Nerves and muscles team up to help you urinate. But you may lose control of your bladder if there's damage to your brain, spinal cord, or central nervous system. This is called neurogenic bladder. It can cause you to pee too much or too little. You may get symptoms of both overactive bladder (OAB) and underactive bladder (UAB). You may not be able to fully empty it.
It’s normal to feel embarrassed if you can’t control when you urinate. But you should talk to your doctor about your symptoms right away. If left untreated, this condition can damage your kidneys. And if you can’t get rid of your urine, you're more likely to get a urinary infection.
What Causes Neurogenic Bladder?
An illness or injury can affect the nerves and muscles in your urinary system. This includes your bladder and urethra. Certain conditions can lead to it, including:
- Multiple sclerosis (MS)
- Parkinson’s disease
- Diabetic neuropathy (nerve damage from diabetes)
- ALS (Lou Gehrig’s disease)
- Alzheimer’s disease
It can also be present when or shortly after you're born. This can happen with:
It may also happen with nerve damage from:
- Infection or tumor in your brain or spinal cord
- Poison from heavy metals
- Spinal cord injury
- Pelvic surgery
- Vaginal child birth
What Are the Symptoms of Neurogenic Bladder?
It depends on what type of nerve damage you have. Your sphincter muscles may be too loose to keep urine in. If you have OAB, you may feel like you need to pee even if your bladder isn’t full. The urge may come on so fast you can’t get to the bathroom in time (urge incontinence).
With UAB, your brain may not get a signal that it’s time to pee. Or your urinary muscles may be too tight to let urine pass (obstructive bladder). You may leak urine when your bladder gets too full (overflow incontinence).
It may cause:
- Repeated urinary tract infections (UTIs)
- An urgent need to pee
- Urine that leaks (day or night)
- Having to pee often
- Not being able to feel a full bladder
- Urine that “dribbles” out
- Holding urine in
- Pelvic pain
- Kidney stones
How Does a Doctor Diagnose Neurogenic Bladder?
Your doctor will want to know your symptoms and medical history. You may need to see a specialist like a urologist. They may do one or all of the following:
- Give you a physical exam.
- Have you keep a urine diary. You should keep track of how often and what time of day you go to the bathroom. Make notes of what you eat and drink. You may notice a pattern that can shed light on the right treatment.
- Measure urine leakage. A special pad turns a different color if you leak urine onto it.
- Test your urine. A urinalysis can show if you have an infection or blood in your pee.
- Look inside your bladder. Doctors put a tiny camera into your bladder to see if there's a tumor, kidney stone, or other blockage (cystoscopy).
- Urodynamic tests. This measures how much urine your bladder can hold and how long it takes to empty.
- Imaging tests. These can include an ultrasound, X-ray, magnetic resonance imaging (MRI), or computed tomography (CT) scan. They may put dye into your bladder (cystography).
- EEG or EMG. An electroencephalograph (EEG) checks to see if there's a problem in your brain. An electromyograph (EMG) checks the nerves and muscles in your bladder.
How Is Neurogenic Bladder Treated?
Your care will depend on the cause and type of your symptoms and how serious they are. There isn't a cure, but you can manage your symptoms and gain control of your bladder.
If you have OAB, you may need to:
- Train your bladder. You can do this by squeezing your pelvic floor during the day or when you need to pee (Kegel exercises).
- Hold it, if you can. Delayed voiding is when you wait a few minutes to urinate after you feel the urge. The goal is to extend this to a few hours.
- Pee on a schedule. You might avoid accidents if you urinate at certain times of the day.
- Take medicine. There are drugs that can relax bladder muscles and stop spasms.
- Lose some weight. Extra body mass can add pressure to your bladder.
- Change your diet. Caffeine, alcohol, spicy foods, dairy, artificial sweeteners, chocolate, citrus fruit, and other foods can irritate your system.
- Use electrical stimulation. A device under your skin sends electricity to the nerve that controls your bladder. These painless pulses help stop overactive signals that tell your brain to pee.
- Get Botox. Your doctor can shoot this neurotoxin into your bladder to temporarily stop it from contracting too much. If you have problems emptying your bladder or have urinary tract infections often, this treatment isn't an option.
If you have UAB, you may need to:
- Schedule your bathroom visits. You may need to pee every 2 to 4 hours, even if you don’t feel the urge. After you urinate, wait a few minutes and try again.
- Use a catheter. This long, thin tube helps drain your bladder. You may need to use it a few times a day. In some cases, it may need to stay in all the time.
- Have surgery. If other treatments fail, you may need a procedure or device to help you urinate.