Urology :: Neurogenic Bladder
What is a neurogenic bladder?
Neurogenic bladder may also be called neuropathic bladder. The muscles and nerves of the urinary system work together to hold urine in the bladder and then release it at the appropriate time. Nerves carry messages from the bladder to the brain and from the brain to the muscles of the bladder telling them either to tighten or release. In a neurogenic bladder, the nerves that are supposed to carry these messages do not work properly.
What causes neurogenic bladder?
In children, a neurogenic bladder may be secondary to a birth defect or it may be acquired as the result of a different problem. The following are some of the most common causes of neurogenic bladder:
- A defect that occurs during early fetal development called spina bifida. Children with spina bifida have an incomplete bony closure of the spinal cord through which the spinal cord may or may not protrude.
- Spinal cord trauma.
- Central nervous system tumors.
In many cases, neurogenic bladder is associated with the following:
- Urine leakage
This often occurs when the muscles holding urine in the bladder do not get the right message.
- Urine retention
This often happens if the muscles holding urine in the bladder do not get the messages to release.
- Damage to the kidney
This often happens if the bladder becomes too full, increases in pressure, and causes increased pressure in the kidneys.
- Infection of the bladder or kidneys
This often results from urine that is held too long before being eliminated.
- Small bladder capacities
Increased muscle activity of the bladder muscle can cause a bladder to contract too frequently and cause the capacity to decrease.
What are the symptoms of neurogenic bladder?
The diagnosis of a neurogenic bladder is commonly made shortly after birth when a spinal defect is noted. Some children will have an inability to urinate or only be able to urinate very small quantities. They may also have incontinence. Each child may experience symptoms differently. Symptoms of neurogenic bladder may vary depending on the cause and other associated conditions. Symptoms of neurogenic bladder may resemble other conditions and medical problems. The specialists at the CHOC Children’s Urology Center carefully assess each patient to ensure a proper diagnosis and treatment.
How is a neurogenic bladder diagnosed?
In addition to a complete medical history and physical examination, diagnostic procedures for neurogenic bladder may include:
VCUG is a specific X-ray that examines the urinary tract and allows specialists to see a direct image of the refluxing ureter.
Ultrasounds are noninvasive tests that produce sounds waves that transmit a picture onto a screen. Parents may be familiar with ultrasounds for pregnancy.
- Urodynamic study
After the child completes an uroflow and post void residual, two thin catheters are placed in the child. One in the urethra and one in the anus. These are used to assist in measuring the pressures of the abdomen and bladder during filling and emptying of the bladder. The child's bladder will be filled with saline so that the bladder volume and pressure may be measured. The tone or amount of contraction of the bladder can also be determined.
- Video Urodynamics
Same as Urodynamics, but the baldder is filled with a radiographic dye and X-ray images of the bladder are taken during filling and emptying. It combines urodynamics and a VCUG into one procedure.
- Home Pressure Tests
These at-home tests gives care providers useful information as to the pressure inside a child's bladder at different volumes of urine. Learn more about home pressure tests.
What is the treatment for a neurogenic bladder?
Specific treatment for a neurogenic bladder will be determined by a pediatric urology team based upon:
- The child's age, overall health and medical history
- The extent of the condition and expected course of the condition
- The child's tolerance for specific medications, procedures or therapies
- The family’s opinion or preference
Treatment for neurogenic bladders will not cure the disorder but will aim to prevent complications. Treatments may include:
- Insertion of a catheter or hollow tube to empty the bladder at regular intervals. This is referred to as “clean intermittent catheterizations” and also referred to as “CIC.” Learn more about performing CIC.
- Prophylactic (preventive) antibiotic therapy to reduce the incidence of infection.
- Medications to relax the muscles of the bladder, such as Ditropan.
- Regular imaging studies (such as ultrasounds, VCUG, urodyanmics or video urodynamics) monitor the kidneys, ureters and bladder.
- Mitrofanoff, ACE, or bladder augmentation surgeries.
- Placement of an artificial sphincter using a procedure that involves placing an artificial cuff around the neck of the bladder that can be inflated to prevent urinary incontinence and deflated when it is time to empty the bladder. These children will still require intermittent catheterization to completely empty the bladder.
Please speak with the child’s doctor about any questions or concerns regarding neurogenic bladder.