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Get the facts. And the help you need.

Neurogenic Bladder

View a PDF version of our "Neurogenic Bladder" fact sheet.

Read "When Nerve Damage Causes Bladder Problems: Neurogenic Bladder" article from the Spring 2014 edition of UrologyHealth extra.

What is it?
How does the urinary system work?
What causes it?
What are the symptoms?
How can it affect your life?
How is it diagnosed?
How is it treated?

How is overactive bladder treated?
How is underactive bladder treated?

What can I do?

Talk with your health care provider
Tool for MS patients (Actionable Screener)
Find-A-Urologist
Other Resources

What is neurogenic bladder?

Neurogenic bladder is the name given to a number of urinary conditions. It is the result of problems with nerves in the body that may control how the bladder stores or empties urine. These conditions include overactive bladder (OAB), incontinence, and obstructive bladder, in which the flow of urine is blocked.

Many women and men have these bladder problems, including people with illness and injury that affect the brain and/or the spinal cord. This includes people with Multiple Sclerosis (MS) and Parkinson's disease, and people who have had stroke or spinal cord injury. People who are born with problems of the spinal cord, such as spina bifida, may also have this type of bladder problem.

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How does a healthy urinary system work?

The bladder and kidneys are part of the urinary tract. These are the organs in our bodies that make, store and pass urine. When the urinary system is working well, the kidneys make urine and move it into the bladder. The bladder is a balloon-shaped organ that serves as a kind of storage unit for urine. It is held in place by pelvic muscles in the lower part of your belly.

When it is not full of urine the bladder is relaxed. Nerve signals in your brain let you know that your bladder is getting full. Then you feel the need to urinate. The brain tells the bladder muscles to squeeze (or "contract"). This forces the urine out through your urethra, the tube that carries urine from your body. Your urethra has muscles called sphincters. They help keep the urethra closed so urine doesn't leak before you're ready to go to the bathroom. The sphincters open up when the bladder contracts.

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What causes neurogenic bladder?

In people with neurogenic bladder, the nerves and muscles don't work together the right way. The bladder may not fill or empty correctly. This is because of damage to nerves.

Bladder muscles may be overactive and contract involuntarily more often than normal and before the bladder fills with urine. Sometimes muscles are too loose and let urine pass before you're ready to go to the bathroom.

In some people, the bladder muscle may be underactive. It will not contract when it is filled with urine and won't empty completely. The sphincter muscles around the urethra may also not work properly. They may remain tight when you are trying to release urine. Some people experience symptoms of both overactive and underactive bladder.

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What are the symptoms of neurogenic bladder?

There are a number of symptoms of neurogenic bladder. They differ from person to person and depend on the type of damage they have had.

Symptoms include:

  • Incontinence: You may experience an urge to go to the bathroom followed by urine leaking that you can't control. You may leak just a few drops of urine. Sometimes you may gush a large amount of urine. Sometimes urine will leak while you sleep.
  • Urgency: This is the sudden urge to go to the bathroom that you can't ignore. This "gotta go" feeling makes you afraid you will leak urine if you don't get to a bathroom right away. You may or may not leak urine after feeling this urge to go.
  • Frequent urination: This is going to the bathroom many times during the day or night. (You may produce only small amounts of urine.) The number of times someone urinates is different from person to person. But many experts agree that going to the bathroom more than eight times in 24 hours is "frequent urination."
  • Urinary retention: This is when you are unable to empty your bladder fully. Some people can only produce a "dribble" of urine. Others strain to push out urine, can't completely empty their bladder, or can't urinate at all.
  • Repeated urinary tract infections (UTI): These may be the first symptom of neurogenic bladder. It is a repeated illness caused by harmful bacteria, viruses or yeast growing in the urinary tract.

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How can neurogenic bladder affect your life?

The symptoms of neurogenic bladder can seriously affect the quality of your life. They may make it difficult for you to get through your day without interruptions. You may feel afraid to go out with friends, take vacations or do every day things. You may be afraid you may not be able to find a bathroom when you need one. Some people begin to cancel activities, and withdraw from their lives.

Neurogenic bladder may affect your work and your relationships. You may feel tired, depressed, anxious and lonely. If you are experiencing incontinence, the leaking urine can sometimes cause skin problems or infections. This is why it is important to talk with your health care provider about your symptoms.

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How is neurogenic bladder diagnosed?

Your health care provider may diagnose your neurogenic bladder using methods such as:

  • Gathering information about your past and current illnesses, medication use and how much and what types of liquids you drink daily. Your health care provider will ask about your symptoms and ask how long you have had them.
  • Performing a physical exam to look for something that may be causing your symptoms. This includes examining your abdomen, prostate, and rectum.
  • Asking you to keep a "bladder diary" to help better understand your day-to-day symptoms.
  • A Pad Test. During this test, you will wear a pad that had been treated with a special dye. The pad changes color when you leak urine.
  • Collecting urine to check for infection or blood.
  • Conducting the following tests:
    • A bladder scan which can show how much urine is still in the bladder after you go to the bathroom.
    • A cystoscopy, which helps to locate problems with the bladder. During this test your health care provider will insert a narrow tube with a tiny lens into the bladder.
    • A "urodynamic" test to check to see how well your lower urinary tract stores and releases urine. There are several urodynamic tests you may be asked to take. You may be asked to urinate into a special funnel to see how much urine you produce and how long it takes. You may have a catheter inserted in your bladder to drain your bladder or to add water to it and check the resulting pressure.

Your health care professional may need to do additional imaging tests such as x-rays and CT scans to diagnose your condition. You may also be referred to a specialist for an exam that may include imaging tests of the spine and brain.

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How is neurogenic bladder treated?

The goals of treatment are to control you symptoms and prevent damage to your kidneys. Treatment will depend on the symptoms you are having, and the cause of your neurogenic bladder. Patients who have neurogenic bladder and have more overactive bladder symptoms will receive different treatment options than patients experiencing underactive bladder symptoms. No matter the cause, treatments are focused on improving your quality of life.

Below are the types of treatments patients may receive depending on the symptoms they are having.

Overactive Bladder (OAB) Treatments

OAB is a very common problem for men and women. It is also the most common type of bladder problem in people who have MS. OAB is not a disease but the name given to a group of troubling urinary symptoms. The most common symptoms of OAB is a sudden and unexpected urge to urinate that you can't control. To manage your OAB symptoms you may be offered the treatment options listed below.

  • Lifestyle Changes, also known as "behavioral treatments," are often the first therapies used to treat neurogenic bladder regardless if your symptoms are from overactive bladder (OAB) or underactive bladder (UAB). These are changes in the way you live day-to-day to help control symptoms.
    • Delayed voiding is teaching yourself to put off voiding, even when you feel an urge. You begin by delaying voiding by a few minutes. Over time, you increase the time to several hours.
    • Scheduled voiding is a technique in which you follow a daily schedule to urinate. You don't go to the bathroom when you feel the urge. You plan to go every two to four hours each day.
    • Bladder exercises called "quick flicks," may help strengthen weak muscles. During this exercise, you squeeze your pelvic muscles tight, and then quickly let them go.
    • Keeping a bladder diary. You may be asked to keep track of each time you go to the bathroom. This can help you and your health care provider better understand your symptoms.
    • For some people weight loss and limiting intake of "bladder irritant" foods and drinks may also be helpful.

Some patients may see an improvement in their condition while using lifestyle treatment options. However, many patients may need additional treatments specific to their OAB bladder condition before seeing relief from their symptoms.

  • Medication(s) may be used if lifestyle changes don't help enough. There are several prescriptions drugs that can help relax the bladder muscle. Other drugs can help stop your bladder from contracting. You take some of these medications by mouth.

    Some drugs are delivered through the skin with a gel or a patch. Your health care provider should follow you closely to look for changes and any side effects of these drugs.

    To get the best results, your health care provider may ask you to take different doses of the drug. Or you may be given a different drug to try. Sometimes behavioral therapy will be used along with drugs.

  • Injections with botulinum toxin (BOTOX®) are used to help patients who have OAB because of brain or spinal cord disease or injury. You and your health care provider will decide if this is right for you.

    When it is injected into bladder muscle, this drug may help keep it from contracting too often. This treatment can wear off, and you may need to have it repeated in six or nine months. Your health care provider should follow you closely to watch for side effects.

  • Neuromodulation therapy is the name given to a group of treatments that deliver electricity or drugs to nerves.
    • Sacral neuromodulation (SNS) is used for patients with OAB when medication or lifestyle changes don't help. The sacral nerves carry signals between your spinal cord and the bladder. Changing these signals can improve OAB symptoms. To do this the surgeon places a thin wire close to the sacral nerves. Then the wire is connected to a small device placed under your skin. The device is battery operated. It delivers harmless electrical impulses to the bladder to stop the "bad" signals that can cause OAB.
    • Percutaneous tibial nerve stimulation (PTNS) is another type of neuromodulation therapy. In this treatment, a needle is inserted into a nerve in your leg called the tibial nerve. The needle is connected to a device that sends electrical impulses. The impulses travel to the tibial nerve, and then to the sacral nerve. This is done in your health care provider's office. Most patients receive 12 treatments for the best results.

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Underactive Bladder (UAB) Treatments

Underactive Bladder (UAB) is a condition in which you aren't able to empty your bladder completely-or at all. You may hesitate before urine flows, or have to push urine out. Your urine may only come out in "dribbles." Treatment options for managing UAB symptoms are listed below.

  • Lifestyle Changes, also known as "behavioral treatments" are often the first therapies used to treat neurogenic bladder regardless if your symptoms are from overactive bladder (OAB) or underactive bladder (UAB). These are changes in the way you live day-to-day to help control symptoms.
    • Scheduled voiding is a technique in which you follow a daily schedule to urinate. You don't go to the bathroom when you feel the urge. You plan to go every two to four hours each day.
    • Double voiding may be helpful for people who have trouble completely emptying their bladders. After urinating, you wait a few minutes and then try again to empty your bladder.
    • Keeping a bladder diary. You may be asked to keep track of each time you go to the bathroom. This can help you and your health care provider better understand your symptoms.
    • For some people weight loss and limiting intake of "bladder irritant" foods and drinks may be helpful.

Some patients with neurogenic bladder may see an improvement in their condition while using lifestyle treatment options. However, many patients may need additional treatments specific to their UAB bladder condition before seeing relief from their symptoms.

  • Medication(s) may be used if lifestyle changes don't help enough. There several prescriptions drugs that can be used to help improve the emptying of the bladder when urinary retention is present. Your health care provider should follow you closely to look for changes and any side effects of these drugs.

    To get the best results, your health care provider may ask you to take different doses of the drug. Or you may be given a different drug to try. Sometimes behavioral therapy will be used along with drugs.

  • Using a Catheter can help you empty your bladder. A catheter is a thin tube that is inserted into the urethra when you need to drain urine. This treatment is called Clean Intermittent Catheterization (CIC) and you can learn to do this yourself. Depending on your symptoms, your health care provider may ask you to do this three to four times a day. Sometimes CIC can help improve how your bladder works after several weeks or months. Some patients may have a different kind of catheter inserted to drain urine at all times. This is called "continuous catheterization."
  • Surgery is used to help some patients with more serious types of underactive bladder:
    • An artificial sphincter is a device that helps treat severe urinary incontinence when your real sphincter muscle isn't working correctly. Surgery is required to place the sphincter cuff around the around the urethra while a pump is placed under the skin in the scrotum or labia. The pump is used to open the sphincter and allow you to pass urine.
    • Urinary diversion surgery is a procedure in which the surgeon creates an opening, called a stoma. Urine moves through the stoma to a collection pouch.
    • Bladder augmentation (augmentation cystoplasty) is a surgical procedure in which part of the large intestine are removed. It is then attached to the walls of the bladder. This increases the size of the bladder and helps it store more urine.
    • Sphincter resection is a procedure in which the weak portion of the urethra sphincter muscle is removed. In some case, a sphincterotomy is performed in which the entire muscle may be cut.

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What should you do if you are having symptoms?

Talk with your health care provider

It's important to find out what is causing your symptoms. Sometimes neurogenic bladder symptoms can lead to more serious bladder problems. But there are a number of treatments available. You and your health care provider will decide which treatment is best for you.

Tool for MS Patients

There is a screening tool available especially for people with Multiple Sclerosis who are having symptoms. This "Actionable Screener" (link coming soon) is a simple-to-use "question and answer" quiz. If you print out your answers, it can help your health care provider better understand the problems you are having.

Find-a-Urologist Tool

You may be referred to a urologist specializing in neurogenic conditions of the bladder. Use our Find-a-Urologist tool to find a specialist near you. Choose "incontinence" as a "special interest area" to find urologists who specialize in helping patients who leak urine.

Other Resources

Neurogenic Bladder Fact Sheet

It's To Time to Talk About OAB

National Kidney and Urologic Disease Clearinghouse

Urinary Incontinence in Men

Urinary Incontinence in Women

Urinary Retention

National Association for Continence

Simon Foundation for Continence

Underactive Bladder Foundation

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Last Reviewed: March 2014

Last updated: May 2014

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Neurogenic Bladder Glossary
  • abnormality: A variation from a normal structure or function of the body.

  • anatomy: The physical structure of an internal structure of an organism or any of its parts.

  • anticholinergic: Blocking impulses from the part of the nervous system that controls heartbeat, blood pressure and other responses to stress. A drug that interferes with the effects of acetylcholine. These drugs assist with bladder storage by increasing bladder contractions and are used to treat urge incontinence.

  • bladder: The bladder is a thick muscular balloon-shaped pouch in which urine is stored before being discharged through the urethra.

  • bladder augmentation: Operation that uses a piece of the intestine (bowel) to enlarge the bladder.

  • bladder capacity: The amount (maximum volume) of urine that the bladder can hold. Often referred to as bladder volume.

  • bladder control: The ability to control the timing of urination. Also referred to as continence.

  • bladder neck: Area of thickened muscle fiber where the bladder joins the urethra. Acting on signals from the brain, bladder neck muscles can either tighten to hold urine in the bladder or relax to allow urine out and into the urethra. These muscles also tighten during ejaculation to prevent backflow of semen into the bladder.

  • catheter: A thin tube that is inserted through the urethra into the bladder to allow urine to drain or for performance of a procedure or test, such as insertion of a substance during a bladder X-ray.

  • catheterization: Insertion of a narrow tube through the urethra or through the front of the abdominal wall into the bladder to allow urine drainage.

  • catheterize: To insert a catheter, which is a thin, flexible tube, into a patient or a specific part of the body to drain liquid.

  • cholinergic: Fibers in the parasympathetic nervous system that release a chemical called acetylcholine.

  • CIC: Also known as clean intermittent catheterization. Periodic insertion of a clean catheter into the urethra after washing your hands to drain the urine from the bladder.

  • CMG: Also known as a cystometrogram. This is a test used to evaluate the bladder's ability to store and release urine. It uses a device to pump water into the bladder. The device then measures the amount of fluid that goes into the bladder when you first feel the desire to void, when you are able to sense fullness, and when your bladder is completely full.

  • compliance: A term used for the bladder to determine its ability to stretch or expand. Persons can have a "poorly compliant bladder" which means that the bladder doesn't stretch as well and holds smaller amounts of urine.

  • congenital: Present at birth.

  • continence: The ability to control the timing of urination or a bowel movement.

  • contract: To shrink or become smaller.

  • detrusor muscle: Contracting muscle in the bladder that helps to expel urine.

  • dilation: The stretching or enlargement of a hollow organ or body cavity.

  • distal: Location of urethral opening between the middle or the penile shaft and the head of the penis (glans).

  • DSD: Also known as detrusor-sphincter dyssynergia. Damage to the nervous system can create a lack of coordination between the bladder and the external sphincter muscle. As a result, the bladder cannot empty completely which creates buildup of urinary pressure. DSD is the combination of these two factors and can lead to severe urinary tract damage.

  • endoscope: A lighted medical instrument consisting of a long tube inserted into the body, usually through a small incision. It is used for diagnostic examination and surgical procedures.

  • external urethral sphincter muscle: Muscle surrounding the external opening of the urethra, the tube that carries urine outside the body from the bladder.

  • gene: The basic unit capable of transmitting characteristics from one generation to the next.

  • hydronephrosis: Swelling of the top of the ureter, usually because something is blocking the urine from flowing into or out of the bladder.

  • hydronephrosis: Swelling at the top of the ureter, usually because something is blocking the urine from flowing into or out of the bladder.

  • hydronephrosis: Swelling at the top of the ureter usually because something is blocking the urine from flowing into or out of the bladder.

  • hypertrophy: When an organ increases to a size larger than normal.

  • incontinence: Loss of bladder or bowel control; the accidental loss of urine or feces.

  • infection: A condition resulting from the presence of bacteria or other microorganisms.

  • intermittent catheterization: Periodic insertion of a narrow tube through the urethra or through the front of the abdominal wall into the bladder to allow urine drainage.

  • ions: Electrically charged atoms.

  • kidney: One of two bean-shaped organs that filter wastes from the blood and discharge these waste products in urine. The kidneys are located on either side at the level of the 12th ribs toward the back. The kidneys send urine to the bladder through tubes called ureters.

  • kidney infection: Also called pyelonephritis. Urinary tract infection involving the kidney. Typical symptoms include abdominal or back pain, fever, malaise and nausea or vomiting.

  • kidneys: One of two bean-shaped organs that filter wastes from the blood and discharge these waste products in urine. The kidneys are located on either side at the level of the 12th ribs toward the back. The kidneys send urine to the bladder through tubes called ureters.

  • MRI: Also referred to a magnetic resonance imaging. A diagnostic procedure that uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within the body.

  • nephritis: Inflammation of the kidneys.

  • neurogenic: Causing or relating to the disorder of nerves.

  • neurogenic bladder: Also called neuropathic bladder. Loss of bladder control caused by damage to the nerves controlling the bladder.

  • neurologic: Pertaining to the nervous system.

  • obstruction: something that obstructs, blocks, or closes up with an obstacle

  • overactive bladder: A condition in which the patient experiences two or all three of the following conditions: urinary urgency, urge incontinence or urinary frequency--defined for this condition as urination more than seven times a day or more than twice at night.

  • pelvis: The bowl-shaped bone that supports the spine and holds up the digestive, urinary and reproductive organs. The legs connect to the body at the pelvis.

  • peripheral: Near the surface of an organ.

  • pyelonephritis: Also referred to as kidney infection usually caused by a germ that has traveled up through the urethra, bladder and ureters from outside the body. Typical symptoms include abdominal or back pain, fever, malaise and nausea or vomiting.

  • reflux: Backward flow.

  • reflux: Backward flow of urine. Also referred to as vesicoureteral reflux (VUR). An abnormal condition in which urine backs up from the bladder into the ureters and occasionally into the kidneys, raising the risk of infection.

  • renal: Pertaining to the kidneys.

  • retention: In ability to empty urine from the bladder, which can be caused by atonic bladder or obstruction of the urethra.

  • sphincter: A round muscle that opens and closes to let fluid or other matter pass into or out of an organ. Sphincter muscles keep the bladder closed until it is time to urinate.

  • sphincter muscle: Circular muscle that helps keep urine from leaking by closing tightly like a rubber band around the opening of the bladder.

  • spina bifida: A condition at birth in which part of the vertebral bodies (or back bones) fail to seal off completely and some part of the spinal cord protrudes through this opening. This condition is often associated with bladder and bowel control problems as well as lack of control of voluntary movement in the lower body.

  • tissue: Group of cells in an organism that are similar in form and function.

  • ultrasound: Also referred to as a sonogram. A technique that bounces painless sound waves off organs to create an image of their structure to detect abnormalities.

  • ureter: One of two tubes that carry urine from the kidneys to the bladder.

  • ureteral: Pertaining to the ureter. Also referred to as ureteric.

  • urethra: A tube that carries urine from the bladder to the outside of the body. In males, the urethra serves as the channel through which semen is ejaculated and it extends from the bladder to the tip of the penis. In females, the urethra is much shorter than in males.

  • urethral: Relating to the urethra, the tube tha carries urine from the bladder to outside the body.

  • urethral sphincter: Muscle fibers around the outside of the urethra that tighten to close off the flow of urine or relax to open the urethra to allow the passage of urine.

  • urge: Strong desire to urinate.

  • urinary: Relating to urine.

  • urinary incontinence: Inability to control urination.

  • urinary incontinence: Involuntary loss of urine associated with a sudden strong urge to urinate.

  • urinary tract: The system that takes wastes from the blood and carries them out of the body in the form of urine. Passageway from the kidneys to the ureters, bladder and urethra.

  • urinate: To release urine from the bladder to the outside. Also referred to as void.

  • urination: The passing of urine.

  • urine: Liquid waste product filtered from the blood by the kidneys, stored in the bladder and expelled from the body through the urethra by the act of urinating (voiding). About 96 percent of which is water and the rest waste products.

  • urology: Branch of medicine concerned with the urinary tract in males and females and with the genital tract and reproductive system of males.

  • UTI: Also referred to as urinary tract infection. An illness caused by harmful bacteria growing in the urinary tract.

  • vas: Also referred to as vas deferens. The cordlike structure that carries sperm from the testicle to the urethra.

  • vesicoureteral reflux: Also referred to as VUR. An abnormal condition in which urine backs up from the bladder into the ureters and occasionally into the kidneys, raising the risk of infection.

  • void: To urinate, empty the bladder.

  • voiding: Urinating.

  • VUR: Also referred to as vesicoureteral reflux. An abnormal condition in which urine backs up into the ureters and occasionally into the kidneys, raising the risk of infection.

Neurogenic Bladder Anatomical Drawings

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