# neurogenic bladder | Symptoms, Causes, Tests and Treatment | OSANG > Neurogenic bladder can occur when any part of the urinary nerve pathway, including the brain, spinal cord, and peripheral nerves, is damaged. It occurs in approximately… - Official page: https://osns.co.kr/en/encyclopedia/neurogenic-bladder - Organization: OSANG Neurosurgery ## Page content Autonomic Medicine ## neurogenic bladder Neurogenic Bladder · N31.9 Neurogenic bladder is a bladder dysfunction caused by lesions of the central or peripheral nervous system that regulates the storage and discharge functions of the bladder. ## At a glance Neurogenic bladder can occur when any part of the urinary nerve pathway, including the brain, spinal cord, and peripheral nerves, is damaged. It occurs in approximately 80-90% of spinal cord injury patients, approximately 75-90% of multiple sclerosis patients, and approximately 40-70% of Parkinson's disease patients. It is largely divided into overactive bladder (storage disorder) and underactive bladder (discharge disorder), and prevention of upper urinary tract complications such as urinary tract infection, hydronephrosis, and renal failure is the key to treatment. - 01Definition and Overview - 02Neural control of urination - 03Classification - 04Characteristics of each cause disease - 05diagnosis - 06treatment - 07complications ## Definition and Overview Neurogenic bladder is a condition in which normal urinary function is lost due to damage to any part of the nerve pathway that controls bladder storage and discharge (cerebral cortex → pontine micturition center → sacral urination center → peripheral nerves → bladder). Normal urination requires recognition of bladder fullness, volitional decision on the timing of urination, and coordinated operation of detrusor muscle contraction and external urethral sphincter relaxation. If any of these steps are impaired, neurogenic bladder occurs. ## Neural control of urination ### autonomic nervous system - Parasympathetic nerve (S2~S4): Contracts the detrusor muscle and relaxes the internal urethral sphincter through the pelvic nerve. Acetylcholine acts on the M3 receptor. - Sympathetic nerve (T10~L2): Relaxes the detrusor muscle (β3 receptor) and contracts the internal urethral sphincter (α1 receptor) through the hypogastric nerve. Involved in storing urine. ### somatic nerves - Pudendal nerve (S2~S4): Responsible for voluntary contraction of the external urethral sphincter. ### central nervous system - Barrington nucleus: control center for the micturition reflex - Cerebral cortex (medial frontal lobe): volitional inhibition of urination ## Classification ### Overactive bladder — upper motor neuron lesion In lesions beyond the pons (stroke, multiple sclerosis, Parkinson's disease, etc.), the cerebrum's ability to inhibit urination is lost, causing uninhibited contraction of the detrusor muscle. Bladder capacity decreases, and urinary frequency, urgency, and urge incontinence occur. ### Detrusor-sphincter dyssynergia (DSD) — spinal cord lesions In spinal cord lesions above the sacral cord (cervical and thoracic spine), detrusor-sphincter dyssynergia (DSD) occurs, in which the external urethral sphincter does not relax at the same time as the detrusor muscle contracts. Pressure within the bladder rises dangerously, increasing the risk of hydronephrosis, vesicoureteral reflux, and renal failure. ### Underactive bladder — lower motor neuron lesions In sacral (S2-S4) or peripheral nerve lesions (diabetic autonomic neuropathy, cauda equina syndrome, or after pelvic surgery), detrusor muscle contractility is reduced and urine output is incomplete. The amount of residual urine increases and overflow incontinence occurs. ## Characteristics of each cause disease ### spinal cord injury Approximately 80-90% of spinal cord injury patients are accompanied by neurogenic bladder. The type is determined by the level of damage, with DSD mainly appearing in cervical and thoracic spine injuries, and hypoactive bladder appearing in conus and cauda equina injuries. ### multiple sclerosis Urinary symptoms are reported in approximately 75-90% of patients. Detrusor overactivity is the most common (approximately 65%), and DSD is also present in approximately 25% of cases. ### Parkinson's disease Frequent urination, urgency, and nocturia occur in approximately 40-70% of patients, which is caused by overactivity of the detrusor muscle. It is understood that dopamine deficiency in the basal ganglia weakens the micturition inhibitory pathway. ### Diabetic autonomic neuropathy It progresses in the following order: decreased bladder sensation → hyperinflation → decreased detrusor contractility. Bladder sensation becomes dull, so you cannot feel urine, which ultimately leads to underactive bladder and increased residual urine. ## diagnosis ### urination log Identify urination patterns by recording urination time, amount, and episodes of urinary incontinence for 3 days. ### Residual urine measurement After urination, the amount of residual urine is measured using ultrasound (bladder scan). Residual urine of more than 100 mL is clinically significant. ### Urodynamic study It is a key test for diagnosing neurogenic bladder. - Cystometry: Measures bladder capacity, detrusor overactivity, and fullness threshold. - Uroflowmetry: rate and pattern of urination - Pressure-flow test: assessment of detrusor contractility and urethral resistance - External urethral sphincter electromyography: DSD confirmation ### imaging test - Renal ultrasound: screening for hydronephrosis and vesicoureteral reflux - Voiding cystourethrography (VCUG): Evaluation of reflux and bladder morphology. - Brain/spinal cord MRI: Identify causative nerve lesions ## treatment ### overactive bladder - Drugs: Anticholinergics (oxybutynin, solifenacin, tolterodine) are first-line treatment. β3 agonists (mirabegron) are also an alternative. - Botulinum toxin: In case of non-compliance with medication, botulinum toxin A injection into the detrusor muscle. It reduces the frequency of urinary incontinence by approximately 50-70%, and the effect lasts for 6-9 months. - Sacral neuromodulation: Cases that do not respond to conservative treatment ### Hypoactive bladder/DSD - Intermittent self-catheterization (CIC): the gold standard in residual urine management. Performed every 4 to 6 hours to prevent bladder overdistension and infection. - α-Blockers (tamsulosin): Relax the bladder neck and sphincter muscles. - Long-term indwelling catheter: Last alternative when self-catheterization is not possible (high risk of infection) ### upper urinary tract protection The most important treatment goal in neurogenic bladder is protection of the upper urinary tract (kidneys). The key is to maintain intravesical pressure below 40 cmH2O, minimize residual urine, and prevent vesicoureteral reflux. ## complications - Recurrent urinary tract infections (UTIs): Frequent due to residual urine and catheter use. - Vesicoureteral reflux and hydronephrosis: caused by high intravesical pressure in DSD. - Chronic renal failure: the end result of long-term upper urinary tract damage. - Autonomic dysreflexia: Dangerous sympathetic hyperreflexia caused by bladder distension in spinal cord injury above T6. ## Frequently asked questions ### Q01What are the symptoms of neurogenic bladder? It varies depending on the location of the lesion. Overactive bladder (upper motor neuron lesion) causes frequent urination, urgency, and urge incontinence, while underactive bladder (lower motor neuron lesion) causes difficulty in urinating, excessive residual urine, and overflow incontinence. It is also common for the two types to be mixed. ### Q02What neurological diseases are most likely to cause neurogenic bladder? It occurs with high frequency in spinal cord injury (80-90%), multiple sclerosis (75-90%), Parkinson's disease (40-70%), stroke (approximately 30%), diabetic autonomic neuropathy, and spina bifida (almost 100%). It can also occur in peripheral neuropathy (Guillain-Barre syndrome, CIDP). ### Q03What is urodynamic testing? This is a test that measures intravesical pressure and detrusor muscle activity by inserting a catheter into the bladder and filling it with water. It can objectively evaluate bladder capacity, presence of detrusor hyperactivity, detrusor-sphincter dysfunction, etc., and is essential for classification and treatment planning of neurogenic bladder. ### Q04What is self-catheterization? This is a method in which the patient empties the bladder at set time intervals using a clean, disposable catheter. It is the most effective way to prevent urinary tract infections and kidney complications caused by residual urine in an underactive bladder, and most patients can self-perform it with appropriate training. ### Q05Are Botox injections used to treat bladder problems? Intravesical injection of botulinumtoxinA (onabotulinumtoxinA) is the standard second-line treatment for drug-refractory neurogenic detrusor overactivity. It reduces the frequency of urinary incontinence by about 50-70%, and the effect lasts for about 6-9 months. ## Related articles - Irritable Bowel Syndrome - sympathetic nervous system - Aging and autonomic nervous system - Autonomic dysfunction after stroke This article provides general medical information and does not replace an individual diagnosis or treatment plan. Please seek a medical assessment if symptoms persist. ## Important notice This Markdown alternative helps search and AI tools understand the public page accurately. It provides general health information and does not replace an individual diagnosis or treatment.