Neurogenic Bladder

3D man with Intestinal problems sitting on the toiletWhat is neurogenic bladder?

Neurogenic bladder is a condition in which the nerves that govern the urinary system and signal when urine should be held in or released from the bladder are disrupted, causing patients to lose bladder control.

The bladder can become either overactive (spastic or hyper-reflexive) or underactive (flaccid or hypotonic).

  • Overactive bladder (often seen with strokes, brain diseases and Parkinson’s disease). With overactive bladders, urination is frequent and uncontrolled, capacity is low and there is incomplete emptying. Bladder capacity may decrease because it is rarely filled to capacity. Residual urine, left if the bladder is not emptied completely, may lead to increased risks of urinary tract infections.
  • Underactive bladder (common in diabetes, polio, syphilis, multiple sclerosis and prior radical pelvic surgery). With underactive bladders, there is a diminished sense of when the bladder is full and individuals cannot contract the sphincter muscles sufficiently, allowing urine to leak from the urethra as the bladder fills beyond its limits.

 

Causes

Conditions that can precipitate a neurogenic bladder include

  • Brain or spinal cord injury
  • Diabetes
  • Acute infections
  • Neurological disorders including Parkinson’s disease and stroke
  • Genetic nerve disorders
  • Heavy metal poisoning

 

Symptoms

  • Urinary incontinence
  • Frequent urination (urinating eight or more times daily)
  • Urgency (feeling the need to urinate immediately)
  • Dribbling urine
  • Loss of sensation of bladder fullness
  • Painful urination which may result from a urinary tract infection
  • Kidney stones

Diagnosis

Diagnostic tests can include:

  • The skull and spine may be examined with X-rays, computed tomography (CT), and magnetic resonance imaging (MRI)
  • An EEG to measure electrical activity in the brain
  • Imaging tests of the bladder and ureters
  • Urodynamic studies (bladder function tests) to measure bladder capacity, bladder pressures, the flow of urine and bladder emptying.
  • Cystoscopy (where a telescope is used to examine the inside of the bladder and urethra)