Neurogenic bladder dysfunction, or neurogenic bladder, refers to urinary bladder problems due to disease or injury to the central nervous system or peripheral nerves involved in controlling urination. There are multiple types of neurogenic bladder depending on the underlying cause and symptoms. Symptoms include an overactive bladder, urgency or frequency of urine, enuresis, or difficulty urinating. A host of diseases or conditions can cause neurogenic bladder including spinal cord injury, multiple sclerosis, stroke, brain injury, spina bifida, peripheral nerve damage, Parkinson’s disease, or other neurodegenerative diseases. Neurogenic bladder can be diagnosed through symptoms, a physical exam, as well as more specialized imaging.Treatment depends on the underlying disease as well as symptoms and can be managed with behavioral changes, medications, surgeries, or other procedures. Irritable bladder symptoms, especially urinary incontinence, can have a significant impact on quality of life.
Nervous bladder classification
There are different types of neurogenic bladder based on the underlying cause. Many of these types may have similar symptoms.
An unstressed bladder is usually the result of brain damage due to a stroke or brain tumor. This can cause a decreased sensation of a full bladder, decreased bladder capacity and urinary incontinence. Unlike other forms of neurogenic bladder, it does not lead to high bladder pressures that can cause kidney damage.
In a spastic neuron (also known as an upper motor neuron or an overactive reflex bladder), the bladder muscle (detrusor) and urethral sphincter do not work together and are usually contracted tightly at the same time. This phenomenon is also called detrusor external sphincter dyssenergia (DESD = detrusor external sphincter dyssenergia). This leads to urine retention with high pressures in the bladder that can damage the kidneys. The size of the bladder is usually smaller than normal due to the increased muscle tone in the bladder. Spastic nervous bladder is usually caused by spinal cord damage above the level of the 10th thoracic (T10) vertebrae.
In a flaccid bladder (also known as a lower motor neuron or hypotensive bladder), the muscles of the bladder lose the ability to contract normally.
- This can lead to an inability to empty urine even if the bladder is full and it causes an over capacity of the bladder. The internal urinary sphincter can contract normally, but incontinence is common. This type of neurogenic bladder is caused by damage to the peripheral nerves that travel from the spinal cord to the bladder.
The mixed type of irritable bladder can cause a combination of the presentations listed above. In mixed type A, the bladder muscle is flaccid but the sphincter is overactive. This creates a large, low-pressure bladder and the inability to empty it, but it does not carry as many risks of kidney damage as a spastic bladder. Mixed type B is characterized by a flaccid external sphincter and a spastic bladder that causes problems with incontinence.
Signs and symptoms
Irritable bladder can cause a range of urinary symptoms including urinary urgency, enuresis, or difficulty urinating (urinary retention). The first sign of a bladder dysfunction may be recurrent urinary tract infections (UTIs). Physical therapy to stimulate the bladder in a spinal cord injury