Types of Neurogenic Bladder

It may sound like a high-tech new medical device, but neurogenic bladder is a common urological condition – and it’s happening more often than you might think. If bathroom time has become a burden, read on to learn the ins-and-outs of neurogenic bladder and how to find relief.

Neurogenic bladder is a broad term for when you lose control of your bladder due to a problem in the brain, spinal cord, or central nervous system. As your bladder fills with urine, a complex network of nerves controls the bladder muscles to store it tightly and sends signals to your brain when it’s time to release it. When your brain and nerves can’t communicate the way they should, it can cause problems in the way your bladder stores or empties urine.

There are three main types of neurogenic bladder: underactive bladder, overactive bladder, and mixed neurogenic bladder.

Underactive Bladder (UAB)

This type occurs when the bladder muscle cannot contract properly, making it difficult to empty the bladder completely. It can lead to urinary retention and the need to use methods such as catheterization to empty the bladder.

An underactive bladder occurs when the bladder muscle (detrusor muscle) cannot contract properly, making it difficult to empty the bladder completely. This results in incomplete urination or sometimes the inability to urinate at all, known as urinary retention. This can cause the bladder to stretch and hold abnormally large amounts of urine, which increases your risk for urinary tract infections and involuntary leaking (urinary incontinence).

Underactive bladder can be caused by a variety of factors that affect the nerve signals between the bladder and the brain or the muscles of the bladder itself. Causes include:

Neurological disorders: Diseases such as diabetic neuropathy, spinal cord injuries, multiple sclerosis, and Parkinson’s disease can damage the nerves that control the bladder.
Aging: The risk of developing an underactive bladder increases with age, possibly due to changes in the nervous system and bladder muscle function.
Surgical procedures: Surgery involving the pelvic area, prostate, or lower spine can sometimes lead to nerve damage that affects bladder control.
Medications: Certain medications can impact bladder muscle contraction or nerve function.

Symptoms of an underactive bladder include:

Difficulty starting urination.
A weak urine stream.
The feeling of incomplete bladder emptying after urination.
Urinary dribbling or leaking.
Frequent urinary tract infections (UTIs)

Diagnosing an underactive bladder typically involves a comprehensive evaluation, including a detailed medical history, physical examination, bladder diary, urinalysis, and specialized tests like urodynamic studies to assess how the bladder fills and empties.

Treatment for an underactive bladder aims to manage symptoms and reduce the risk of complications. It may include:

Intermittent catheterization: Regularly emptying the bladder using a catheter can help prevent UTIs and kidney damage.
Medications: Certain drugs can help improve bladder function, although options are limited for underactive bladder compared to overactive bladder.
Lifestyle modifications: Adjusting fluid intake and implementing timed voiding schedules can help manage symptoms.
Surgery: In some cases, surgical interventions might be considered to reduce bladder capacity or address anatomical obstacles to urine flow.

Overactive bladder (OAB)

An overactive bladder is characterized by sudden, involuntary contractions of the muscle in the bladder wall, which leads to frequent and urgent needs to urinate. This urgency can occur at any time, regardless of the amount of urine in the bladder, and may be difficult to control. Overactive bladder can significantly impact an individual’s quality of life, causing embarrassment, inconvenience, and in some cases, social isolation.

The main symptoms of overactive bladder include:

A sudden and strong need to urinate, even if the bladder isn’t full.
Frequent urination, typically eight or more times in 24 hours.
Waking up two or more times during the night to urinate.
Involuntary loss of urine immediately following an urgent need to urinate (urge incontinence).

The exact cause of overactive bladder is not always clear, but it involves overactivity of the bladder muscles. Possible factors contributing to or exacerbating OAB include:

Neurological disorders: Conditions like stroke, multiple sclerosis, and Parkinson’s disease can interfere with the nervous system’s control over the bladder.
Urinary tract infections: These can irritate the bladder and cause symptoms similar to those of an overactive bladder.
Bladder abnormalities: Such as tumors or stones, can trigger OAB symptoms.
Medications: Some medications can increase urine production or require the bladder to work harder to empty completely.
Excessive fluid intake, caffeine, or alcohol consumption: These can exacerbate symptoms by increasing urine production or bladder irritation.

Diagnosis of overactive bladder may involve a physical examination, urinalysis to rule out infections or other conditions, a bladder diary, and possibly urodynamic tests to assess bladder function and capacity.

Treatment for overactive bladder can include:

Behavioral interventions: Such as bladder training, pelvic floor exercises (Kegel exercises), and managing fluid intake to help control symptoms.
Medications: Antimuscarinic or beta-3 adrenergic agonist medications can relax the bladder muscle and increase bladder capacity.
Nerve stimulation therapies: Techniques such as sacral nerve stimulation (SNS) or percutaneous tibial nerve stimulation (PTNS) can help control the nerve impulses to the bladder.
Botox injections: Injecting botulinum toxin type A into the bladder muscle can reduce symptoms of urgency and urge incontinence by relaxing the bladder.

Mixed Neurogenic Bladder

Some patients experience symptoms of both overactive and underactive bladder, a condition called Mixed Neurogenic Bladder. This can happen when different parts of the nervous system that control bladder function are damaged or impaired, leading to mixed signals.

The symptoms and severity can vary widely depending on the extent and location of the nervous system damage. For example, a person with a mixed neurogenic bladder might have difficulty initiating urination or fully emptying their bladder (a symptom of underactive bladder), while also experiencing sudden, uncontrollable urges to urinate or involuntary urine leakage (symptoms of overactive bladder).

The causes of mixed neurogenic bladder are similar to those of other types of neurogenic bladder, including spinal cord injuries, neurological diseases (such as multiple sclerosis or Parkinson’s disease), diabetes, stroke, and congenital abnormalities like spina bifida.

Diagnosis of a mixed neurogenic bladder typically involves a comprehensive evaluation that may include a patient’s medical history, physical examination, urinalysis, urodynamic tests (to assess how well the bladder and urethra are storing and releasing urine), and imaging studies.

Treatment for mixed neurogenic bladder is tailored to the individual’s symptoms and might include a combination of strategies such as medication (to address both retention and incontinence); intermittent catheterization (to help empty the bladder); behavioral therapies (like bladder training and pelvic floor exercises); and possibly surgical interventions. The goal of treatment is to manage symptoms, prevent complications, and improve the quality of life for the individual.

If you or a loved one struggle with neurogenic bladder, you’re not alone. America’s Best Care Plus can help you find fast and convenient relief with our line of intermittent catheters and supplies through our urology program. Our expert team will help you find the right fit and deliver your medical supplies right to your door every month. Learn more on our website and contact our team today to learn how you can get started on the road to relief.