidneys (hydronephrosis)
- Kidney damage or failure if there’s a lot of extra pressure from backed-up pee
- Blood in your urine due to kidney damage or kidney stones
- Urinary infections, including your bladder, ureters, or kidneys
- Permanent damage to your bladder and urethra
You can lessen the chances you’ll have neurogenic bladder complications if you see your doctor regularly. Tell them about any new symptoms or old ones that get worse. Let your health care team know anytime you get a fever or pain that doesn’t go away. This could be a sign of an infection.
Neurogenic Bladder Treatment
Your care will depend on what’s causing your symptoms and how serious they are. Whether you have symptoms of OAB or UAB also matters. While there’s no cure for neurogenic bladder, you can manage your symptoms and get control.
Your doctor may suggest medication, lifestyle changes, or other treatments including:
Overactive bladder treatment
If you have OAB, you may need to:
- Train your bladder. You can do this by squeezing your pelvic floor muscles during the day or when you need to pee (Kegel exercises).
- Hold it, if you can. Delayed voiding is when you wait a few minutes to urinate after you feel the urge. The goal is to extend this time to a few hours.
- Pee on a schedule. You might avoid accidents if you urinate at certain, regular times of the day.
- Take medicine. Some medications can relax bladder muscles and stop spasms.
- Use electrical stimulation. A device under your skin sends electricity to the nerve that controls your bladder. These painless pulses help stop overactive signals that tell your brain to pee.
- Get Botox. Your doctor can inject this neurotoxin into your bladder to temporarily stop it from contracting too much. If you have trouble emptying your bladder or have UTIs often, Botox isn't an option.
Rarely, your doctor may suggest surgery to help manage your symptoms. These procedures may boost how much urine your bladder can hold or help you control when you pee.
Underactive bladder treatment
If you have UAB, you may need to:
- Schedule your bathroom visits. Your doctor might suggest you try to pee every 2 to 4 hours, even if you don’t feel the urge. After you urinate, wait a few minutes and try again.
- Use a catheter. This long, thin tube helps drain your bladder. You may need to use it a few times a day. In some cases, it may need to stay in all the time. This is the go-to treatment for UAB.
- Try electrical stimulation. You may be able to get a device put under your skin to help you pee. One kind is called sacral neuromodulation. It’s used for OAB and UAB and sends signals to the nerves that control your bladder.
- Have surgery. If other treatments fail, you could need a procedure or device to help you urinate.
Home remedies for neurogenic bladder treatment
Along with medical treatment, your doctor may suggest that you:
- Keep a healthy weight. Extra body mass can put pressure on your bladder, especially if you tend to carry your weight in your midsection.
- Change your diet. Things such as caffeine, alcohol, spicy foods, dairy, artificial sweeteners, chocolate, and citrus fruits can irritate your bladder. Ask your doctor to refer you to a dietitian to know more about which diet changes might benefit your bladder.
- Get the right amount of fluid. Stay hydrated no matter your symptoms. But you may need to change how much water you drink depending on if you’re trying to pee more or less often. Ask your doctor what’s the right amount of liquid for you.
- Manage constipation. You might pee more often or leak urine if you go a while without pooping. That’s because a full colon can put pressure on your bladder. Getting enough fluid and fiber in your diet may help you stay regular.
- Stop smoking. Smoking can make you cough a lot, which can make you leak urine (stress incontinence). The chemicals in tobacco products can also damage your blood vessels and raise your odds of bladder cancer (your kidneys filter toxins that end up in your pee).
Takeaways
Neurogenic bladder is when there’s a problem with the muscles and nerves that control your bladder. You may pee too much or too little. Treatment includes lifestyle changes, medications, and sometimes devices or surgery. Pelvic floor exercises and bladder training can help you gain more control. Work with your doctor to find the right treatment plan.
Neurogenic Bladder FAQs
How do you treat a neurogenic bladder?
Treatment for neurogenic bladder depends on your symptoms, but the goal is to improve your quality of life and protect your kidneys. You may gain more control with diet and lifestyle changes, pelvic floor exercises, medication, or other medical treatments. Sometimes, surgery or devices can help you pee more or less often.
What is a flaccid neurogenic bladder?
This is when your bladder muscles don’t contract when they should. Flaccid neurogenic bladder causes symptoms of underactive bladder. When that happens, your bladder can fill with pee and overflow, causing you to leak urine.
What is a spastic neurogenic bladder?
This is when your bladder muscles squeeze on their own, causing overactive bladder. You may feel like you need to pee even if there’s not much urine in your bladder. You may leak urine if your bladder muscles don’t coordinate well with the sphincter muscles in your urethra (the part of your body that opens and closes to keep urine in or to let pee out.
How to train a neurogenic bladder
If you have overactive bladder (OAB), you’ll learn exercises (such as Kegels) to strengthen your pelvic floor muscles. Strong pelvic floor muscles can help you hold your pee in for longer once you get the urge to go.
What is the first-line treatment for neurogenic bladder?
Lifestyle changes are often the first thing your doctor will suggest. This may include bladder training, diet changes, or pelvic floor exercises. If those don’t help enough, your doctor may give you medication to relax your bladder muscles (if you have OAB) or catheters (a tube that helps empty your bladder when you have UAB).
