Neurogenic Bladder: What Are My Treatment Options?

Bladder problems can develop due to neurological diseases or nerve damage

Medically reviewed by Matthew Wosnitzer, MDMedically reviewed by Matthew Wosnitzer, MD

Neurogenic bladder is caused by damage to the nerves that allow you to control the timing of urination. Treatments for neurogenic bladder can include physical therapy, medication, or interventional procedures.

Neurogenic bladder causes varied symptoms, which can include bladder urgency, frequent urination, incontinence, the feeling of a full bladder, and urinary retention (not being able to empty the bladder).

This article describes the causes, symptoms, and treatment of neurogenic bladder.

Neurogenic Bladder Treatment Overview

Your treatment plan is guided by the underlying cause of nerve damage, your symptoms, the severity, and how your life is affected.

Treatments may include:

• Physical therapy, bladder training, pelvic floor therapy

• Medications to treat the underlying cause (such as multiple sclerosis medication)

• Medication to help control the bladder

• Injections to stimulate or inhibit the nerves and muscles of the bladder, such as Botox (onabotulinumtoxinA)

• Urinary catheter placement to allow urine to flow from the bladder if there is blockage, spasm, elevated post-void residual (urine remaining in the bladder after urinating), or urinary retention

• Treatment for complications, such as urinary tract infection (UTI)

• Surgery to repair damage to the bladder, nerves, or muscles

• Surgery to remove a tumor that’s in or near the bladder

• Placement of nerve stimulators or devices to help optimize nerve and muscle function in neurogenic bladder

• Counseling to help you manage the stress of living with neurogenic bladder

You may need ongoing therapy with a combination of treatments. As your condition changes over time, you might need changes to your treatment plan.

Symptoms: How Neurogenic Bladder Feels

With neurogenic bladder, you can have a combination of overactive and underactive bladder symptoms. Urgency, frequency, and incontinence are sometimes described as overactive bladder symptoms, while a full bladder and urinary retention are symptoms of an underactive bladder.

You might not specifically feel that a weak bladder causes the symptoms, but after you get a diagnosis, your healthcare providers will let you know which signs to look for.

Symptoms of neurogenic bladder can include:

• The sudden need to pee

• Frequent need to pee

• Leaking pee when you don’t want to

• Inability to fully empty your bladder

• Inability to start a urine stream

• Feeling like something is preventing urine from coming out

• Lower abdominal discomfort

Complications

Complications of neurogenic bladder can cause additional symptoms, including:

• UTI, with burning urination, blood in the urine, cloudy urine, or fever

• Bladder retention, with lower abdominal discomfort and a sense of abdominal fullness or bloating

• Leaking urine, which can cause skin irritation, redness or discoloration, soreness, and possibly a skin infection

• Interstitial cystitis, which is inflammation of the bladder

• Vesicoureteral reflux and kidney damage (in severe cases, urine can back up from the bladder to the kidneys)

In addition to these health complications, living with neurogenic bladder can cause stress, anxiety, or depression. Feeling like you could wet your pants in public or feeling that you always need to be near a toilet can limit your freedom, which can take an emotional toll and may affect your quality of life.

Nocturia

Nocturia is getting up to pee during the night. This can cause disrupted sleep and fatigue in the morning. Sometimes, nocturia may result in wetting the bed.

Neurogenic Bladder Damage and Related Conditions

Urination involves your bladder and urethra (the tube that pee comes out of), which are coordinated by voluntary muscles that you consciously control and involuntary muscles that you do not control. Nerves control all of these muscles. You can develop neurogenic bladder if the nerves that stimulate your bladder muscles become damaged.

Some nerves to the bladder allow you to hold your urine, and some allow you to pee. This is why neurogenic bladder can sometimes cause opposite symptoms—you might have incontinence, urgency, and retention due to the combination of nerves and muscles that are damaged. Bladder spasms can cause sudden leaking, and bladder weakness can make it difficult to pee.

Medical disorders that can cause neurogenic bladder include:

• Multiple sclerosis (MS), an autoimmune condition in which the immune system attacks the myelin sheath that protects nerves

• Neuropathy (nerve disease), such as diabetic neuropathy due to diabetes or alcoholic neuropathy due to alcohol misuse or overuse

• Stroke

• Parkinson’s disease, amyotrophic lateral sclerosis (ALS), or other neurodegenerative diseases

• Injury in or near the bladder due to trauma, surgery, radiation therapy, or cancer

Many of these medical conditions can cause permanent damage or worsening effects. Multiple sclerosis is a chronic condition that can cause symptoms that sometimes worsen and sometimes improve. Some medications can cause neurogenic bladder, which should resolve once the medication is stopped.

Seeing a Specialist

You may need to see a urologist or a neurologist, or both, for treatment of a neurogenic bladder that is not responding to standard treatment. A urologist is a physician specializing in treating kidney and bladder disease, while a neurologist is a physician specialized in treating conditions affecting the nervous system.

Related: What Type Of Healthcare Providers Diagnose And Treat Urinary Incontinence?

Urologist-Prescribed Neurogenic Bladder Treatment

A urologist will use diagnostic tests (post-void residual, urodynamics, cystoscopy) to identify the specific problem that you’re having and to help decide which treatments you need.

Therapies for neurogenic bladder (with overactive symptoms) include:

• Anticholinergic medication: These medications block muscle movement and can reduce bladder muscle spasms. Examples include Ditropan (oxybutynin), Detrol (tolterodine), Toviaz (fesoterodine), Enablex (darifenacin), trospium chloride, and VESIcare (solifenacin).

• Beta-3 adrenergic receptor agonists: These medications relax certain muscles. Examples include Myrbetriq (mirabegron) and Gemtesa (vibegron).

• Other medications: Medications that have varied actions include estrogen therapy, imipramine, and amitriptyline.

Related: How Overactive Bladder Is Treated

Complementary and Alternative Remedies

It’s important for you to know that neurogenic bladder requires treatment and evaluation by a medical professional. It is not safe to self-diagnose or self-treat neurogenic bladder.

Nevertheless, some alternative and complementary remedies may help improve your urinary control. You should discuss these options with your urologist or other treating professional to know whether they are safe for you and whether you need professional guidance.

Alternative remedies that may help people who have neurogenic bladder include:

• Acupuncture

• Breathing exercises

• Meditation

These therapies may help you gain a better ability to sense and control your urination so that you can avoid accidents and complications.

How to Manage Chronic Neurogenic Bladder

Living with neurogenic bladder can be challenging. You may experience urgency, incontinence, infections, and fluctuating symptoms.

It’s important for you to adjust your day-to-day life to maximize your comfort and independence while reducing the risk of complications.

Lifestyle adjustments to consider include:

• Make sure you have a job or activities that allow you access to the toilet when necessary.

• Have a schedule for your fluid intake.

• Follow a schedule for urination.

• Consider wearing a pad or disposable underwear in case you have leakage.

• Bring extra clothes and underwear with you when leaving the home so you can change if necessary.

Pay attention to your symptoms so that you can discuss any concerns or changes with your healthcare provider. If your symptoms change over time, you may need adjustments in your treatment.

Learn More: Coping With Overactive Bladder

Summary

Neurogenic bladder is a chronic condition that develops due to damage of the nerves that control urination. Causes for this condition include neuropathy, traumatic injury, multiple sclerosis, stroke, and more.

You should not ignore any urinary problems you're experiencing because neurogenic bladder can cause complications when it is not treated. Effective treatment can help improve your symptoms, overall health, and quality of life.

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