When Nerve Damage Causes Bladder Problems: Neurogenic Bladder

Until a few short years ago, Rob, who is in his 80s, had been relatively free of health problems. He was an active guy, skiing and hiking in his beloved Washington State mountains. Husband, father and grandfather, he was living a happy retirement from Boeing Aircraft. Then what he thought was a small nagging problem was diagnosed as a complex medical problem.

When ongoing heartburn was keeping him awake at night, he went to a GI doctor for help. A scan showed Rob’s bladder was so enlarged it was pushing against his stomach, causing the heartburn. One doctor visit after another revealed more than one medical issue. Rob began a series of tests and surgeries to treat bladder cancer, prostate cancer and an aortic aneurysm.

His cancers were removed, but nerve damage from his surgery left Rob unable to fully empty his bladder. Today, he relies on using a straw-like tube, called a catheter, to help empty his bladder completely. Rob has neurogenic bladder—and he isn’t alone. Millions of Americans have this health issue. Neurogenic bladder is when a person lacks bladder control due to damage to the nerves carrying messages between the bladder and the brain. This damage may be the result of a spinal cord injury, an infection of the brain or spinal cord, heavy metal poisoning or diseases affecting the nerves, such as stroke, multiple sclerosis, Parkinson’s disease or diabetes. People born with problems of the spinal cord, such as spina bifida, are also at risk for neurogenic bladder.

What Goes Wrong?

Several muscles and nerves must work together for your bladder to hold urine until you are ready to empty it. Nerve messages go back and forth between the brain and the muscles that control bladder emptying. If these nerves are damaged by illness or injury, the muscles may not be able to tighten or relax at the right time.

In people with neurogenic bladder, the nerves and muscles don’t work together very well. As a result, the bladder may not fill or empty the right way. Bladder muscles may be overactive and squeeze more often than normal and before the bladder is full of urine. Sometimes the muscles are too loose and let urine leak before you’re ready to go to the bathroom (incontinence). In other people, like Rob, the bladder muscle may be underactive, meaning it will not squeeze when it is filled with urine and won’t empty fully or at all. The sphincter muscles around the urethra may also not work right and may stay tight when you are trying to empty your bladder.

Symptoms

The symptoms of neurogenic bladder differ from person to person. They also depend on the type of nerve damage the person has. Symptoms may include urinary tract infections, kidney stones and not being able to control how many times you urinate, when you urinate or how much you urinate.

People with overactive bladders (often seen with strokes, brain diseases and Parkinson’s disease) may feel a sudden urge to go to the bathroom that cannot be ignored. After this “gotta go” feeling, some people leak urine—a few drops or a gushing amount. Another overactive bladder symptom is going to the bathroom often (more than eight times in 24 hours).

Some people with neurogenic bladder have the opposite problem. They can’t empty their bladder at all or only produce a “dribble” of urine. These symptoms are common in people with diabetes, multiple sclerosis, polio, syphilis or a prior major pelvic surgery.

The symptoms of neurogenic bladder may seem like symptoms of other illnesses and medical problems. Always talk to your health care provider for a diagnosis.

Seeking the Source

Neurogenic bladder involves the nervous system and the bladder, and doctors will conduct different tests to determine the health of both. Talking to your health care provider about your symptoms can be an important first step. Your provider may ask you for your medical history and your daily habits. They may also ask you to complete a physical exam. A physical exam for women may look at the abdomen, pelvis and rectum. For men, the abdomen, rectum and prostate may be checked. You may also need to leave a urine sample to be tested for infection.

Some patients are asked to keep a “bladder diary” to get a better sense of their day-to-day symptoms. You may also be asked to do a “pad” test. For this test, you wear a pad that has been treated with a special dye. This dye changes color when you leak urine.

Your health care provider may order other tests to measure how your urinary tract is working or may order an x-ray or scan to help diagnose you.

Treatment Options

Neurogenic bladder is a serious condition, but when it is watched closely and treated the best way, patients can see large improvements in their quality of life. Specific treatment for neurogenic bladder will be decided by your health care provider based on:

• your age, overall health and medical history
• the cause of the nerve damage
• the type of symptoms
• the severity of symptoms
• your tolerance for certain medications, procedures or therapies
• their expectations for the course of the condition

Lifestyle Changes

For many patients, the first treatments often used are lifestyle changes. Also known as “behavioral treatments,” these are changes people can make in their daily lives to control their symptoms.

Weight loss and limiting the intake of “bladder irritating” foods and drinks may be helpful. You may be asked to try avoiding coffee, tea, alcohol, soda, other fizzy drinks, citrus fruit and spicy foods. Some people may be asked to try and schedule regular trips to the bathroom or even try timing their trips to the bathroom.

People with an overactive bladder may be asked to try “quick flicks” to help relax their bladder muscles when the muscles start squeezing. This exercise may help decrease that “gotta go” feeling when it hits. Your health care provider can explain this exercise in more detail. Another behavioral treatment for those with overactive bladder is called “delayed voiding.” This is when patients start delaying going to the bathroom by a few minutes and thenslowly increasing the time to a few hours. This helps patients learn how to put off going to the bathroom, even when they feel an urge.

Medical Treatments

When behavioral treatments alone aren’t working well, drugs may be prescribed. Some drugs are used to relax overactive bladder muscles. These may be taken by mouth or delivered through the skin (with a gel or a patch).

If, like Rob, you need help emptying your bladder, you may be prescribed other drugs. You may also be asked to use a catheter. Rob inserts a catheter into his bladder twice daily to make sure it is fully emptied. Some patients use “continuous catheterization,” another type of catheter that stays in place to drain urine at all times.

Injections with botulinum toxin (Botox®) can be used to help patients whose overactive bladder symptoms cannot be controlled by other medications. When it’s injected into the bladder muscle, it can stop the muscle from squeezing too often. There are other non-surgical treatments for neurogenic bladder, such as PTNS nerve stimulation. Talk to your health care provider to learn more about what is available.

Surgical Treatments

If lifestyle or medical treatments do not work, your health care provider may suggest surgery.

For patients with overactive bladder symptoms, a surgery called sacral neuromodulation (SNS) is the only surgery available. SNS targets the nerves carrying signals between the spinal cord and the bladder. In this procedure, the surgeon places a small, battery-powered device under the skin (often called a “bladder pacemaker”). The device sends harmless electrical impulses to the bladder to stop the “unhealthy” signals that cause your bladder to be overactive.

There are a number of surgeries to help people whose underactive bladder symptoms are not relieved using other treatments. These surgical options include surgically tightening the sphincter or lower pelvic muscles to improve bladder control. In very severe cases, surgery may be done to redirect the flow of urine so that it empties into a pouch or bag worn on the outside of the body. Every case is unique and will be decided through a conversation between a patient and his or her health care provider.

The Bottom Line

Neurogenic bladder may seem like a lot to handle, but there are many treatment options for you to consider. Talk to your health care provider to determine what is best for you.

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