What is neurogenic bladder?

Normally, nerves carry messages back and forth between the bladder and the brain. The nerves tell the brain when the bladder is full. The brain then sends signals, telling the bladder muscles to hold or release urine. With neurogenic bladder, the messages aren’t sent or received properly. This can lead to problems with bladder control.

What causes neurogenic bladder?

Damage to nerves may be caused by:

• Nerve problems that are present at birth (congenital), such as spina bifida

• Injury to or infection of the brain or spinal cord

What are the signs?

These are the signs of neurogenic bladder:

• Trouble holding or releasing urine

• Failure to potty train

• Urinary tract infection (UTI)

• Swollen kidneys or other congenital urinary problems

• Thickened bladder wall

How is neurogenic bladder diagnosed?

Children with conditions or injuries affecting the brain or spinal cord are more likely to have neurogenic bladder. Your healthcare provider will ask you about your child’s health. The healthcare provider will do a physical exam to look for problems and observe urination. To help get more information:

• Your child may need urine tests to find an infection and protein in the urine. Protein in urine can be a sign of kidney disease.

• You may be asked to keep a record of your child’s voiding habits.

• Your child may have a kidney and bladder ultrasound can to check for swelling of the kidneys and look at the bladder.

• Your child may have a urodynamics study to give the healthcare provider a detailed look at how well your child’s bladder and urethra work.

• Your child may have a voiding cystourethrogram (VCUG) to find out if urine flows backward from the bladder into the kidneys.

How is neurogenic bladder treated?

Treatment depends on the cause of your child’s neurogenic bladder and what type of voiding problem they have. Your child may need one or more of the following treatments:

• Timed voiding. This  means using the toilet at regularly scheduled times. It can help your child avoid wetting accidents and protect the kidneys.

• Intermittent catheterization. This drains the bladder on a regular schedule. It involves inserting and removing a tube (catheter) through the urethra into the bladder each time it needs to be emptied.

• Indwelling catheter. Some injuries need a more permanent catheter placement.

• Medicine. Your child may be given medicine to relax the bladder muscles and prevent muscle spasm (involuntary tightening of muscles).

• Surgery. Surgery protects the kidneys and allows for the controlled holding in and releasing of urine and stool. Surgery may be done to:

  • Create a new opening in the belly through which a temporary catheter can be placed to empty the bladder

  • Make the bladder larger

  • Tighten the sphincter so it can better hold in urine

Your child’s healthcare provider can discuss surgery with you, if it is an option.

Timed voiding

Timed voiding means urinating at scheduled times. It lets kids who are potty trained empty their bladders on a regular basis. This helps prevent infections and avoid wetting accidents. To practice timed voiding, your child will need to visit the bathroom at set times throughout the day. Their healthcare provider can suggest how often your child should urinate. Your child should not wait until the urge to urinate arises before using the toilet.

What are the long-term concerns?

Left untreated, children with this condition are likely to have bladder and kidney problems. Constipation and the inability to hold in stool may also be more likely. You can take steps to help with these problems. Your child’s healthcare provider can discuss your child’s condition with you and how your child is likely to progress long-term. Also, the condition may change over time. It will need to be monitored throughout your child’s lifetime.

Coping

Dealing with neurogenic bladder can be hard to cope with. Incontinence can also cause embarrassment and lead to self-esteem issues for your child. Your support and patience are vital for your child’s treatment and emotional development. It takes work and time to learn how to best manage your child’s condition. Encourage your child’s success by ensuring that they follow the treatment plan. In some cases, a psychological therapist can help the child and family follow the treatment plan.

To learn more

If you have questions, talk to your child’s care team. Also, look for support materials in your local library or bookstore. These online resources can also be helpful:

• National Association for Continence at www.nafc.org

• Spina Bifida Association at www.spinabifidaassociation.org