Definition & Overview

Neurogenic bladder is a condition wherein the brain is unable to control bladder function due to an injury to the spinal cord – the main communication line between the brain and different organs. Various diseases or disorders that affect the spinal cord can also cause such a condition.

The bladder is part of the urinary system, which also includes the kidneys, ureters, and urethra. The kidneys filter blood to extract waste products that are transferred to the bladder as urine. When the bladder is full, it sends signals to the brain informing it of its state. The brain will then make the bladder muscles contract and release urine out of the body through the urethra.

The communication between the bladder and the brain is made possible by the spinal cord. If the spinal cord is injured or affected by a disease, the communication process is interrupted, resulting in several medical conditions including either an overactive or underactive bladder. An overactive bladder is characterized by frequent urination or incontinence even when the bladder is not full. On the other hand, an underactive bladder occurs when the bladder is filled beyond its capacity resulting in too much pressure on the muscles. This condition will then lead to the inability of the muscles to retain urine, which will eventually leak into the urethra.

Cause of Condition

Neurogenic bladder is caused by the inability of the brain to communicate with the bladder and vice versa due to a problem with the nerves that run through the spinal cord. The problem can be caused by an injury, disease, or disorder. Some of the most common causes of spinal cord problems are, Parkinson’s disease, spinal cord injury, stroke, tumors of the brain or spinal cord, birth defects that affect the spinal cord, encephalitis, attention deficit hyperactivity disorder (ADHD), and multiple sclerosis.

Other conditions, such as nerve damage, vitamin B12 deficiency, and nerve damage due to diabetes, syphilis, and excessive alcohol consumption can also be the primary cause of the condition.

Key Symptoms

The symptoms of neurogenic bladder will depend on the exact problem. People with an overactive bladder will experience the need to urinate frequently because they feel that the bladder has not been emptied.

Meanwhile, those who have an underactive bladder problem will find it difficult to urinate even though the bladder is full. However, urine will often leak due to the damage to the bladder muscles.

Neurogenic bladder can also lead to a variety of health problems, such as frequent urinary tract infections because of the body’s inability to flush the bacteria, viruses, or yeast in the urinary tract. The infection could then spread to the kidneys causing serious problems. If the infection enters the bloodstream, it can travel to other parts of the body, causing life-threatening conditions.

Neurogenic bladder not only causes health concerns, but also social problems as well. Due to their condition, patients often experience fear of meeting with friends or performing chores outside, such as shopping for groceries, since they avoid situations and locations wherein they won’t have access to a bathroom.

The condition can also affect relationships because it often results in fatigue, anxiety, loneliness, and depression.

Who to See & Types of Treatment Available

If you are experiencing difficulties urinating, such as incontinence or frequent urination, you should consult your doctor, especially when the condition has begun affecting your way of life.

Your doctor will review your medical history, which will also involve asking questions on the symptoms you’re experiencing. Reviewing your history will provide the doctor an insight of your past medical problems that may have contributed to your current condition. Your doctor may also inquire on your lifestyle, such as your diet and daily activities. This is followed by a physical exam to search for any visual problems in your abdomen, rectum, and prostate for men.

If the doctor determines that you do have a problem with your urinary system, more tests will be performed to determine the exact location of the problem. Keep in mind that the urinary system stretches all the way from the tip of the urethra to the kidneys.

Such tests could include a urine culture to check for infections and a bladder scan to determine if your bladder is emptying fully. The doctor may also perform a procedure called cystoscopy. In this procedure, the doctor will insert a narrow scope up the urethra all the way into the bladder to view its condition. Another test that is typically performed is a urodynamic test to determine how the urinary tract stores and releases urine according to your fluid intake.

If the doctor suspects that the problem could be a neurogenic bladder following the results of the tests, imaging tests of your skull, spine, and urinary tract will be performed. Such tests could include an X-ray, MRI, or CT-scan.

The treatment of neurogenic bladder can include electrical-stimulatory therapy, drug therapy, physical-psychological therapy, intermittent self-catheterization, and surgery.

These different types of therapy are designed to help you improve bladder control despite nerve damage. Surgery is mostly only considered if other forms of treatment fail to improve your condition. Surgical procedures can include the placement of artificial sphincters that will perform the duty of the muscle sphincters. The surgeon may also opt to create a stoma or an opening so that urine is transferred to a collection pouch.

In some cases, the doctor may opt to increase the size of the bladder by performing a bladder augmentation, otherwise known as an augmentation cystoplasty.

References:

  • Wein AJ, Dmochowski RR. Neuromuscular dysfunction of the lower urinary tract. In: Wein AJ, Kavoussi LR, Novick AC, et al., eds. Campbell-Walsh Urology. 10th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 65.
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