Neurogenic bladder arises due to issues with the nerves responsible for the neural pathways in the bladder muscles, leading to problems with urination and bladder control.

This condition can significantly affect the patient’s life, causing discomfort. Dr. Ashraf, a consultant in kidney and urinary tract tumor surgery, infertility, and sexual and reproductive health, provides an overview of the best treatment methods for neurogenic bladder and the procedures that can help alleviate symptoms and improve quality of life.

Treatment of Neurogenic Bladder

Dr. Ashraf explains that the primary goals of treating neurogenic bladder are to manage symptoms and prevent kidney damage, specifically.

Below are the key treatment methods:

Lifestyle Changes

For individuals with mild nerve damage, the first step might involve making lifestyle changes to control symptoms, which may include:

Scheduled Urination: Instead of only going to the bathroom when feeling the need to urinate, it’s better to hold off and urinate at specific times. This helps extend the amount of time one can hold urine.

• Double Voiding: This technique is useful for those who cannot completely empty their bladder. After urination, the person waits a few seconds to a minute, then relaxes and tries again to empty any remaining urine from the bladder.
• Delayed Urination: The person starts by delaying urination for a few minutes, then gradually increases the time to a few hours. This helps in learning how to postpone urination even when the urge arises.
• Pelvic Floor Exercises (Kegel Exercises): These exercises help relax bladder muscles and increase the strength of the sphincter muscles. Dr. Ashraf outlines the method as follows:
  Tighten the muscles responsible for the flow and stop of urine for 3 seconds, then relax these muscles for 5 to 10 seconds. Add one second each week until the person can tighten the muscles for 10 seconds. Repeat these exercises 10 times in each session, with 3 to 8 sessions per day.

Limiting Certain Foods and Drinks

Some foods and beverages can irritate the bladder and significantly affect neurogenic bladder symptoms, potentially exacerbating them. Examples include:

• Spicy foods
• Coffee
• Tea
• Citrus fruits
• Dairy products
• Carbonated drinks
• Artificial sweeteners

Maintaining a Healthy Weight

It’s important to maintain a healthy weight, as excess weight increases pressure on the bladder.

Medications

Medications may be recommended if lifestyle changes are insufficient. Dr. Ashraf mentions the most common medications prescribed:

• Medications for Overactive Bladder: These drugs relax the overactive bladder muscles. Commonly prescribed medications include:
  • Oxybutynin
  • Tolterodine
  • Solifenacin
  • Mirabegron
• Botox Injections: Botox is recommended for patients with an overactive bladder due to a disease or injury to the brain or spinal cord. Botox, when injected into the bladder muscle, helps prevent it from contracting too much. However, the injections need to be repeated every 6 months to a year.
• Medications Affecting the Nervous System: In some cases, medications that affect the nervous system may be prescribed to alleviate neurogenic bladder symptoms, such as:
  • GABA supplements
  • Anti-epileptic drugs

Neuromodulation Therapy

Neuromodulation therapy involves treatments that deliver electricity or medication to the nerves and is used for patients with an overactive bladder who do not respond to medications or lifestyle changes. Options include:

• Sacral Neuromodulation: During this procedure:
  • A thin wire is placed near the nerves that carry signals between the spinal cord and the bladder (sacral nerves).
  • The wire is connected to a small device placed under the skin that sends electrical pulses to the bladder.
  • These electrical pulses help stop signals that lead to overactive bladder.
• Percutaneous Tibial Nerve Stimulation (PTNS): This involves inserting a needle into the leg’s tibial nerve, which is then connected to a device that sends electrical pulses to the tibial nerve and subsequently to the sacral nerve.

Dr. Ashraf notes that patients may need 12 sessions to achieve better results.

Catheterization

There are two types of catheterization:

• Clean Intermittent Catheterization (CIC): This involves inserting thin, flexible tubes through the urethra into the bladder to drain urine. The patient can insert this themselves several times daily to empty the bladder.
• Continuous Catheterization: This requires the catheter to remain in place at all times, either through the urethra or directly into the bladder via the lower abdomen (suprapubic tube).

Surgical Procedures

Surgical options include:

• Artificial Sphincter: Used for severe urinary incontinence, where an artificial sphincter is placed around the urethra, with a pump placed under the skin in the scrotum or labia to open the sphincter and allow the patient to urinate.
• Urinary Diversion: In this procedure, the surgeon creates an opening or stoma on the abdomen, and depending on the surgery, a catheter is inserted through the stoma to empty the bladder, or an external pouch is placed over the stoma to collect urine.
• Bladder Augmentation: Part of the intestine is removed and attached to the bladder walls to increase the bladder’s capacity and help it store more urine.
• Sphincterotomy: The weakened part of the urethral sphincter is removed, and in some cases, the entire sphincter may be removed.

How to Determine the Appropriate Treatment for Neurogenic Bladder?

The treatment method for neurogenic bladder is determined based on several factors, including:

• Patient’s age
• General health
• Medical history
• Cause of nerve damage
• Symptoms experienced by the patient and their severity
• The patient’s ability to tolerate certain medications or procedures

Complications of Untreated Neurogenic Bladder

Dr. Ashraf warns that failing to treat neurogenic bladder can lead to complications, including:

• Urine leakage
• Urinary retention
• Kidney or urinary tract infections
• Damage to small blood vessels in the kidneys
• Bladder, ureter, or kidney infections
• Kidney damage

Sources:

• Urology Health – Neurogenic Bladder
• Johns Hopkins Medicine – Neurogenic Bladder
• Weill Cornell – Neurogenic Bladder Treatment Options
• University of Michigan Health – Neurogenic Bladder
• Mount Sinai – Neurogenic Bladder
• WebMD – What Is Neurogenic Bladder?
• Cleveland Clinic – Neurogenic Bladder
• MyHealth Alberta – Neurogenic Bladder Aftercare