Neurogenic bladder

We speak of a neurogenic bladder (or neuropathic bladder) when bladder problems are caused by a disease or injury of the nervous system, which controls bladder filling and emptying.

The most common causes

• spinal cord injuries
• stroke
• multiple sclerosis, Parkinson's disease, amyotrophic lateral sclerosis
• diabetic neuropathy
• nerve damage after major pelvic surgery
• congenital malformations, such as spina bifida

Two opposite behaviours

• Overactive (‘spastic’) bladder: it contracts on its own, causing urgency, frequent voiding, including at night, and urine leakage. Often the sphincter does not relax in a coordinated way and the bladder empties poorly.
• Underactive (‘flaccid’) bladder: it does not contract enough, becomes overfilled and urine dribbles out through ‘overflow’.

Mixed forms are common.

Why it needs long-term follow-up

The problem is not just incontinence. High pressures in the bladder and stagnant urine can cause infections, stones and kidney damage (hydronephrosis), often without obvious symptoms. Early management prevents permanent damage.

Diagnosis

Measurement of the post-void residual (the urine left after voiding) by ultrasound, ultrasound of the kidneys and bladder, kidney function tests and, where indicated, urodynamic testing, which studies how the bladder fills and empties.

Treatment

• intermittent catheterisation: emptying the bladder at regular times with a thin catheter, which patients usually learn to use themselves; it is safer than an indwelling catheter
• medicines that reduce involuntary bladder contractions
• injections of botulinum toxin into the bladder wall, in selected cases
• regular checks of kidney function
• surgery, reserved for particular cases