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Neurogenic bladder

Neurogenic detrusor overactivity; NDO; Neurogenic bladder sphincter dysfunction; NBSD

 

Neurogenic bladder is a problem in which a person lacks bladder control due to a brain, spinal cord, or nerve condition.

Causes

 

Several muscles and nerves must work together for the 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.

Disorders of the central nervous system commonly cause neurogenic bladder. These can include:

  • Alzheimer disease
  • Birth defects of the spinal cord, such as spina bifida
  • Brain or spinal cord tumors
  • Cerebral palsy
  • Encephalitis
  • Learning disabilities such as attention deficit hyperactivity disorder (ADHD)
  • Multiple sclerosis (MS)
  • Parkinson disease
  • Spinal cord injury
  • Stroke

Damage or disorders of the nerves that supply the bladder can also cause this condition. These can include:

  • Nerve damage (neuropathy)
  • Nerve damage due to long-term, heavy alcohol use
  • Nerve damage due to long-term diabetes
  • Vitamin B12 deficiency
  • Nerve damage from syphilis
  • Nerve damage due to pelvic surgery
  • Nerve damage from a herniated disk or spinal canal stenosis

 

Symptoms

 

The symptoms depend on the cause. They often include symptoms of urinary incontinence.

Symptoms of overactive bladder may include:

  • Having to urinate too often in small amounts
  • Problems emptying all the urine from the bladder
  • Loss of bladder control

Symptoms of underactive bladder may include:

  • Full bladder and possibly urine leakage
  • Inability to tell when the bladder is full
  • Problems starting to urinate or emptying all the urine from the bladder (urinary retention)

 

Treatment

 

Medicines may help manage your symptoms. Your health care provider may suggest:

  • Medicines that relax the bladder (oxybutynin, tolterodine, or propantheline)
  • Medicines that make certain nerves more active (bethanechol)
  • Botulinum toxin
  • GABA supplements
  • Anti-epileptic drugs

Your provider may refer you to someone who has been trained to help people manage bladder problems.

Skills or techniques you may learn include:

  • Exercises to strengthen your pelvic floor muscles (Kegel exercises)
  • Keeping a diary of when you urinate, the amount you urinated, and if you leaked urine. This may help you learn when you should empty your bladder and when it may be best to be near a bathroom.

Learn to recognize the symptoms of urinary infections (UTIs), such as burning when you urinate, fever, low back pain on one side, and a more frequent need to urinate. Cranberry tablets may help prevent UTIs.

Some people may need to use a urinary catheter. This is a thin tube that is inserted into your bladder. You may need a catheter to be:

  • In place all the time (indwelling catheter).
  • In your bladder 4 to 6 times a day to keep your bladder from becoming too full (intermittent catheterization).

Sometimes surgery is needed. Surgeries for neurogenic bladder include:

  • Artificial sphincter
  • Electrical device implanted near the bladder nerves to stimulate the bladder muscles
  • Sling surgery
  • Creation of an opening (stoma) in which urine flows into a special pouch (this is called urinary diversion)

 

Support Groups

 

If you are having urinary incontinence, organizations are available for further information and support.

 

Possible Complications

 

Complications of neurogenic bladder may include:

  • Constant urine leakage that can cause skin to break down and lead to pressure sores
  • Kidney damage if the bladder becomes too full, causing pressure to build up in the tubes leading to the kidneys and in the kidneys themselves
  • Urinary tract infections

 

When to Contact a Medical Professional

 

Call your provider if you:

  • Are unable to empty your bladder at all
  • Have signs of a bladder infection (fever, burning when you urinate, frequent urination)
  • Urinate small amounts, frequently

 

 

References

Chapple CR, Osman NI. The underactive detrusor. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:chap 77.

Goetz LL, Klausner AP, Cardenas DD. Bladder dysfunction. In: Cifu DX, ed. Braddom's Physical Medicine and Rehabilitation. 5th ed. Philadelphia, PA: Elsevier; 2016:chap 20.

Panicker JN, DasGupta R, Batla A. Neurourology. In: Daroff RB, Jankovic J, Maziotta JC, Pomeroy SL, eds. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 47.

 
  • Voiding cystourethrogram

    Voiding cystourethrogram - illustration

    One method of examining bladder function is by injecting dye that is visible on X-rays through a tube (catheter) to fill the bladder. X-rays are taken while the bladder is full and while the patient is urinating (voiding) to determine if fluid is forced out of the bladder through the urethra (normal) or up through the ureters into the kidney (vesicoureteral reflux). This study is usually done with the patient lying on an X-ray table.

    Voiding cystourethrogram

    illustration

    • Voiding cystourethrogram

      Voiding cystourethrogram - illustration

      One method of examining bladder function is by injecting dye that is visible on X-rays through a tube (catheter) to fill the bladder. X-rays are taken while the bladder is full and while the patient is urinating (voiding) to determine if fluid is forced out of the bladder through the urethra (normal) or up through the ureters into the kidney (vesicoureteral reflux). This study is usually done with the patient lying on an X-ray table.

      Voiding cystourethrogram

      illustration

    A Closer Look

     

      Talking to your MD

       

        Self Care

         

          Tests for Neurogenic bladder

           

             

            Review Date: 5/30/2016

            Reviewed By: Amit M. Shelat, DO, FACP, Attending Neurologist and Assistant Professor of Clinical Neurology, SUNY Stony Brook, School of Medicine, Stony Brook, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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