Neurogenic bladder
Neurogenic detrusor overactivity; NDO; Neurogenic bladder sphincter dysfunction; NBSDNeurogenic bladder is a problem in which a person lacks bladder control due to a brain, spinal cord, or nerve condition.
Causes
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:
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Alzheimer disease
Alzheimer disease
Dementia is a loss of brain function that occurs with certain diseases. Alzheimer disease (AD) is the most common form of dementia. It affects memo...
Read Article Now Book Mark Article - Birth defects of the spinal cord, such as spina bifida
- Brain or spinal cord tumors
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Cerebral palsy
Cerebral palsy
Cerebral palsy (CP) is a group of disorders that involve the brain. This affects nervous system functions, such as movement, learning, hearing, seei...
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Encephalitis
Encephalitis
Encephalitis is irritation and swelling (inflammation) of the brain, most often due to infections.
Read Article Now Book Mark Article - Learning disabilities such as attention deficit hyperactivity disorder (ADHD)
Attention deficit hyperactivity disorde
Attention deficit hyperactivity disorder (ADHD) is a problem caused by the presence of one or more of these findings:Not being able to focusBeing ove...
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Multiple sclerosis (MS)
Multiple sclerosis
Multiple sclerosis (MS) is an autoimmune disease that affects the brain and spinal cord (central nervous system).
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Parkinson disease
Parkinson disease
Parkinson disease results from certain brain cells dying. These cells help control movement and coordination. The disease leads to shaking (tremors...
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Spinal cord injury
Spinal cord injury
Spinal cord trauma is damage to the spinal cord. It may result from direct injury to the cord itself or indirectly from disease of the nearby bones,...
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Stroke
Stroke
A stroke occurs when blood flow to a part of the brain stops. A stroke is sometimes called a "brain attack. " If blood flow is cut off for longer th...
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Damage or disorders of the nerves that supply the bladder can also cause this condition. These can include:
- Nerve damage (neuropathy)
- Nerve damage due to long-term, heavy alcohol use
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Nerve damage due to long-term diabetes
Nerve damage
Nerve damage that occurs in people with diabetes is called diabetic neuropathy. This condition is a complication of diabetes.
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Nerve damage due to vitamin B12 deficiency
Vitamin B12
Vitamin B12 is a water-soluble vitamin. Water-soluble vitamins dissolve in water. After the body uses what it needs of these vitamins, leftover amo...
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Syphilis
Neurosyphilis is a bacterial infection of the brain or spinal cord. It usually occurs in people who have had untreated syphilis for many years....
Read Article Now Book Mark Article - Nerve damage due to pelvic surgery
- Nerve damage from a herniated disk or spinal canal stenosis
Spinal canal stenosis
Spinal stenosis is narrowing of the spinal column that causes pressure on the spinal cord, or narrowing of the openings (called neural foramina) wher...
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Symptoms
The symptoms depend on the cause. They often include symptoms of urinary incontinence.
Urinary incontinence
Urinary (or bladder) incontinence occurs when you are not able to keep urine from leaking out of your urethra. The urethra is the tube that carries ...
Read Article Now Book Mark ArticleSymptoms of overactive bladder may include:
- Having to urinate too often but 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 or tolterodine)
- Medicines that make certain nerves more active (bethanechol)
- Botulinum toxin
- GABA supplements
- Antiepileptic medicines
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)
Kegel exercises
Pelvic floor muscle training exercises are a series of exercises designed to strengthen the muscles of the pelvic floor.
Read Article Now Book Mark Article - 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.
Urinary tract infections
A urinary tract infection, or UTI, is an infection of the urinary tract. The infection can occur at different points in the urinary tract, including...
Read Article Now Book Mark ArticleSome 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:
Urinary catheter
A urinary catheter is a tube placed in the body to drain and collect urine from the bladder.
Read Article Now Book Mark Article- 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:
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Artificial sphincter
Artificial sphincter
Sphincters in the urinary system are muscles that allow your body to hold in urine. An inflatable artificial (man-made) sphincter is a medical devic...
Read Article Now Book Mark Article - 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.
Organizations
The following organizations are good resources for information on incontinence. Fecal (bowel) incontinence:International Foundation for Functional Ga...
Read Article Now Book Mark ArticlePossible Complications
Complications of neurogenic bladder may include:
- 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.
Goetz LL, Klausner AP. Neurogenic lower urinary tract dysfunction. In: Cifu DX, ed. Braddom's Physical Medicine & Rehabilitation. 6th ed. Philadelphia, PA: Elsevier; 2021:chap 20.
Panicker JN, DasGupta R, Batla A. Neurourology. In: Jankovic J, Maziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 45.
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Voiding cystourethrogram - illustration
One method of examining bladder function is by injecting dye that is visible on X-rays through a tube (catheter) to fill the bladder. X-rays are taken while the bladder is full and while the patient is urinating (voiding) to determine if fluid is forced out of the bladder through the urethra (normal) or up through the ureters into the kidney (vesicoureteral reflux). This study is usually done with the patient lying on an X-ray table.
Voiding cystourethrogram
illustration
-
Voiding cystourethrogram - illustration
One method of examining bladder function is by injecting dye that is visible on X-rays through a tube (catheter) to fill the bladder. X-rays are taken while the bladder is full and while the patient is urinating (voiding) to determine if fluid is forced out of the bladder through the urethra (normal) or up through the ureters into the kidney (vesicoureteral reflux). This study is usually done with the patient lying on an X-ray table.
Voiding cystourethrogram
illustration
Review Date: 6/13/2024
Reviewed By: Joseph V. Campellone, MD, Department of Neurology, Cooper Medical School at Rowan University, 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.