Neurogenic Bladder

Neurogenic Bladder following Spinal Cord Injury (SCI)

After a Spinal Cord Injury (SCI), the bladder, along with the rest of the body, undergoes dramatic changes. Since messages between the bladder and the brain cannot travel up and down the spinal cord, a person may lose voluntary bladder control. Depending on the type of spinal cord injury, the bladder may become either "floppy" (flaccid) or "hyperactive" (spastic or reflex).

A flaccid, or “floppy” bladder loses strength and cannot contract for emptying. This type of bladder can be easily overstretched with too much urine, which can damage the bladder wall and increase the risk of bladder infection.

With a spastic or reflex bladder, the bladder muscles are “hyperactive” and increase in tone. They may contract automatically, causing accidental voiding (incontinence).

Symptoms

The most common symptoms of neurogenic bladder are:
  • small urine volume during voiding
  • urinary frequency and urgency
  • dribbling urine
  • loss of sensation of bladder fullness
  • urinary incontinence
  • urinary tract infection
  • kidney stones, and associated symptoms including chills, shivering and fever.

Causes

Neurogenic bladder can be caused by accidents that result in trauma to the brain or spinal cord. It may also be caused by:
  • diabetes
  • stroke
  • genetic nerve problems
  • infections
  • heavy metal poisoning

Diagnosis

To diagnose a neurogenic bladder, your doctor will examine the nervous system (including the brain) and the bladder itself. The exam will include a complete medical history, as well as a physical examination.
Diagnostic tests may include:
  • imaging tests of the skull and spine
  • imaging tests of the bladder and ureters
  • urodynamic studies: tests that involve filling, measuring volume, and emptying the bladder to determine how much it can hold and to ensure that it empties properly.
Treatment for neurogenic bladder may include:
  • catheterization – insertion of a hollow tube to empty the bladder at regular intervals
  • medications – these can relax the bladder to allow more filling; other relieve obstruction between the bladder and the urethra.
  • artificial sphincter – placing an artificial cuff around the neck of the bladder that can be inflated to prevent urinary incontinence and deflated to empty the bladder.
  • Surgical options

Complications

Complications of neurogenic bladder may include:
  • damage to blood vessels in the kidney
  • urine leakage
  • urine retention
  • bladder infection or urinary tract infection (UTI)

Recovery

Please view the self-care information available on the UW Department of Rehabilitation Medicine website.