(Neurogenic Incontinence—Adult)
Definition
Definition
Neurogenic bladder is abnormal bladder function caused by a nerve problem. The bladder may empty too often or at the wrong time ( incontinence) or the bladder may be unable to completely empty the urine (urinary retention). In this case, urine may leak out of the overfilled bladder.
Contact your doctor if you think you may have this condition. The sooner it is treated, the lower the chance of developing other serious conditions, such as a urinary tract infection.
Bladder With Nerves, FemaleCopyright © Nucleus Medical Media, Inc.
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Causes
Causes
Neurogenic bladder is caused by problems with the nerves carrying messages between the bladder and the brain. The nerve problems may be caused by:
- Spinal cord injury
- Tumors of the brain or spinal cord in the pelvic area
- Infection of the brain or spinal cord
- Medical conditions affecting the nerves, such as:
Risk Factors
Risk Factors
Factors that increase your chance of developing neurogenic bladder include:
- Nerve or spinal cord conditions present since birth, such as spina bifida or spinal cord tumor
- Diabetes
- Stroke
Symptoms
Symptoms
Symptoms of neurogenic bladder may include:
- Urinary incontinence
- Dribbling urine stream
- Straining during urination
- Inability to urinate (urinary retention)
- Overflow of urine from a full bladder
- Painful urination
Diagnosis
Diagnosis
You will be asked about your symptoms and medical history. A physical exam will be done. You may be asked to keep a diary of how often you empty your bladder and other urinary habits. If your doctor thinks that your symptoms may be caused by a nerve problem, you may have some of the tests below. You may also be referred to an urologist for further evaluation and treatment.
Your bodily fluids may be tested. This can be done with:
- Urinalysis
- Blood tests
Images may be taken of your kidneys, ureters, and bladder. This can be done with:
Other tests may be done, including:
- Bladder function tests
- Urodynamics
Treatment
Treatment
Treatment focuses on relieving symptoms by emptying your bladder regularly.
Treatment options include:
Behavioral Therapy
- Bladder training—setting a regular schedule to empty your bladder and drinking less fluid
- Exercises to strengthen muscles around the bladder that help control urine flow
- Painless electrical stimulation to help the function of bladder muscles
Catheters
A thin tube, called a catheter, can be inserted to empty the bladder. You can learn to do this yourself or a trained healthcare professional may do it for you.
Medications
Your doctor may recommend anticholinergic drugs (antimuscarinics) or botulinum toxin injections to help control symptoms.
Surgery
Surgery may be an option for severe cases when all other treatments fail. Surgical procedures include:
- Removing part of the muscle that holds the bladder closed—This allows urine to flow out into a collection tube attached to the penis (for men only).
- Inserting a tube into an opening in the abdomen—This allows urine to flow out into a collection bag.
- Using tissue from the bowel to make the bladder larger
- Replacing the bladder with a pouch made from sections of the bowel or other tissue
- Inserting a small tube-like device, called a stent, into the bladder neck to allow urine to flow out.
Prevention
Prevention
While most cases of neurogenic bladder cannot be prevented, people with diabetes may be able to delay or avoid the problem by carefully controlling their blood sugar levels over the long-term. Also, wearing seat belts and avoiding activities that increase the risk of spinal cord injuries will prevent neurogenic bladder from this cause.
RESOURCES:
Urology Care Foundation http://www.urologyhealth.org
CANADIAN RESOURCES:
HealthLink BC http://www.bchealthguide.org
References:
Nerve disease and bladder control. National Kidney and Urologic Diseases Information Clearinghouse website. Available at:
http://kidney.niddk.nih.gov/kudiseases/pubs/nervedisease/index.htm
Updated June 29, 2012. Accessed October 27, 2014.
Neurogenic bladder. Urology Care Foundation website. Available at:
http://www.urologyhealth.org/urology/index.cfm?article=9
Updated May 2014. Accessed October 27, 2014.
Scientific Committee of the First International Consultation on Incontinence. Assessment and treatment of urinary incontinence. Lancet. 2000;355:2153-2158.
7/28/2014 DynaMed’s Systematic Literature Surveillance
http://www.ebscohost.com/dynamed:
Mangera A, Apostolidis A, et al. An updated systematic review and statistical comparison of standardised mean outcomes for the use of botulinum toxin in the management of lower urinary tract disorders. Eur Urol. 2014;65(5):981-990.
Last Updated: 12/20/2014