Neurogenic Bladder and Overactive Bladder - Causes, Diagnosis and Treatment

What Is a Neurogenic Bladder?

Neurogenic bladder (neurogenic lower urinary tract dysfunction), is a lack of bladder control due to neural problems. Several muscles and nerves are working together to allow the bladder to hold urine until it empties. The nerve damage that causes the neurogenic bladder usually occurs due to an illness or an injury that results in the failure to relax or tighten the muscles at the right time, and the bladder fails to fill or empty properly. Millions of people have neurogenic bladders. This includes people with multiple sclerosis (MS), Parkinson’s disease, spina bifida, spinal cord injury, people who have had a stroke, major pelvic surgery, diabetes, or other illnesses.

What Is an Overactive Bladder?

Overactive bladder (OAB) is not a disease, it is a group of symptoms affecting the urinary bladder. The most common symptom is an uncontrolled and sudden need to urinate. Another symptom is the urge to pass urine multiple times a day and night. Causes of overactive bladder include abdominal trauma, nerve damage, infections, medications, and certain fluids. Overactive bladder has a prevalence of 16.5 % and it affects daily life performance. Usually, overactive bladder is more common in the elderly population.

What Are the Causes of Neurogenic and Overactive Bladder?

Neurogenic Bladder:

The most common causes of neurogenic bladder are conditions that affect the nerves that control the bladder. These include:

• Multiple Sclerosis: This autoimmune disease affects the central nervous system, including the nerves that control the bladder.

• Spinal Cord Injury: Damage to the nerves in the spinal cord can disrupt the communication between the bladder and the brain, leading to neurogenic bladder.

• Parkinson's Disease: This progressive nervous system disorder affects movement and can also affect bladder function.

• Spina Bifida: This birth defect affects the development of the spine and can result in nerve damage that affects bladder function.

• Stroke: A stroke can damage the nerves that control the bladder, leading to neurogenic bladder.

• Tumors: Tumors in or near the spinal cord or brain can put pressure on the nerves that control the bladder.

• Diabetes: Uncontrolled high blood sugar levels can damage the nerves that control the bladder.

• Infections: Certain infections, such as meningitis or herpes, can damage the nerves that control the bladder.

• Certain Medications: Some medications, such as anticholinergics or opioids, can affect bladder function and lead to neurogenic bladder.

Overactive Bladder:

The exact causes of overactive bladder are not fully understood, but there are several factors that may contribute to the development of the condition:

• Neurological Conditions: Conditions that affect the nervous system, such as multiple sclerosis, Parkinson's disease, or stroke, can disrupt the signals between the brain and the bladder, leading to overactive bladder.

• Age: As people age, changes in the bladder muscles and nerves may cause overactive bladder.

• Bladder Muscle Problems: Problems with the muscles that control the bladder can lead to overactivity, such as weak or overactive bladder muscles.

• Urinary Tract Infections: Infections in the urinary tract can cause the bladder to become overactive.

• Bladder Irritants: Certain foods and drinks, such as caffeine, alcohol, acidic or spicy foods, and artificial sweeteners, can irritate the bladder and lead to overactive bladder.

• Medications and Alcohol: Some medications, such as diuretics or drugs for high blood pressure, can increase urine production and lead to overactive bladder.

What Are the Symptoms of Neurogenic and Overactive Bladder?

Neurogenic Bladder:

• Urinary Incontinence: This is the inability to control the flow of urine, leading to leakage.

• Urinary Retention: This is the inability to fully empty the bladder, leading to a feeling of incomplete emptying, frequent urination, or urgency.

• Kidney Damage: In severe cases, neurogenic bladder can lead to kidney damage and other complications.

• Urinary Tract Infections: People with neurogenic bladder are at an increased risk of developing urinary tract infections due to the incomplete emptying of the bladder.

• Increased Frequency of Urination: People with neurogenic bladder may need to urinate more often than usual, including during the night.

Overactive Bladder:

• Urinary Urgency: A sudden, intense urge to urinate that is difficult to control.

• Urinary Frequency: Needing to urinate more often than usual, typically more than eight times in a 24-hour period.

• Urgency Incontinence: Leaking urine during an episode of urgency.

• Nocturia: Waking up more than once during the night to urinate.

How Is Neurogenic and Overactive Bladder Diagnosed?

• Urinalysis: This test involves analyzing a urine sample for signs of infection or other abnormalities.

• Cystoscopy: This procedure involves inserting a thin, flexible tube with a camera into the bladder to examine it for any abnormalities or signs of disease.

• Ultrasound Scan: This test uses sound waves to create an image of the bladder and can help determine if the bladder is emptying fully.

• Imaging Tests: X-rays, CT scans, or MRI scans can be used to examine the urinary system and identify any abnormalities or damage to the nerves.

• Urodynamic Testing: This test involves measuring the pressure and flow of urine in the bladder during urination. It can help determine how well the bladder is functioning and identify any problems.

What Is the Treatment of Neurogenic and Overactive Bladder?

• Medications: Depending on the underlying cause, a doctor may prescribe medications to help control bladder function. For example, medications to relax the bladder muscles can help treat urinary retention, while medications that tighten the bladder muscles can help treat urinary incontinence.

• Catheterization: If the bladder is not emptying fully, catheterization is recommended, which involves inserting a thin tube into the bladder to drain urine.

• Behavioral Modifications: Certain lifestyle changes may help manage symptoms of neurogenic bladder, such as scheduling regular trips to the bathroom, training the bladder to hold urine for longer periods, and avoiding foods and drinks that can irritate the bladder.

• Surgery: In some cases, surgery may be needed to correct abnormalities in the bladder or to restore normal bladder function.

• Sacral Neuromodulation: This is a minimally invasive procedure that involves implanting a device under the skin that sends electrical impulses to the sacral nerves, which control the bladder. This can help improve bladder control and reduce urinary urgency and frequency.

• Botox Injections: Botox can be injected into the bladder muscle to help reduce contractions and improve bladder control. This treatment is typically reserved for those who have not responded to other treatments.

Conclusion

Both neurogenic bladders and overactive bladders clinically manifest as a lack of bladder control. Several factors can contribute to its development, such as age, neurological conditions, bladder muscle problems, bladder irritants, urinary tract infections, medications, and other medical conditions. The symptoms can interfere with daily activities, disrupt sleep, and cause embarrassment or anxiety. So it's important to talk to a healthcare provider if there are symptoms of neurogenic or overactive bladder, as they can help determine the underlying cause and recommend the appropriate treatment.