Neurogenic Bladder

Medically Reviewed by Smitha Bhandari, MD on August 25, 2022
Written by Keri Wiginton
4 min read

Neurogenic bladder is when a problem in your brain, spinal cord, or central nervous system makes you lose control of your bladder. You may pee too much or too little. You could have symptoms of both overactive bladder (OAB) and underactive bladder (UAB). You may not be able to fully empty it.

It’s normal to have some stress and anxiety if you can’t control when you urinate. Talk to your doctor about what’s going on as soon as possible so you can start on a treatment to help manage your symptoms.

Your symptoms depend on what’s causing the condition. The sphincter muscles that hold your urethra closed to keep urine in may be too loose. 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 that you can’t get to the bathroom in time (urge incontinence).

With UAB, your brain may not get the signal that it’s time to pee. Or, your urinary muscles may be too tight to let urine pass (obstructive bladder). You could also leak urine when your bladder gets too full (overflow incontinence).

Other symptoms of neurogenic bladder include:

  • Repeated urinary tract infections (UTIs)
  • An urgent need to pee
  • Leaking urine (day or night)
  • Having to pee often
  • Not being able to feel a full bladder
  • Not being able to empty your bladder all the way (urinary retention)
  • Urine that “dribbles” out
  • Holding urine in
  • Pelvic pain
  • Kidney stones
  • Erectile dysfunction in men

 

An illness or injury can affect the nerves and muscles in your urinary system. This includes your bladder and urethra. Conditions that might lead to neurogenic bladder include:

  • Multiple sclerosis (MS)
  • Parkinson’s disease
  • ALS (Lou Gehrig’s disease)
  • Alzheimer’s disease
  • Encephalitis
  • Learning disorders like ADHD
  • A lack (deficiency) of vitamin B12

Some people have it when they’re born or shortly afterward. This can happen with:

Neurogenic bladder may also happen with nerve damage (neuropathy) from:

  • Stroke
  • Infection or tumor in your brain or spinal cord
  • Poison from heavy metals
  • Spinal cord injury
  • Pelvic surgery
  • Vaginal childbirth
  • Diabetes
  • Long-term alcohol use
  • A herniated disc
  • Syphilis

 

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 these things:

  • Give you a physical exam.
  • Have you keep a urine diary. Keep track of how often you go to the bathroom and at what time of day. Also note what you eat and drink. You may notice a pattern that can help your doctor find the best 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 can 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,  MRI, or CT scan. They may also 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.

Without treatment, neurogenic bladder can cause:

  • Urine leakage or retention
  • Kidney damage
  • Urinary tract infections

Your care will depend on what’s causing your symptoms and how serious they are. There’s no cure for neurogenic bladder, but you can manage your symptoms and get control.

If you have OAB, you may need to:

  • Train your bladder. You can do this by squeezing your pelvic floor muscles 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 time to a few hours.
  • Pee on a schedule. You might avoid accidents if you urinate at certain times of the day.
  • Take medicine. Some medications can relax bladder muscles and stop spasms.
  • Keep a healthy weight. Extra body mass can add pressure to your bladder.
  • Change your diet. Things like caffeine, alcohol, spicy foods, dairy, artificial sweeteners, chocolate, and citrus fruit 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 inject 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 might 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 could need a procedure or device to help you urinate.