Neurogenic Bladder: A Brief Guide
What Is Neurogenic Bladder?
- Neurogenic bladder means your bladder isn’t working properly because of nerve, brain, or spinal cord damage.
- The bladder, urethra, and nervous system normally coordinate to store and release urine. When the nerve signals are disrupted, that coordination is lost.
- It may lead to leakage, frequent urination, inability to empty, or a mix of problems.
- Neurogenic Bladder is also referred to as Neurogenic Lower Urinary Tract Dysfunction (NLUTD)
Types & Patterns of Dysfunction
Depending on where and how the nerves are affected, bladder behavior can vary:
|
Pattern |
What Happens |
Symptoms You Might See |
|
Overactive bladder / storage problem |
Bladder muscle (detrusor) contracts too often or unpredictably |
Urgency, frequent urination, incontinence |
|
Underactive bladder / emptying problem |
Bladder muscle doesn’t contract well or at all |
Urine retention, weak stream, dribbling |
|
Detrusor-sphincter dyssynergia (DSD) |
Bladder contracts while sphincter resists — a mismatch |
High pressure in bladder, may push urine upward → kidney risk |
|
Mixed dysfunction |
Some combination of overactivity + underactivity |
Both leakage and incomplete emptying |
Common Causes & Risk Factors
- Spinal cord injury or trauma
- Multiple sclerosis, Parkinson’s disease, stroke
- Nerve damage from diabetes or surgery
- Tumors on the brain or spinal cord
Signs & Symptoms to Watch For
- Frequent urination or strong, sudden urgency
- Leakage or incontinence
- Weak or interrupted flow
- Difficulty emptying the bladder completely
- Recurrent urinary tract infections
- Kidney stones
- Unable to feel that the bladder is full
How It’s Evaluated & Diagnosed
- Medical history & symptom review
- Physical exam, sometimes including neurologic exam
- Urinalysis & urine culture
- Bladder ultrasound (checking how much urine remains after urination)
- Imaging of the head and spine
- Urodynamic testing to assess bladder pressure, muscle behavior, flow dynamics
- Cystoscopy in some cases to visualize the bladder/urethra
Management & Treatment Strategies
Behavioral & Conservative Measures
- Scheduled voiding or toileting schedules
- Double voiding (urinate, wait, then try again)
- Limiting fluid intake before bed
- Avoiding bladder irritants (caffeine, alcohol)
Catheterization & Drainage Options
- Intermittent catheterization (IC): Insert catheter periodically to empty bladder fully
- Indwelling catheter: a tube left in bladder (short or long term)
- External (condom) catheter: for men, a sheath-type device to collect urine
Medications & Injections
- Anticholinergics to reduce bladder overactivity
- Other bladder-relaxing drugs, e.g. beta-3 agonists
- Botulinum toxin (Botox) injections into the bladder wall to reduce involuntary contractions
Neuromodulation & Advanced Therapies
- Sacral nerve stimulation or peripheral nerve stimulation
- Surgical options: bladder augmentation, diversion, reconstructive procedures (in severe cases)
Goals of Therapy & Monitoring
- Prevent damage to kidneys and upper urinary tract
- Maintain safe bladder pressures
- Minimize UTIs and bladder distention
- Maximize continence (control of leakage)
- Preserve quality of life
Remember: Always ask your healthcare provider for specific advice on when to call to report symptoms, and when to seek urgent/emergency care.
This handout is for educational purposes only and is not a substitute for professional medical advice. Always follow your healthcare provider’s instructions.
Sources:
- https://www.uptodate.com/contents/neurogenic-bladder-in-adults-the-basics?search=neurogenic%20bladder&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2
- https://my.clevelandclinic.org/health/diseases/15133-neurogenic-bladder
- https://www.hopkinsmedicine.org/health/conditions-and-diseases/neurogenic-bladder
- https://www.urologyhealth.org/urology-a-z/n/neurogenic-bladder