Voiding Dysfunction and Neurogenic Bladder

Overview • CausesSymptomsEvaluationTreatment 

Overview - What is a Neurogenic Bladder?

The bladder is a hollow organ that has two main roles.

  1. Fill and store urine without leakage (incontinence)
  2. Empty urine at a time of your choosing

In order to accomplish these two goals, there are several nerve pathways and control center that need to work in coordination.  Anytime there is a break in the pathway or a disruption in the communication, one or both of the functions of the bladder may be disrupted.    Such disruption can lead to problems like incontinence, inability to empty the bladder or, less commonly, kidney disease. 

Causes

There are many causes of a neurogenic bladder.  Common causes include neurological conditions such as:

  1. Stroke
  2. Parkinson’s Disease
  3. Multiple Sclerosis
  4. Spinal Cory Injury / Surgeries
  5. Central Nervous System Tumors
  6. Transverse Myelitis
  7. Spinal Bifida

Nerve pathways may also be affected by other disease such as diabetes, pelvic surgeries or radiation.

Symptoms

Neurogenic bladders present with a wide array of symptoms.  Simply, bladders usually fall into two categories; overactive or underactive.

An overactive bladder will often present with incontinence.  Leakage may be caused by an overactive bladder (one that wants to squeeze more than you want it to), by a stiff bladder or because of sphincteric incompetence. 

An underactive bladder usually retains all or some of the urine.  Urinary incontinence may or may not be seen in this scenario.

Evaluation

A careful history is necessary to understand what condition(s) may predispose you to a neurogenic bladder.  We will also ask you to complete a 3 day bladder diary to give us a better understanding of your voiding habits at home.  The hallmark of the evaluation, is a test called urodynamics.  With this test, we will take your bladder through its normal  phases and try to understand how your bladder is functioning to allow us to better tailor a treatment plan. 

Depending on the cause and the findings on urodynamics, we will often obtain a renal ultrasound to evaluate the kidneys.

Treatment

The treatment for a neurogenic bladder is multi-factorial.  Our main goal is to achieve a good quality of life using the resources available to each individual patient.  Treatment plans are tailored to the patient and their caregivers (if needed) abilities and goals and may involve a combination of option.

Treatment options may include medications such as anticholinergics or beta-3 agonists.  Other procedures include using BotoxÒ for incontinence and electrical stimulation techniques.  Surgical procedures such as augmentation Enterocystoplasty, urinary diversion and catheterizable stomas will also be explored as indicated.  If you are not able to empty your bladder, we will discuss different kinds of catheterization techniques including clean intermittent catheterization.

Our philosophy in managing your neurogenic bladder is to set goals of care together (these may change as the causative disease changes) and work towards a feasible plan to achieve those goals.