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Neurogenic Bladder Dysfunction: Symptoms, Risks, and Management

man with neurogenic bladder dysfunction after spinal cord injury

Neurogenic bladder dysfunction describes lack of bladder control (incontinence) caused by damage to the spinal cord or brain.

As a result, you might not be able to tell when your bladder is full and can become accident-prone.

To help you better understand what to expect with neurogenic bladder dysfunction after spinal cord injury, this article will go over its symptoms, risks, and management.

Neurogenic Bladder Dysfunction After Spinal Cord Injury

Neurogenic bladder after a spinal cord injury occurs because messages between the brain and the bladder muscles aren’t able to get past the spinal cord damage.

As a result, the brain doesn’t receive signals that the bladder is getting full.

Similarly, the bladder muscles don’t receive signals from the brain to contract.

The brain regulates the bladder muscles so that when your bladder relaxes, the sphincter contracts to prevent leaking and when the bladder contracts, the sphincter relaxes and releases urine.

After a spinal cord injury, these muscles might contract or relax at the same time, resulting in accidents and other bladder-related complications.

Now that you understand how spinal cord injury affects bladder function, let’s discuss how long neurogenic bladder dysfunction lasts.

Loss of Bladder Control Can Be Temporary

living with neurogenic bladder dysfunction after spinal cord injury

For some, neurogenic bladder dysfunction can be temporary.

After a spinal cord injury, you may experience spinal shock, which is the temporary loss of reflexes caused by inflammation of the spinal cord.

Essentially all reflexes below your level of injury, including your bladder reflexes, become paralyzed.

Luckily, this is only a temporary situation. Spinal shock can last anywhere from a couple of days to 3 months.

Once the spinal cord stabilizes and swelling starts to die down, reflexes might gradually start to return. This depends mostly on the severity of your spinal cord injury.

In the following section, we’ll discuss how your level of injury affects how you experience neurogenic bowel dysfunction.

Types of Neurogenic Bladder Dysfunction

Two types of neurogenic bladder dysfunction can occur after a spinal cord injury: suprasacral and sacral.

Bladder function is innervated by the sacral region of the spinal cord.

Therefore, someone with a spinal cord injury above the sacral region will experience neurogenic bladder dysfunction differently than someone with an SCI at the sacral region.

Let’s discuss the differences between the two.

Suprasacral Neurogenic Bladder

Suprasacral neurogenic bladder dysfunction occurs after cervicalthoracic, or lumbar spinal cord injuries.

With a suprasacral SCI, your bladder reflex will be unaffected; however, you will not be able to control when you empty it because the messages from the brain cannot reach the muscles of the bladder.

As a result, the bladder muscles become overactive and have high tone.

The detrusor (a muscle that makes up the wall of the bladder) and sphincter both involuntarily contract, which reduces bladder capacity and increases bladder pressure.

Sacral Neurogenic Bladder

Injuries to the sacral region of the spinal cord affect your bladder differently because bladder function is innervated by the S2, S3, and S4 spinal nerves.

When you injure these nerves, it affects your bladder reflex and denervates the sphincter, causing flaccid bladder.

Flaccid bladder is characterized by low muscle tone. The detrusor is a flexible muscle, so when it’s relaxed, it can fill up with urine and essentially become too full.

Next, we’ll discuss the risks associated with neurogenic bowel dysfunction.

Neurogenic Bladder Risks

Suprasacral and sacral neurogenic bowel dysfunction can both result in urinary retention, increased urinary frequency, and leaking (overflow incontinence).

However, poorly managed neurogenic bladder dysfunction can cause more serious complications including:

  • Urinary tract infections
  • Hydronephrosis (kidney swelling due to urine build-up)
  • Kidney stones or urinary calculi
  • Bladder cancer

Now that you understand the risks associated with neurogenic bladder dysfunction, let’s go over effective management interventions.

Neurogenic Bladder Dysfunction Management

urinary catheter for bladder management after SCI

Proper management of neurogenic bladder dysfunction is essential for optimizing quality of life after spinal cord injury.

Commonly utilized bladder management interventions include:

  • Catheterization. A catheter is a thin tube that helps drains urine from your bladder. Depending on your lifestyle and preferences, you can decide to have a catheter connected at all times or follow a schedule.
  • Electrical stimulation. Electrical stimulation involves implanting an electrode array near the spinal cord. It sends electrical currents that mimic brain signals to the sacral nerves and stimulate normal bladder function.
  • Anticholinergic medications. Anticholinergic medications are often the first line of treatment for overactive bladders. It’s suggested that they can increase bladder capacity and reduce bladder pressure.
  • Bladder augmentation. Surgically enlarging the bladder can help individuals with overactive bladders prevent urinary tract infections and kidney complications by increasing bladder capacity.
  • Botox injections. Botox can temporarily denervate spastic bladder muscles to increase bladder volume and relieve high bladder pressure.

Depending on your specific symptoms, management for neurogenic bladder will vary. Most patients benefit from using a combination of various interventions.

Understanding Neurogenic Bladder: Key Points

Learning to manage bladder problems is a crucial step towards regaining your independence after spinal cord injury.

The level and severity of your SCI have significant influence over how you experience neurogenic bladder dysfunction.

Hopefully, this article helped you better understand what neurogenic bladder dysfunction is and how to effectively manage it. Good luck!

Photos from top to bottom: iStock/Manuel-F-O/vadimguzhva/drawdrawdraw

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