The bladder, a balloon-shaped organ located in the pelvis, functions as a storage reservoir for urine before it is eliminated from the body. This process of filling and emptying is precisely controlled by complex signals between the bladder muscles and the nervous system, including the brain, spinal cord, and peripheral nerves. A healthy bladder relies on these coordinated nerve messages to know when to relax and fill, and when to contract and empty, ensuring proper urinary control.
What is Neurogenic Bladder?
Neurogenic bladder describes a condition where nerve damage disrupts communication between the brain and the bladder. This damage impairs the bladder’s ability to store or release urine effectively. Also known as neurogenic lower urinary tract dysfunction (NLUTD), it causes bladder muscles to not tighten or relax as they should, leading to control problems.
Primary Types of Neurogenic Bladder
Neurogenic bladder primarily manifests in two distinct classifications: overactive (spastic or hyperreflexic) bladder and underactive (flaccid or areflexic) bladder, depending on the nature and location of the nerve damage.
Overactive/Spastic Bladder (Hyperreflexic Bladder)
In an overactive neurogenic bladder, nerve damage causes the detrusor muscle to contract involuntarily and frequently, even when the bladder is not full. This leads to symptoms like a sudden, strong urge to urinate (urgency), frequent urination (more than eight times in 24 hours), and urinary incontinence. The bladder may empty too quickly, making it difficult to defer urination or store larger volumes.
Underactive/Flaccid Bladder (Areflexic Bladder)
Conversely, an underactive neurogenic bladder occurs when nerve damage prevents bladder muscles from contracting effectively. This leads to incomplete bladder emptying, causing urine to remain and potentially overstretching the bladder. Individuals may experience difficulty initiating urination, a weak or dribbling stream, or a feeling of incomplete emptying. In severe cases, this can result in overflow incontinence, where urine leaks when the bladder is overly full.
Underlying Conditions Leading to Neurogenic Bladder
Neurogenic bladder can arise from various neurological conditions and injuries. Common causes include:
Spinal cord injuries, which disrupt nerve pathways between the brain and bladder.
Neurological diseases like Multiple Sclerosis (MS), Parkinson’s Disease, and stroke, damaging central nervous system control.
Conditions present at birth, such as spina bifida, due to spinal cord developmental issues.
Diabetes, leading to diabetic neuropathy and damage to peripheral nerves.
Major pelvic surgeries, which can result in nerve damage.
Recognizing the Signs
Individuals with neurogenic bladder may experience a range of symptoms. These can include:
Urinary incontinence (involuntary leaking of urine).
Frequent urination (needing to urinate often).
A sudden, strong need to urinate (urgency).
Difficulty starting urination or a weak, dribbling urine stream.
A persistent feeling of incomplete bladder emptying.
Recurrent urinary tract infections (UTIs), as incomplete emptying can lead to bacterial growth.
Approaches to Diagnosis and Management
Diagnosis
Diagnosing neurogenic bladder involves a comprehensive evaluation of the nervous system and bladder function. Healthcare providers begin with a detailed medical history, physical exam, and urine tests to check for infections.
Specialized tests include urodynamic studies, which assess how the lower urinary tract stores and releases urine by measuring bladder capacity and pressure. Imaging techniques like ultrasound, MRI, and X-rays of the skull, spine, bladder, and ureters are used to identify nerve damage or structural changes. Cystoscopy, involving a thin tube with a camera, allows for direct visualization of the urinary tract.
Management
Management strategies improve bladder function. Behavioral therapies, such as timed voiding schedules, can help regain some control. Medications are prescribed to relax an overactive bladder or improve contractions in an underactive one.
Catheterization, either intermittent (self-insertion multiple times a day to drain urine) or continuous (an indwelling tube for constant drainage), is a common method to ensure complete bladder emptying, especially for underactive bladders. Botulinum toxin injections into the bladder muscle can help relax an overactive bladder.
When other treatments are insufficient, surgical interventions, such as bladder augmentation to increase bladder size or the placement of an artificial sphincter, may be considered.