Managing Neurogenic Bladder in Spinal Cord Injury

By Scihealthhub – November 16, 2024

This article uncovers the best practices and strategies for managing neurogenic bladder in individuals with spinal cord injuries (SCIs).

Neurogenic bladder is a common complication of spinal cord injury, affecting approximately 70-84% of individuals with the condition. It can lead to significant physical discomfort, social inconvenience, and serious complications (1, 2).

Using an appropriate bladder management method, along with medications, forms the foundation of effectively managing neurogenic bladder in individuals with spinal cord injury.

Whether you are newly injured or have been living with spinal cord injury for years, understanding these management strategies can help you take control of your bladder health and overall well-being.

How the Urinary System Works

To understand how spinal cord injury causes neurogenic bladder, it’s essential first to explain how the normal urinary system functions.

The four organs of the urinary system—kidneys, ureters, bladder, and urethra—must work in harmony for normal urination. Additionally, effective transmission of electrical signals between the bladder and brain is necessary.

There are millions of tiny filters in the kidneys, through which it filters the blood and produces urine as a waste by-product.

Urine produced in kidney passes through the ureter into the bladder and stores here for a while. When the urine exceeds the bladder storage capacity of 400 to 500cc, you’ll get a signal from your brain of being pressed. But you will still be able to hold the urine and release it at your convenient time through the urethra.

What is Neurogenic Bladder?

Neurogenic bladder is a condition characterized by disrupted electrical signals between the bladder and brain, resulting in abnormal bladder function and difficulty with urination. When caused by spinal cord injury, it is referred to as neurogenic bladder in spinal cord injury.

Other Causes of Neurogenic Bladder

Aside from spinal cord injury, other possible causes of neurogenic bladder include:

• Diabetes
• Stroke
• Alzheimer’s disease
• Parkinson’s disease
• Traumatic brain injury
• Multiple sclerosis
• Cerebral palsy
• Dementia
• Brain or spinal cord tumors
• Birth defects affecting the spinal cord, such as spina bifida

Symptoms of Neurogenic Bladder

Symptoms of neurogenic bladder due to spinal cord injury or other causes may result from abnormal bladder function or the use of urinary catheters. They can include:

• Repeated urinary tract infections (UTIs)
• Difficulty emptying the bladder
• Urinary incontinence (leaking of urine)
• Incomplete bladder emptying
• Frequent urination in small amounts
• Inability to sense a full bladder
• Urinary urgency (sudden, uncontrollable urge to urinate)
• Elevated bladder pressure (intravesical pressure)
• Vesico-ureteral reflux (urine flowing back toward the kidneys). This is present in more than 20% of people with spinal cord injury neurogenic bladder (2).
• Kidney and bladder stones
• Kidney damage, potentially leading to kidney failure if not managed properly
• Bladder cancer – the combination of urinary tract infections, bladder stones and use of catheter increases the risk of bladder cancer 20 times in people with spinal cord injury (3).

Goals of Management

The primary goals of managing neurogenic bladder are to:

1. Achieve continence (ability to hold and release urine at the right time) and avoid the negative effects of incontinence, such as skin damage, psychological stress, and depression.
2. Prevent kidney damage from high bladder pressures.
3. Reduce the risk of UTIs.
4. Prevent bladder damage from over-distension.
5. Improve overall quality of life (2, 4).

Management of Neurogenic Bladder in Spinal Cord Injury

The management of neurogenic bladder in spinal cord injury involves a combination of:

• Health education
• Appropriate bladder management methods
• Medications
• Surgical interventions

Health Education

It is essential for individuals with spinal cord injury to gain knowledge about managing complications such as neurogenic bladder, pressure ulcers, and abnormal bowel function. Being well-informed can lead to fewer complications and an improved quality of life.

In one study, fewer than 50% of people with spinal cord injury had adequate knowledge about bladder management and pressure ulcers after hospital discharge.

Your healthcare provider is the best source of information to help you make informed decisions about your health. Additionally, trusted websites like SciHealthHub.com can offer valuable insights, though it’s advisable to discuss or verify this information with your healthcare provider.

Bladder Management Methods

There are several bladder management methods, each with its advantages and disadvantages. Your healthcare provider can help determine the most suitable method for your specific needs to maintain healthy kidney and bladder function. These methods include:

• Clean Intermittent Catheterization (CIC): Involves inserting a catheter through the urethra into the bladder to drain urine. Once the bladder is emptied, the catheter is removed. This is the preferred method for many individuals with spinal cord injury.
• External Condom Catheter: A urine collection device worn like a condom by men.
• Incontinence Pads: Absorbent pads worn inside underwear to soak up urine.
• Indwelling Urethral Catheter: A catheter is inserted through the urethra into the bladder and left in place, connected to an external collection bag. It can be changed every two weeks.
• Indwelling Suprapubic Catheter: Inserted through an incision below the belt line into the bladder and connected to an external collection bag. It is also changed every two weeks.
• Valsalva, Credé Voiding, and Abdominal Tapping: These techniques help empty the bladder by increasing abdominal pressure (Valsalva), applying manual pressure to the lower abdomen (Credé), or tapping rhythmically on the lower abdomen (abdominal tapping) to trigger urination.

Personally, I use intermittent catheterization most of the time and an external condom catheter when on the go. A comprehensive discussion on these bladder management options is available in our article Bladder Management Options in Spinal Cord Injury.

Use of Medications

Medications are often part of the treatment for neurogenic bladder in spinal cord injury.

Oxybutynin is a commonly prescribed anticholinergic medication that reduces bladder pressure and vesico-ureteral reflux, lowering the risk of kidney damage.

Antidepressants like imipramine can also be beneficial due to their anticholinergic and muscle-relaxing properties, improving urine storage and reducing bladder pressure.

Surgical Treatments

Surgical interventions may be considered when conservative treatments (medications and bladder management methods) fail due to reduced effectiveness or intolerance to side effects. Surgical options include:

• Botulinum Toxin Injection: Botox injections into the bladder muscle help relax the bladder, reduce pressure, and increase capacity. The effects typically last up to 9 months (6). Botox was approved by the FDA in 2011 for adults with spinal cord injury neurogenic bladder who do not respond well to anticholinergic medications (7).
• Augmentation Cystoplasty: This procedure increases bladder capacity using a section of the intestine. The surgeon removes a portion of the intestine, attaches it to the bladder, increasing its size, and lowering pressure.
• Bladder Sphincter Procedures to Facilitate Emptying: Sphincterotomy, urethral stents, and balloon dilation are methods used to improve urinary outflow and reduce bladder pressure.
• Bladder Sphincter Procedures to Treat Incontinence: The most common procedure is the placement of an artificial urinary sphincter. An inflatable cuff is placed around the urethra to hold urine, which can be deflated to allow urination.

Other surgical options include:

• Neuromodulation: Implanting an electrical device to regulate bladder activity.
• Urinary Diversion: Creating a new pathway for urine to leave the body.

Conclusion

Spinal cord injury can disrupt the flow of signals between the bladder and the brain, leading to neurogenic bladder. Clean intermittent catheterization combined with anticholinergic medications is the first-line treatment for neurogenic bladder in spinal cord injury.