As you probably already know, our brain and bladder have a very unique connection. When they work together, everything is good and dandy. But when they don’t, it can cause things to get a little complicated. I’m talking leaks, drips, Gotta-Go with the spritz complicated. When our brain, spinal cord, or nerves are unable to adequately communicate with the bladder, it’s sometimes due to a neurogenic bladder.
A ‘What’ Bladder?
So you’re probably wondering, what exactly is a “neurogenic” bladder? The word neurogenic means “caused by the nerves or nervous system.” Therefore, if the nerves that communicate with the bladder are damaged by illness or injury, then it’ll alter how the bladder is controlled.
Now, you should also know that all nerves aren’t the same. How the bladder’s behavior changes with damaged nerves depends on which nerves have been impacted. Certain nerves cause the bladder to become spastic, or overactive. Other nerves may cause the bladder to become flaccid, or underactive. Some people may experience a mix of both. And all this can lead to incontinence.
What Causes Neurogenic Bladder?
A neurogenic bladder is sometimes the result of a birth defect. For instance, individuals born with cerebral palsy, Spina bifida, or sacral agenesis could have bladder complications due to their brain and spinal development. Other circumstances that could cause a neurogenic bladder include:
- Heavy metal poisoning
- Tumors of the central nervous system
- Parkinson’s disease
- Multiple sclerosis
- Spinal cord injury or surgery
- Vitamin B12 deficiency
- Other injuries or illnesses to the nerves
Symptoms of Neurogenic Bladder
The symptoms of a neurogenic bladder come down to the nerves impacted. If the injured nerves result in an overactive bladder, then symptoms might include:
- Urinating often in small amounts
- Trouble completely emptying the bladder
- Poor bladder control due to random bladder contractions (e.g. urge incontinence)
If the injured nerves cause an underactive bladder, then you may notice these symptoms:
- Inability to tell when the bladder is full
- Issues with starting to pee
- Unknowingly having a full bladder and experiencing leaks (e.g. overflow incontinence)
Complications to Look For
There are a few complications of neurogenic bladder, too. Urinary tract infections and bladder stones are both common and possible complications with a neurogenic bladder. Painful urination is a symptom of both conditions.
Kidney damage can also occur. If the bladder repeatedly becomes too full, then that’ll put pressure on the tubes leading up to the kidneys and inevitably impact the kidneys themselves. Lastly, repeat bladder leaks can break down the skin and cause pressure ulcers. If you have a neurogenic bladder (or another bladder condition), then you’ll want to clean and protect your skin often to prevent skin irritation.
Neurogenic Bladder Diagnosis
So, how in the world do you find out if you have a neurogenic bladder? If you haven’t already, start keeping track of when you go to the bathroom, your symptoms, and more in a bladder diary. After that, make an appointment with your doctor. They’ll likely do several tests of the nervous system and the bladder to pinpoint exactly what’s going on. Some of those tests include:
- CT Scan
- Cystoscopy – Doctors use a small telescope to examine the inside of your bladder and urethra.
- Various urodynamic tests – these tests will look at 1) how much urine the bladder can hold, 2) the pressure within the bladder, 3) how well urine flows, and 4) how well the bladder empties when full.
How Do You Treat a Neurogenic Bladder?
The treatment for a neurogenic bladder will likely be based on the severity of the condition. A doctor may suggest making some lifestyle changes, such as losing weight, cutting out caffeine, or avoiding spicy foods. They might also suggest a behavioral treatment called delayed voiding to help with urine control.
If lifestyle changes alone won’t cut it, then drug therapy is implemented. The medication given will depend on if you have an overactive bladder or an underactive bladder. Usually, anticholinergic medications, like oxybutynin, are prescribed. However, don’t be surprised if your doctor suggests Botox injections for your bladder, too.
Those with an underactive bladder are more likely to need catheterization. The suggested method is intermittent self-catheterization, which is where the patient themselves inserts the flexible tube through the urethra and into the bladder. This will allow an overly full bladder to drain. Sometimes doctors insert an indwelling urethral catheter. However, they have a high risk of UTIs and aren’t recommended.
Surgery is the Last Resort
Surgery is only recommended if nothing else works. One surgery for a neurogenic bladder is a bladder augmentation. Here, they remove part of the colon and attach it to the wall of the bladder. Patients notice reduced pressure on the bladder and the ability to hold more urine.
Another surgery option is the ileal conduit. With this surgery, part of the small bowel is taken out and used to make a urine stoma or opening. This stoma drains urine into a bag attached outside of the body.
Don’t Forget About Absorbent Products
Worried about accidental drips and dribbles? Then consider using incontinence pads or incontinence underwear. These are perfect to use while you’re trying to figure out what treatment method will work best for you. Trying to figure out the weird connection between your brain and bladder is hard enough. You shouldn’t have to worry about if you’ll have a leak in public too.
And That There is a Neurogenic Bladder
Many people will read this article and learn about neurogenic bladder for the very first time. And guess what? That’s okay! If you didn’t know it existed before this, then don’t feel bad, because a lot of people don’t. But there’s one thing that I think we all know and it’s that our bladder, brain, and nerves are pretty darn unique. If you think a neurogenic bladder may be what’s causing your leaks, then contact your doctor.
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By Jessica Thomas, MPH