Emptying your bladder involves more than just feeling like you have to go to the bathroom. In fact, it is actually your brain that tells you when your bladder needs to be emptied.
Nerve cells within the bladder will send signals to the spinal cord when it is full. The spinal cord is an organized system of nerves extending throughout your body. When it receives cell signals from the bladder, the spinal cord transmits them to the brain. As soon as the brain interprets the signals, you know you have to empty your bladder.
If this part of the nervous system isn't working properly, you may not know when you need to urinate. The inability to control bladder functions due to a nervous system impairment is often diagnosed as a neurogenic bladder.
What Are the Causes of Neurogenic Bladder?
This medical condition is nearly always associated with another condition. Generally, you cannot have a neurogenic bladder disorder unless you have experienced or are experiencing one or more risk factors that impact your nervous system. The risk factors that can cause neurogenic bladder include:
- Multiple sclerosis
- Diabetes
- Spinal cord injury
- Stroke
- Cerebral palsy
- Parkinson's disease
- Spinal cord or brain tumors
- Spina bifida, or other spinal cord defects present at birth
- Alzheimer's disease
- Neuropathy
- Spinal stenosis
- Herniated disk
Simple aging is not a risk factor for a neurogenic bladder. However, aging does increase your risk for diabetes, stroke, Alzheimer's, and other conditions that could damage the nervous system.
Two rare causes of a neurogenic bladder are vitamin B12 deficiency and heavy metal poisoning. Lacking enough B12 in the body can lead to bladder leaks, incontinence, tingling and numbness of your feet and hands, and memory loss.
Certain compounds of mercury, arsenic, manganese, and other heavy metals are known to cause irreversible damage to the nervous system.
Symptoms of a Neurogenic Bladder
Leaking urine, feeling like you have to urinate more than usual, and having the inability to empty the bladder are common signs of a possible neurogenic bladder.
Depending on the level of nerve damage affecting the communication system between the bladder and spinal cord, you might not sense your bladder is full. Recurring urinary tract infections and kidney stones may indicate a neurogenic bladder condition.
Neurogenic Bladder Complications
Kidney damage is one of the most serious complications of a neurogenic bladder. If the bladder repeatedly becomes too full, it puts pressure on the tubes that lead up to the kidneys. This eventual pressure on the kidneys makes the organs have to work harder to function normally.
Another less serious complication involves urine leakage and skin irritations. Just like babies can develop a rash from wearing a wet diaper too long, adults can also experience skin irritation from wearing inferior incontinence products. This type of condition is called incontinence-associated dermatitis.
Symptoms of incontinence-associated dermatitis include:
- Burning and itching of the skin
- Redness and soreness affecting the skin areas exposed to urine
- Large patches of inflammation
- Lesions
IAD can often be avoided by wearing incontinence products made with high-quality materials that absorb urine and prevent it from irritating sensitive skin. Just make sure to change your incontinence products as needed to help prevent leaks and skin irritation.
Neurogenic Bladder Diagnosis
If your physician suspects you have a neurogenic bladder, they will typically conduct a series of bladder, spinal cord, and brain tests. They will also evaluate your past and current medical history to rule out possible causes of neurogenic bladder symptoms.
Tests include but are not limited to:
- X-rays of the spine and skull
- Ultrasounds
- Cystoscopy, which is an examination of the urinary tract by inserting a tube equipped with a camera into the urethra
- Urodynamics, which involves having patients retain urine to see how much their bladder can hold without leaking
Other neurological tests may be done to determine if nerve damage exists due to an underlying medical condition.
The Difference Between a Neurogenic Bladder and Stress Incontinence
When your bladder is partially full and something puts pressure on bladder muscles, such as when you laugh, sneeze, or cough forcefully, that kind of pressure may be too much for the bladder to resist. Consequently, it allows urine to leak out that you can't control at that time.
Leaking small amounts of urine occasionally differs from incontinence. People with stress incontinence can, for the most part, control their urine flow — just not all the time. When muscles supporting the bladder are weakened due to a hysterectomy, prostate disease in men, or obesity, the bladder may slip down enough to reach the pelvic bottom where enough pressure exists to cause stress incontinence.
By preventing muscles that close the urethra from squeezing together to stop urine flow, a stress incontinence condition will allow urine to leak during times of physical or external stress.
Risk factors for stress incontinence include:
- Weight
- History of at least two vaginal deliveries
- Pelvic surgeries
- Chronic coughing due to smoking or allergies
- Diabetes or kidney disease
Unlike stress incontinence, neurogenic bladder symptoms are not fully due to weak bladder muscles. The difference involves nerve damage caused by another medical condition that is characteristic of a neurogenic bladder.
Neurogenic Bladder Treatments
Treatments for a neurogenic bladder are based on the severity of the condition. Doctors may suggest making some lifestyle changes, such as losing weight, cutting out caffeine, or avoiding spicy foods if symptoms are mild to moderate. They might also suggest a behavioral treatment called delayed voiding to help with urine control.
Delayed Voiding
Also called bladder training, delayed voiding involves waiting about 10 minutes to urinate when you feel the urge to go. The purpose of bladder training is to increase the time between urinating so that you reduce the number of trips you make to the bathroom.
Double Voiding
Instead of getting up from the toilet when your urine flow stops, wait one or two minutes and try urinating again. Double voiding can help avoid leakage problems for people with neurogenic bladder and age-related incontinence.
Drug Therapy
Lifestyle changes alone may not make much difference in minimizing neurogenic bladder symptoms. However, a combination of drug therapy and lifestyle changes can make a difference when learning to cope with a neurogenic bladder.
The medications prescribed depend on whether you have an overactive bladder or an underactive bladder. Overactive bladder symptoms involve experiencing leakage, needing to urinate more than eight times in 24 hours, and feeling sudden urges to urinate.
Underactive bladder symptoms include incomplete emptying of the bladder, straining to urinate, and not sensing whether the bladder is empty.
Anticholinergic Drugs
People with a neurogenic bladder and overactive bladder symptoms are generally prescribed anticholinergic medications that relax bladder muscles. This helps reduce leakage or urgency by calming bladder spasms. Cogentin and AtroPen are examples of anticholinergic drugs used to treat a neurogenic, or overactive, bladder.
Antispasmodic Drugs
Antispasmodic drugs also relax bladder muscles. Controlling contraction of the bladder muscles helps improve the ability of the bladder to hold more urine, so you don't feel the urge to urinate all the time.
Antidepressant Medications
Physicians sometimes prescribe tricyclics to treat urge incontinence or a neurogenic bladder. One of the earliest antidepressants to be approved by the FDA, tricyclic antidepressants alter brain chemistry and nerve signaling to help relieve depression and anxiety. However, they can also relax spasmodic bladder muscles that contribute to symptoms of a neurogenic bladder.
Botox Injections
By suppressing nerve activity in bladder muscles, Botox can control urge incontinence and leaks. People who find that Botox helps control a neurogenic bladder typically need to receive an injection every 6-8 months since the effects are only temporary.
Catheterization
Self-Catheterization
Individuals with an underactive bladder are more likely to need catheterization. The suggested method is clean, intermittent catheterization. This involves inserting a catheter tube at home when necessary to allow a full bladder to drain completely.
Indwelling Urinary Catheter
Doctors may insert an indwelling urinary catheter if a patient does not want to perform the insertion at home. These catheters remain in position for several weeks by having a fluid-filled balloon placed in the bladder. Indwelling catheters are not a popular treatment for a neurogenic bladder because they carry a risk of causing UTI infections.
Surgery for a Neurogenic Bladder
Bladder Augmentation
Surgery is only recommended if nothing else works. Bladder augmentation is one type of neurogenic bladder surgery that involves removing a small section of the colon and attaching it to the wall of the bladder. Bladder augmentation reduces pressure on the bladder, so patients can hold more urine without dribbling or leaking.
Ileal Conduit Surgery
Ileal conduit surgery is more invasive than bladder augmentation. During this procedure, the surgeon removes a section of the small intestine to make a urine stoma, or opening. The stoma allows urine to drain into a bag attached outside the body.
Ileal conduits are primarily meant to replace a bladder that is no longer functioning or needs to be removed to improve a person's general health. Doctors generally recommend ileal conduit surgery for those who have neurogenic bladder symptoms severe enough to impact their quality of life.
Dietary Changes
Some beverages and foods tend to irritate the bladder and exacerbate symptoms of overactive and underactive bladder. Avoiding or reducing the consumption of certain drinks and foods and maintaining a healthy, balanced diet can help reduce mild to moderate symptoms of a neurogenic bladder.
- Caffeinated beverages: Caffeine is a diuretic that can increase urine output. People with a neurogenic bladder or age-related incontinence may want to switch to decaffeinated drinks to reduce leakage.
- Alcohol: An even stronger diuretic than caffeine, alcohol interferes with the release of vasopressin into the bloodstream. Vasopressin is an antidiuretic hormone that helps your kidneys retain urine before they actually need to send urine to the bladder. Without enough vasopressin in the blood, the kidneys can flood the bladder with urine and cause you to leak urine.
- Diabetic foods: For people coping with diabetes and a neurogenic bladder, managing their blood glucose is especially important to help control leaks and minimize the frequent urge to urinate. A basic diabetic diet consists of eating lean protein, including plenty of fruits and vegetables, and avoiding sugary and processed foods. Diabetics with a neurogenic bladder should also adhere to medication guidelines and take prescriptions as directed by their physician.
Incontinence Products
Nexwear's incontinence products remove the constant worrying about unexpected leaks. For example, Nexwear's incontinence pads or incontinence underwear are perfect to use while you and your doctor are deciding what treatment method works best for you.
The Bottom Line
You may not have previously known what a neurogenic bladder is. However, it's likely you already knew your bladder, brain, and nerves all rely on each other to function properly.
If you think a neurogenic bladder may be what is causing your leaks, schedule an appointment with your doctor and tell them about your symptoms. Keep a bladder diary before visiting your doctor to provide detailed information that will help them diagnose a neurogenic bladder or any other type of incontinence. You can download and print this bladder diary form from the American Urological Association.
By gaining some knowledge about the condition, you can manage your symptoms and help ensure your neurogenic bladder does not prevent you from enjoying your life. Nexwear is helping millions of people just like you stay physically and socially active without fear of embarrassing leaks.
Nexwear delivers high-quality incontinence products to your home promptly and discreetly. Shop Nexwear today.)
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