Neurogenic Bladder Can Be Cured

A neurogenic bladder is when someone can’t control peeing because their brain, spine, or nerves have problems. Your bladder uses muscles and nerves to keep pee in until it’s time to go. These nerves send signals to your brain about when to release the pee. If these nerves get damaged from being sick or hurt, the bladder muscles might not work right. Then, the bladder might not hold or release pee properly.

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Lots of people have this problem. It happens to those with diseases like MS, Parkinson’s, or spina bifida. It can also happen if someone has had a stroke, hurt their spinal cord, had big surgery in the lower belly area, has diabetes, or other health issues.

The urethra, bladder, and kidneys are part of what’s called the urinary system. They handle pee—making it, storing it, and getting rid of it. When everything’s working right, your kidneys filter your blood and create pee, which they send to your bladder. Think of your bladder like a storage bag that can expand, sitting in your lower belly and held up by muscles.

When your bladder isn’t full, it’s in chill mode. But as it fills up, your brain gets signals that you need to pee. When you find a bathroom, your brain tells your bladder to squeeze. This pushes the pee out through the urethra, the tube you pee from.

You also have special muscles in your urethra called sphincters. They’re like little gates that stay closed so you don’t leak pee. When you’re ready to pee, these gates open up as the bladder squeezes.

Your bladder uses muscles and nerves to hold pee until you’re ready. Nerves talk to your brain and bladder muscles. If these nerves get damaged by sickness or injury, the muscles might not work right.

When the bladder or its nerve signals are harmed, you can get something called neurogenic bladder. This might be due to issues in the brain or spine (like strokes, spinal cord injuries, or diseases that weaken muscles), problems with the nerves outside the brain and spine (like diabetes, alcohol damage, low vitamin B12, a slipped disk, or surgery damage), or both (like Parkinson’s disease, multiple sclerosis, or syphilis). Sometimes, blockages (like an enlarged prostate, prostate cancer, blocked stool, or a narrow urethra) make it worse.

People with neurogenic bladder struggle because their nerves and muscles don’t work well together. Their bladder may not hold or release pee correctly. If the bladder is overactive, it squeezes too often, making you feel like you need to pee a lot.

Sometimes, the muscles that shut the bladder (sphincters) are too weak, causing pee to leak when you don’t want it to. This is called incontinence.

Others might have a bladder muscle that doesn’t squeeze when it should, making it hard to pee fully. The sphincter muscles might also be too tight, making peeing difficult. Some people have problems with both too much and too little bladder activity.

Renal injury (or Kidney injury) and deterioration

Certain populations with neurogenic bladder are at a heightened risk of upper urinary tract deterioration due to lower urinary tract dysfunction. This risk is particularly evident in individuals with specific conditions such as spina bifida, spinal cord injury, transverse myelitis, and multiple sclerosis. The relationship between neurologic injury and lower urinary tract function significantly influences the likelihood of upper tract damage. In cases of spina bifida and spinal cord injury, kidney injury often progresses to renal failure (or kidney failure).

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Urinary incontinence

Urinary incontinence, arising from detrusor overactivity, stress urinary incontinence, or overflow incontinence, significantly affects individuals with neurogenic bladder, impacting their quality of life, self-esteem, social interactions, and causing psychosocial stress.

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Urinary tract infections

Urinary tract infections (UTIs) pose a considerable health burden for individuals with neurogenic bladder, with an estimated annual rate of 2.5 episodes per year. Due to various patient factors and increased susceptibility to upper tract infections, delayed diagnosis, and atypical symptoms, each UTI episode can be severe, leading to significant healthcare costs and contributing to hospital readmissions.

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Urolithiasis

Urinary stasis and chronic bacteriuria in patients with neurogenic bladder increase the risk of urinary stone formation, with UTIs identified as an independent risk factor for stone disease, highlighting a potential link between infection and stone formation, particularly in individuals with spinal cord injury.

Doctors treat neurogenic bladder to help you feel better and keep your kidneys safe. They want to make your life better. With the right care, people can feel much better.

Choosing Treatment

Your doctor will pick the best treatment for you. They will think about:

• How old you are, your health, and your past health.

• What caused the nerve damage.

• What kind of symptoms you have and how bad they are.

•  What drugs or treatments you’re okay with.

• What they think will happen with your condition.

Medical Treatments

• Catheters: For an underactive bladder, you might use a tube to help pee. There are two kinds:

• Clean intermittent catheterization (CIC): You put in a tube yourself to pee a few times a day.

• Continuous catheterization: A tube stays in your bladder to drain pee all the time.

• Sacral neuromodulation (SNS) therapy: For serious overactive bladder, a wire near your spine changes nerve signals to your bladder.

• Percutaneous tibial nerve stimulation (PTNS): A needle in your leg sends signals to help your bladder. You get treatments often.

Surgery

If other treatments don’t work, you might have surgery. Types include:

• Artificial sphincter: A device to help control pee when muscles aren’t working right.

• Urinary diversion: The surgeon makes a new way for pee to leave your body.

• Bladder augmentation: Making your bladder bigger so it can hold more pee.

• Sphincter resection: Cutting weak muscles to help control pee.

Manack et al. [2] looked at insurance and pharmacy records for about 60,000 people with neurogenic bladder over four years. They found that 29-36% had infections in the lower part of the urinary system. About 9-14% had trouble emptying their bladder, and 6-11% had blockages in their urinary system. A small number, 1.4-2.2%, had infections in the upper urinary system. This group also had serious health problems, like blood infections in 2.6-4.7% and sudden kidney failure (or renal failure) in 0.8-2.2%. On average, people with neurogenic bladder went to the doctor’s office 16 times and the emergency room half a time each year. About one in three of these visits ended up with a hospital stay.

 

In most cases, even in the United States, patients with neurogenic bladder who seek medical help for urinary incontinence often hear the most common phrase: “I’m sorry, I can’t help you. If you’re willing, I can recommend another doctor for your treatment.”