Neurogenic Bladder: Symptoms, Causes, Diagnosis, and Treatment

There are several different types of bladder control problems. One of these is called neurogenic bladder, which means that the cause of your urination problems is related to the nerves that control your bladder.

Neurogenic bladder can cause you to have an overactive bladder, underactive bladder, or both.

Symptoms of Neurogenic Bladder

The symptoms of neurogenic bladder include a variety of urination problems, some of which may actually seem to be at odds with one another. Neurogenic bladder can manifest with urinary incontinence (loss of bladder control) as well as urinary retention (the inability to release urine).

You may experience any combination of the following symptoms with neurogenic bladder:

• Feeling the urge to urinate frequently
• Releasing only small amounts of urine each time you go to the toilet
• Leaking of urine without noticing it
• Leaking of urine without the ability to stop it
• The sudden urge to urinate, with little or no warning
• Impaired ability to start the stream of urine
• Impaired ability to completely empty the bladder
• Unusual, uncomfortable, or painful sensations in the lower abdominal area

Effects of Neurogenic Bladder

Incontinence and urinary retention can both cause a variety of problems, with often unpleasant consequences.

Effects of incontinence (urinary leaking):

• Wetting clothes
• Unpleasant odor from urine leaks
• Skin irritation from urine leaks
• Sores on the skin that may be painful and can become infected
• Unpredictability of urinary urges
• Embarrassment due to leaking small or large amounts of urine when around other people

Effects of urinary retention (bladder retention):

• Physical discomfort
• Abdominal pain or pressure
• Urinary tract infection resulting from urine remaining in the bladder for too long, which can allow infectious bacteria to thrive. A urinary tract infection often requires treatment with prescription-strength medications.
• Kidney damage due to pressure from the bladder, which may lead to kidney dilation (hydronephrosis), increased creatinine, or other issues as a result of incomplete emptying of the bladder.

Causes of Neurogenic Bladder

There are several causes of neurogenic bladder, which are are generally serious neurological conditions that produce a variety of different symptoms in addition to neurogenic bladder. However, these illnesses do not always cause neurogenic bladder, because they do not always impair the nerves associated with bladder control.

The most common of causes of neurogenic bladder include:

• Multiple sclerosis
• Stroke
• Nerve damage from surgery
• Spine injury
• Neuropathy, including diabetic neuropathy
• Dementia
• Cancer

These medical problems can interfere with the function of the nerves that control your bladder. The bladder itself is a muscular sac that holds the body's fluid waste after it gets filtered in the kidneys.

Normally, the bladder holds a reasonable amount of urine (the typical adult bladder capacity is 500 milliliters) until it is convenient to urinate, and then, right before urination, the pelvic floor muscles relax and the bladder muscle voluntarily squeezes to release urine from the body. There are nerves that "activate" the bladder muscles to start, stop, or hold in the urine, depending on the situation and your conscious intentions.

Neurogenic bladder occurs when the nerves are not able to maintain this control of holding in the urine or releasing the urine at the most convenient time.

Diagnosis of Neurogenic Bladder

Your healthcare provider can diagnose neurogenic bladder based primarily on your history of symptoms. Sometimes, further testing can help with the diagnosis.

Additional tests that you may need include:

• Urinalysis
• Urine culture
• Bladder ultrasound
• Cystoscopy
• Urodynamic testing

These tests may not specifically identify neurogenic bladder, but they can provide additional information to help your healthcare provider rule out other causes, and they can identify complications, such as an infection.

Treatment of Neurogenic Bladder

There are several effective treatments for neurogenic bladder. Medical and surgical management of neurogenic bladder is complicated and often requires a team of healthcare providers and therapists. Sometimes, you may need a combination of different treatments, or you might need to have your medication or therapy adjusted as you are getting started on the treatment.

A number of medications are available to help control the bladder muscles. They include the following.

• Anticholinergics: oxybutynin, tolterodine, fesoterodine, darifenacin, trospium, and solifenacin. Trospium does not cross the blood-brain barrier and may be best suited for older patients or those with confusion.
• Beta-3 adrenergic receptor agonists: Myrbetriq (mirabegron) and Gemtesa (vibegron), the only drugs currently available of this type, relax the bladder muscle and increase bladder capacity.
• Other medications: estrogen therapy, imipramine, and amitriptyline. These medications act on the nerves or muscles to help you regain some control of the urination process.

Therapies for neurogenic bladder include:

• Treatment of the underlying cause (multiple sclerosis, neuropathy, etc.).
• Surgical treatment involves placement of nerve stimulators or devices to help optimize nerve and muscle function in neurogenic bladder.
• Injections of medication can be administered directly into the muscles that control the bladder.
• Bladder training through physical therapy or occupational therapy.
• Using a catheter to empty the bladder: a catheter is a straw-like tube that can be inserted into the bladder to allow the urine to flow. This method is only useful under certain circumstances of urinary retention; you will be given instructions about how to do it from a healthcare professional until you feel ready to do it on your own.
• Lifestyle modification can help you cope with the symptoms, though it cannot cure the condition. Modification options include wearing a pad or diaper, urinating on a schedule to avoid surprises, and avoiding drinks and medications that are either dehydrating or have a diuretic effect (promoting excess fluid loss from the body). You can also help prevent UTIs by making an effort to keep your bladder as empty as possible. If you have recurrent UTIs with painful or uncomfortable symptoms, ask your healthcare provider for a referral for further management with a urologist and/or infectious disease specialist.

A Word From Verywell

Neurogenic bladder can be an inconvenient result of several medical conditions. In addition to the embarrassment and discomfort associated with a lack of bladder control, neurogenic bladder can also cause additional health problems, such as infections and sores.

There are effective ways to manage neurogenic bladder so that you can lead a productive life with as little interference of your bladder dysfunction as possible. Your medical team can direct you to the best resources to manage your life with neurogenic bladder.

Since you may need lifestyle adjustments as well as medical therapy, it is important to maintain contact with your medical team and to follow up closely so that you can benefit from the best treatment plan available for you.