A neurogenic bladder is dysfunctional.
What is a Neurogenic Bladder?
Neurogenic bladder dysfunction means that the bladder is not working correctly, due to a disease of the peripheral nerves or central nervous system in charge of controlling urination. The main symptom is “difficulty or full inability to pass urine without use of a catheter or other method”. Any disorder that impairs bladder signaling may cause neurogenic bladder, including diseases of the spinal cord, herniated disk injury, brain tumors, pregnancy and spina bifida or other neural tube defects. Diseases in the peripheral nerves, such as B12 deficiency, diabetes, or alcoholism can also cause this condition. Pelvic surgery could lead to this complication.1 MS (multiple sclerosis), brain or spinal cord infection, stroke, heavy metal poisoning, and Parkinson’s disease may also trigger neurogenic bladder. This condition affects “millions of Americans”. Neurogenic bladder (lacking bladder control) might present as “overactive bladder (OAB), incontinence, and underactive bladder (UAB) or obstructive bladder, in which the flow of urine is blocked.”2 Overactive bladder symptoms include trouble emptying the bladder, loss of control, and urinating in small amounts too often. For patients with underactive bladder, symptoms are urinary retention and inability to tell when there is a full bladder, difficulties emptying the bladder or beginning urination, and urine leakage. Other medical conditions that can lead to neurogenic bladder are Alzheimer disease, cerebral palsy, encephalitis, and ADHD (attention deficit hyperactivity disorder). Nerve damage (neuropathy) from long-term alcoholism or diabetes, syphilis, pelvic surgery, or spinal stenosis can also lead to these bladder issues. Complications of neurogenic bladder include urine leakage leading to pressure sores, kidney damage, and urinary tract infections.3
Doctors consider many factors when diagnosing neurogenic bladder including patients reporting a weak urination stream, the inability to urinate or urinating too frequently (8+ times a day), urgency, and painful urination (which could indicate an infection). Tests are often ordered, such as bladder function tests (“urodynamic studies”) to measure bladder capacity, bladder pressures, the flow of urine, and bladder emptying”. The inside of the bladder can be examined via cystoscopy, in which a cystoscope, or a small telescope, is used. Patients may also be examined with CT, MRI, or X-rays. Aside from the physical examination, patients are generally asked about medical history, neurological problems, stroke, or back injuries.4 Doctors need to find out the cause behind the urinary dysfunction. Atonic bladder and flaccid bladder are some other medical terms used when the “organ (can) dilate as usual but fail to empty”. The brain may be sending incorrect signals due to a medical condition (like MS), an injury to the spinal cord, or from a “blockage of the urinary canal” (enlarged prostate, bladder stones).5
Treatment Options for Neurogenic Bladder Dysfunction
Catheterization is a treatment method that can be done in a couple of ways: intermittent or via stoma. With intermittent catheterization, patients use straight, disposable catheters, several times a day, in order to empty the bladder. Patients may either do this on their own or with a caregiver’s help. An option for patients who cannot tolerate these straight, disposable catheters is the Foley (indwelling, permanent) catheter, which “allows continuous drainage of urine into a sterile drainage bag that is worn by the patient.” Another catheterization method involves creating “a stoma that is continent and readily accepts a catheter” in order to “bypass the urethra to empty the bladder directly”. In some cases, botulinum toxin may be injected in order “to relax one of the two sphincters involved in normal urination”.6 Besides Botox, doctors may suggest medicines to relax the bladder, such as “oxybutynin, tolterodine, or propantheline”, medication to make nerves active (bethanechol), GABA supplements, or anti-epileptic prescriptions. Additionally, patients may benefit from Kegel exercises, to strengthen the muscles of the pelvic floor, and keeping a diary about urination to learn when to be near a bathroom. It is important that patients learn the symptoms of a UTI (urinary tract infection), as well, to make sure they are treated for that condition. Symptoms of a UTI include fever, one-sided low back pain, frequent desire to urinate, and burning during urination. Cranberry is often recommended to prevent UTIs. Some patients may need an indwelling catheter (all the time) and others may just need one 4-6 times per day to prevent the bladder from becoming overly full. For some, surgery is required, such as sling surgery, artificial sphincter, implanting an electrical device to stimulate bladder muscles, or the previously mentioned stoma opening (“in which urine flows into a special pouch…called urinary diversion”).7
Alternative and Home Treatments
Aside from drugs, surgery, or electrical-stimulatory therapy, doctors may also recommend physical-psychological therapy, otherwise known as “timed voiding” which “combines will power and exercise”. Not only does the patient keep a diary of voiding (fluid intake, leakage episodes, urination times) to know when to urinate, but the patient is also taught how to gain control over voiding through physical exercises, such as Kegel exercises.8 Bladder retraining involves “carefully timing…catheterization intervals”. Over time, the patient can learn to “lengthen the intervals so that the bladder holds more” and has “fewer inappropriate contractions”. For example, the patient can start by waiting 15 extra minutes to void the bladder, and if the urge is still too strong, they can use methods to distract themselves, such as contracting the muscles of the pelvic floor (Kegel exercises) to stop the urine flow. The Kegel contractions can be done for 3-5 seconds at a time at first, and then “build up to 10-second contractions”. Slow breathing and crossing the legs can also distract the patient until they reach the “goal interval time”.9 Chiropractic management was used in a case study of a 5-year-old male with bowel and urinary incontinence. The techniques used included the Activator instrument, and “shortwave diathermy to the lumbar spine and sacrum”. There were 5 treatments provided over 4 weeks, and this resulted in the child being “able to maintain satisfactory control of his bladder and bowel…for…6 months”. When the incontinence returned, the child underwent a second set of treatments, which “reestablished satisfactory control”.10 In another case study, a 12-year-old female “showed a marked improvement in a chronic Autonomous Neurogenic Bladder (ANB)” while she was “being treated for a functional scoliosis”.11 Chiropractic care has also been used for the treatment of enuresis (bed-wetting). In general, children learn control over their bladders by the age of 5. Some children do not learn at all by 5, and some have “lapsed back to wetting the bed”. Chiropractors can adjust the lumbar area and or sacrum, as misalignments in that region can irritate the nerves, leading to “inappropriate bladder function”. Learning to walk and childhood falls can lead to repeated trauma to the sacrum. Adjusting the spine may lead to a cessation of bed-wetting in children with a spinal cause for their enuresis.12 In terms of massage therapy, patients may respond to myofascial release. This treatment can be done “directly to the prostate” or “directed toward the spine” in order to address “muscle and structural imbalances” and to strengthen the pelvic floor muscles to correct or avoid prolapse. Pelvic organ prolapse is a risk for women after childbirth, due to the fact that the ligaments and pelvic floor muscles overly stretch during pregnancy and childbirth..13
Learn more about overactive bladder.