When people have disabilities, they often have trouble with bladder control. Damage to the brain or spinal cord that causes a disability also can affect bladder function. A variety of bladder problems fall under the category of a neurogenic bladder.
Types of Bladder Problems
For the urinary system to work properly, two groups of muscles must coordinate: the bladder (where urine is stored) and the sphincter (muscles around the urethra that prevent urine from leaking). Depending on the nerves involved and nature of the damage, the muscles in someone with a disability might become overactive or underactive. That may cause pressure inside the bladder to increase and places the kidneys at risk.
Underactive bladder: Because the bladder is too relaxed, it doesn’t empty completely during urination. That leftover urine can cause urinary tract infections and give the feeling of having to urinate often.
Overactive bladder: The bladder squeezes (contracts) even when you aren’t trying to urinate. That can cause leakage (urinary incontinence). Otherwise, pressure rising inside the bladder can damage the kidneys.
Underactive sphincter: Because the sphincter is too relaxed, urine can leak even when you aren’t trying to urinate (urinary incontinence).
Overactive sphincter: If the sphincter is too tight, it doesn’t relax enough to let out urine when you want to urinate.
Tests and Treatments
If your healthcare provider suspects that a patient has a neurogenic bladder, they may order imaging tests or a bladder pressure test (urodynamics). Treatments may include behavioral changes, medications, catheterization programs, or surgical procedures.
The main goal of treatment is to maintain low pressure when the bladder fills and empties. That protects the kidneys from damage caused by high pressure in the bladder. Other goals may include decreasing urinary incontinence, minimizing urinary tract infections, and increasing a patient’s independence through a bladder management program.
If you have a neurogenic bladder, be sure to see your urology provider regularly to ensure your kidneys are safe with your current bladder program.
Jenna Katorski, C.N.P., is a family nurse practitioner, who is board-certified through the American Academy of Nurse Practitioners. She works in the physical medicine and rehabilitation department at Gillette Lifetime Specialty Healthcare St. Paul-Phalen Clinic. She cares for adults who have spina bifida, cerebral palsy, traumatic brain injury, or other childhood-onset disabilities. She completed a Bachelor of Science and Master of Science in Nursing at the University of Minnesota in Minneapolis, Minn. She has been a principal investigator or a co-investigator for a number of clinical research studies, made professional presentations, and served on numerous professional and organizational committees. In addition, she is a member of the Society of Urologic Nurses and Associates, Developmental Disabilities Nurses Association and Sigma Theta Tau (an international nursing society).