Several muscles and nerves must work together for the bladder to hold urine until you are ready to empty it. Nerve messages go back and forth between the brain and the muscles that control bladder emptying. If these nerves are damaged by illness or injury, the muscles may not be able to tighten or relax at the right time.
Disorders of the central nervous system commonly cause neurogenic bladder. These can include:
Nerve damage from a herniated disk or spinal canal stenosis
Symptoms
The symptoms depend on the cause. They often include symptoms of urinary incontinence.
Symptoms of overactive bladder may include:
Having to urinate too often in small amounts
Problems emptying all the urine from the bladder
Loss of bladder control
Symptoms of underactive bladder may include:
Full bladder and possibly urine leakage
Inability to tell when the bladder is full
Problems starting to urinate or emptying all the urine from the bladder (urinary retention)
Treatment
Medicines may help manage your symptoms. Your health care provider may suggest:
Medicines that relax the bladder (for example, oxybutynin, tolterodine, or propantheline)
Medicines that make certain nerves more active (bethanechol)
Botulinum toxin
GABA supplements
Antiepileptic drugs
Your provider may refer you to someone who has been trained to help people manage bladder problems.
Skills or techniques you may learn include:
Exercises to strengthen your pelvic floor muscles (Kegel exercises)
Keeping a diary of when you urinate, the amount you urinated, and if you leaked urine. This may help you learn when you should empty your bladder and when it may be best to be near a bathroom.
Learn to recognize the symptoms of urinary tract infections (UTIs), such as burning when you urinate, fever, low back pain on one side, and a more frequent need to urinate. Cranberry tablets may help prevent UTIs.
Some people may need to use a urinary catheter. This is a thin tube that is inserted into your bladder. You may need a catheter to be:
In place all the time (indwelling catheter).
In your bladder 4 to 6 times a day to keep your bladder from becoming too full (intermittent catheterization).
Sometimes surgery is needed. Surgeries for neurogenic bladder include:
Electrical device implanted near the bladder nerves to stimulate the bladder muscles
Sling surgery
Creation of an opening (stoma) in which urine flows into a special pouch (this is called urinary diversion)
Electrical stimulation of the tibial nerve in the leg may be recommended. This involves placing a needle into the tibial nerve. The needle is connected to an electrical device that sends signals to the tibial nerve. The signals then travel up to the nerves in the lower spine, which control the bladder.
Support Groups
If you are having urinary incontinence, organizations are available for further information and support.
Possible Complications
Complications of neurogenic bladder may include:
Constant urine leakage that can cause skin to break down and lead to pressure sores
Kidney damage if the bladder becomes too full, causing pressure to build up in the tubes leading to the kidneys and in the kidneys themselves
Urinary tract infections
When to Contact a Medical Professional
Contact your provider if you:
Are unable to empty your bladder at all
Have signs of a bladder infection (fever, burning when you urinate, frequent urination)
Urinate small amounts, frequently
References
Chapple CR, Osman NI. The underactive detrusor. In: Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 118.
Review Date:
4/25/2022
Reviewed By:
Joseph V. Campellone, MD, Department of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.