Neurogenic bladder occurs when neurological (nervous system) conditions affect the bladder. Depending on the nerves involved and the nature of the damage, the neurogenic bladder can be either overactive or underactive.

What is the Bladder?

The bladder is a hollow organ located in the pelvis or lower abdominal region. It serves two crucial functions:

• It stores urine.
• It expels urine from the body through a complex communication network with the spinal cord and the brain.

When a person cannot control their urination, a condition called urinary incontinence occurs. If the bladder cannot empty completely or if the person leaks urine before reaching the toilet (a condition known as overactive bladder), it may indicate a problem with urine storage. Urinary incontinence can also occur when the bladder is not emptied (overflow incontinence), the sphincter controlling urine flow does not work (stress incontinence), or bladder spasms cause leakage before reaching the toilet (urge incontinence).

What Causes Neurogenic Bladder?

Neurogenic bladder can result from congenital (present at birth) causes. Some congenital conditions that can lead to a neurogenic bladder are:

• Spina bifida (myelomeningocele): This disorder occurs when the fetus’s spine does not fully develop during the first month of pregnancy. Babies born with myelomeningocele often have paralysis or weakness that affects the function of the bladder.
• Sacral agenesis: A condition where parts of the lower spine are missing.
• Cerebral palsy: A group of chronic disorders that weaken a person’s ability to control body movement and posture. These disorders result from injuries to the brain’s motor area and can be caused by problems that occur in the womb or after birth. Cerebral palsy may not become apparent in every child until the first year of life.

Various medical conditions can also lead to neurogenic bladder, including:

• Stroke
• Parkinson’s disease
• Multiple sclerosis
• Spinal cord injuries
• Spinal surgeries
• Erectile dysfunction
• Trauma/accidents
• Central nervous system tumors
• Heavy metal poisoning

What Are the Symptoms of Neurogenic Bladder?

The most common symptom of neurogenic bladder is the inability to control urine. Other symptoms may include:

•  Weak or dribbling urine stream
•  Frequent urination (urinating eight or more times a day)
•  Urgency (feeling or needing to urinate immediately)
•  Painful urination, which may indicate a urinary tract infection

How Is Neurogenic Bladder Diagnosed?

• Urodynamic studies: These studies include bladder function tests that measure how much urine the bladder can hold, the pressure inside the bladder, how well urine flows, and how well the bladder empties. Special sensors can be placed inside the urinary tract (through a tube where urine passes) or on the skin near the rectum to see if the muscles and nerves in these areas are functioning properly.
• Cystoscopy: A procedure where a doctor uses a small telescope (cystoscope) to examine the inside of the bladder and urethra.
•  X-rays
•  Computed tomography (CT) scans
•  Magnetic resonance imaging (MRI)

How Is Neurogenic Bladder Treated?

The main treatments for neurogenic bladder include:

• Clean intermittent catheterization (CIC): Catheters are thin and flexible tubes that can be inserted into the bladder through the urethra to empty urine.
• Medications: These may include anticholinergic medications like oxybutynin, tolterodine, and others.
• Botulinum A toxin (Botox®) injections: Your doctor may inject Botox into the bladder or urinary sphincters.
• Bladder augmentation (augmentation cystoplasty): This is a surgical procedure where segments of the intestine (sigmoid colon) are removed and attached to the bladder walls. This procedure reduces the internal pressure of the bladder and increases its urine storage capacity.
• Ileal conduit: A portion of the small intestine is used to create a urinary stoma. This stoma diverts urine out of the body and into an external pouch.
• Lifestyle changes: These may include avoiding certain foods or beverages that can irritate the bladder. Examples include caffeinated drinks like coffee, carbonated beverages, spicy foods, and citrus fruits. Weight loss can reduce pressure on the bladder. Behavioral therapy called “delayed voiding” can help some people achieve better urinary control.
  Absorbent undergarments, pads, daily liners, and adult diapers can help protect the skin and clothing while preventing wetness and odors. Bed pads, sheets, and mattress protectors can be useful for protecting the bed.