Understanding Neurogenic Bladder: When Nerve Problems Make It Difficult to Control Urination

Neurogenic bladder is a condition in which a person has difficulty controlling their bladder due to problems affecting the brain, spinal cord, or nerves that regulate urinary tract function. Normally, the nerves and muscles of the bladder work together to store urine until a person is ready to urinate. Nerve signals travel back and forth between the brain and the muscles that control bladder emptying. When these nerves are damaged by disease or injury, the bladder muscles may not tighten or relax at the right time, disrupting the normal process of storing and emptying urine.

Neurogenic bladder can affect people with various conditions involving the nervous system. It may occur in people with multiple sclerosis (MS), Parkinson’s disease, spina bifida, or those who have experienced a stroke or spinal cord injury. Bladder dysfunction caused by nerve problems may also occur after major pelvic surgery, in people with diabetes, or as a result of other medical conditions that affect the nerves.

dr. Andika Afriansyah, Sp.U, Subsp. FFN (K), MARS

To manage bladder dysfunction associated with neurological problems, Mandaya Royal Hospital Puri has urologists with expertise in neuro-urology. One of them is dr. Andika Afriansyah, Sp.U, Subsp. FFN (K), MARS, a urologist and consultant in Functional, Female, and Neuro-Urology who treats various urinary tract and bladder disorders related to nervous system function.

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Types of Neurogenic Bladder

In general, there are two main types of bladder control problems associated with neurogenic bladder. The type depends on which nerves are affected and the nature of the damage. They include:

Overactive bladder (spastic or hyperreflexic bladder), in which the bladder contracts excessively or at inappropriate times.
Underactive bladder (flaccid or hypotonic bladder), in which the bladder muscles cannot contract properly, making it difficult to empty the urine.

What Are the Symptoms of Neurogenic Bladder?

The most common symptom of neurogenic bladder is the inability to control when to urinate. However, symptoms may vary depending on the type of neurogenic bladder a person has.

Symptoms of an Overactive Bladder

An overactive bladder may cause symptoms such as:

Difficulty starting urination, a weak urine stream, or urine that dribbles out slowly.
Loss of bladder control or urinary incontinence.
Urinating eight or more times a day.
A sudden and strong urge to urinate.

Symptoms of an Underactive Bladder

An underactive bladder may cause symptoms such as:

The bladder does not empty completely or at all during urination (urinary retention).
The bladder becomes too full, causing urine to leak or overflow.
Being unable to feel when the bladder is full.

Causes of Neurogenic Bladder

Neurogenic bladder may be present from birth or develop as a congenital condition. Some birth defects that can cause neurogenic bladder include:

Caudal regression syndrome, a developmental disorder affecting the lower spine and spinal cord.
Cerebral palsy, a group of disorders that affect movement, balance, and posture.
Spina bifida, a birth defect in which the spine and spinal cord do not develop or close properly.

In addition to congenital conditions, several neurological disorders can affect the nerves that control bladder function. These conditions include:

Tumors of the central nervous system.
Multiple sclerosis (MS).
Parkinson’s disease.
Stroke.

Neurogenic bladder may also result from damage to the spinal cord or nerves caused by injury. Examples include:

Spinal cord injuries.
Traumatic injuries, such as falls or motor vehicle accidents.

These conditions can disrupt communication between the brain, nerves, and bladder muscles. As a result, the bladder may have difficulty storing or emptying urine normally.

How Is Neurogenic Bladder Diagnosed?

Because neurogenic bladder involves both the nervous system and bladder function, doctors may perform several examinations to determine the underlying cause and assess the patient’s condition. The diagnostic process usually begins with a discussion about symptoms, medical history, daily habits, medications, and eating and drinking patterns.

Doctors may also ask patients to keep a bladder diary to record how frequently they urinate and when urine leakage occurs. In certain cases, a physical examination and pad test may also be performed to evaluate urinary control problems.

Additional tests may include:

Urine tests or urine culture, to detect infection or blood in the urine.
Bladder scan, an ultrasound examination used to determine how much urine remains in the bladder after urination.
Cystoscopy, a procedure that uses a small tube with a camera to examine the urethra and bladder.
Urodynamic testing, to assess how well the lower urinary tract stores and releases urine.
Imaging tests, such as X-rays, ultrasound, CT scans, or imaging of the brain and spine when necessary.

The type of examination performed will depend on the patient’s symptoms, medical history, and suspected cause of neurogenic bladder.

Complications of Neurogenic Bladder

Neurogenic bladder that is not properly managed may increase the risk of various problems affecting the urinary system. Possible complications include:

Kidney damage or impaired kidney function.
Kidney stones or stones in other parts of the urinary tract, such as the ureters.
Backflow of urine from the bladder to the kidneys.
Recurrent urinary tract infections (UTIs).

In addition to affecting physical health, neurogenic bladder can also affect quality of life. Concerns about urine leakage or urine odor in public may cause a person to feel anxious, distressed, or socially isolated.

Therefore, symptoms related to bladder control should not be ignored. Proper evaluation and treatment can help reduce the risk of complications while maintaining urinary tract function and quality of life.

Treatment for Neurogenic Bladder

Treatment for neurogenic bladder depends on its underlying cause, type of bladder dysfunction, symptoms, and the patient’s overall condition. Doctors may recommend several treatment options.

1. Bladder Augmentation

Augmentation cystoplasty, or bladder augmentation, is a surgical procedure that increases the size of the bladder so it can hold a larger volume of urine.

2. Botulinum Toxin (Botox) Injections

Botulinum toxin or Botox injections may be administered into the bladder muscle or urinary sphincter to help relax the muscles. This treatment may increase the bladder’s ability to store urine and reduce urinary urgency, frequency, and leakage.

3. Continuous Catheterization

In certain cases, patients may use a urinary catheter continuously to help drain urine from the bladder. The catheter may be inserted through the urethra into the bladder or through the lower abdominal wall.

4. Medications

Doctors may prescribe certain medications to help manage neurogenic bladder symptoms. Some medications that may be used include oxybutynin, tolterodine, mirabegron, and solifenacin.

5. Self-Catheterization

Clean intermittent catheterization is a method of emptying the bladder using a catheter that is inserted through the urethra at regular intervals. Patients are taught how to perform catheterization themselves according to a schedule determined by their doctor.

6. Urinary Reconstruction and Diversion

In certain cases, doctors may perform urinary reconstruction or urinary diversion surgery. This procedure may use a section of the intestine to create a new pathway for urine to leave the body through a surgically created opening called a stoma, which drains into a urine collection bag outside the body.

What Type of Doctor Treats Neurogenic Bladder?

At Mandaya Royal Hospital Puri, patients with neurogenic bladder can consult dr. Andika Afriansyah, Sp.U, Subsp. FFN (K), MARS, a urologist and consultant in Functional, Female, and Neuro-Urology. With expertise in neuro-urology, dr. Andika treats various urinary tract disorders associated with problems affecting the nervous system, including bladder dysfunction caused by stroke, diabetes, and other neurological conditions.

dr. Andika completed his medical degree at the University of Indonesia in 2008. He then continued his training in Urology at the University of Indonesia and completed the program in 2020.

To further develop his expertise, dr. Andika completed Consultant Training in Functional, Female, and Neuro-Urology at the Indonesian Urology Collegium in 2022. This specialized training supports his expertise in evaluating and treating various bladder and urinary tract dysfunctions associated with neurological conditions.

Expertise of dr. Andika Afriansyah, Sp.U, Subsp. FFN (K), MARS

As a urologist with subspecialty expertise in Functional, Female, and Neuro-Urology, dr. Andika treats various conditions, including:

Urinary tract disorders in women, including recurrent urinary tract infections (UTIs).
Urination problems, such as difficulty urinating, weak urine flow, and incomplete bladder emptying.
Urinary incontinence or the inability to control urination (urinary leakage) in adults and older people.
Bladder dysfunction caused by neurological disorders (neuro-urology), including conditions associated with diabetes or after a stroke.
Various urinary tract dysfunctions requiring evaluation and treatment by a urologist with expertise in Functional, Female, and Neuro-Urology.

dr. Andika’s Practice Schedule at Mandaya Royal Hospital Puri

dr. Andika Afriansyah, Sp.U, Subsp. FFN (K), MARS sees patients at Mandaya Royal Hospital Puri according to the following schedule:

Tuesday: 4:00–8:00 PM WIB
Thursday: 4:00–8:00 PM WIB
Saturday: 9:00 AM–4:00 PM WIB

To make your visit to Mandaya Royal Hospital Puri more convenient, you can use the WhatsApp Chat, Book Appointment, or the Care Dokter application, which can be downloaded from Google Play and the App Store. The application allows you to make appointments, check queue numbers, and access other information.

*The information provided on this page is intended for educational purposes and general information only and does not represent the full range of medical services that may be provided by each doctor. To determine the appropriate treatment for your medical condition, you are advised to consult directly with the relevant doctor.

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