Neurogenic bladder is the loss of normal bladder function caused by damage to part of the nervous system.
The nervous system controls two processes in the lower urinary tract to maintain continence. One is relaxing the bladder wall so that it can fill with urine until the person wants to urinate. At that point, the bladder wall contracts. The other is the urinary sphincter. The sphincter acts like a valve at the opening of the bladder. It contracts to hold urine in the bladder. The person relaxes it to release urine when the bladder contracts. A person with urinary incontinence from a neurogenic bladder has leakage of urine because the nervous system that controls the bladder or the sphincter is not working properly. Either the bladder is unable to relax or the sphincter is unable to close.
Injury to the brain and spinal cord above the waist level produces a bladder that is unable to relax, or one that contracts too frequently. Such injuries include stroke, spinal cord injury, head injury and multiple sclerosis.
A weak or inactive urinary sphincter is caused by injuries to the nerves that go from the spinal cord to the sphincter. These injuries happen with trauma or surgery, or a person may be born with them.
The leakage of urine may be constant or intermittent. It may or may not be associated with the urge to urinate. This depends on the level of the nervous system injury. Urinary tract infections may occur frequently.
A complete history and physical exam and a detailed neurologic exam may be needed to pinpoint the exact nervous system injury. Other tests show the function of the lower urinary tract and help to guide treatment. These include a cystogram, which means putting contrast material into the bladder for X-rays. Urodynamics tests measure the pressure on the bladder and urethra. In cystoscopy, the urethra and bladder are examined with a small telescope.
There is no way to prevent this condition.
A bladder wall that does not relax or that contracts too often can lead to high bladder pressure. The pressure can back up into the kidneys and damage them. If the problem is the urinary sphincter, there is no risk of kidney damage. The incontinence itself may make urinary tract infections and hygiene problems more likely. Skin irritation and odor are likely to occur.
There are no risks to others.
The goals of treatment are to control infection, and prevent incontinence. This can be accomplished by regular evacuation of the urine from the bladder, medications, or surgery.
Evacuations of urine from the bladder include Crede's method, and intermittent self-catherization. Crede's method involves applying manual pressure with the use of the hand over the lower abdomen. This promotes complete emptying of the bladder.
Intermittent self-catherization involves the insertion of a rubber tube into the bladder on a set schedule to empty the bladder. A person can be trained to do this him or herself.
A male can use a condom catheter. A condom catheter looks like an ordinary condom that attaches at the end to a short tube leading into a drainage bag. The drainage bag catches the urine. The bag attaches to the leg or stomach and can be worn underneath clothing. Another option for drainage is a urinary catheter, a thin rubber tube that is inserted into the bladder and left in place.
If the bladder problem is not too severe, a medication called oxybutynin may be taken to relax the bladder. If the bladder wall relaxes enough, and the person purposely urinates often, the incontinence may be prevented.
Medications do not usually work for problems with the urinary sphincter. Surgery to repair the sphincter may be needed. Surgery is also used for bladder problems if they do not do not respond to medications. The urine is diverted to an outside opening made in the abdomen called an ostomy. This is accomplished by removing a short segment of the small intestines. The ureters are connected to this segment of small intestines. This is then attached to the opening in the abdomen. The urine is then collected in a bag that is applied to the abdomen.
Medications to relax the bladder may cause dry mouth, constipation, and drowsiness. The use of a urinary catheter carries an increased risk of infection.
Surgery to enlarge the bladder with pieces of intestine can have the usual side effects of major intestinal surgery. These include a long time on a special diet, and some pain after surgery. Infection, bleeding, and rupture of the bladder are also possible.
The person should be encouraged to drink plenty of fluids. This will help prevent urinary tract infections, bladder stones, and kidney stones. If surgery was performed, teaching will need to be done on the care of the ostomy.
A person with neurogenic incontinence needs to be watched to make sure the kidneys are not affected. This is done with kidney function blood tests, urine tests, and x-rays of the kidneys.
Author:Stuart Wolf, MD
Editor:Duff, Ellen, BA
Reviewer:Karen Preston, PHN, MS, CRRN
The Merck Manual of Medical Information, Home edition, 1997
Professional Guide to Diseases, Sixth Edition. Springhouse: Springhouse Corporation, 1998
Tierney, Lawrence, editor, "Current Medical Diagnosis and Treatment, 39th edition", 2000