The neurogenic bladder

The neurogenic bladder is a condition whereby the bladder is dysfunctional due to neurological damage of some kind. The nerves or part of the brain that controls the bladder has been damaged, and can no longer send the right signals for the bladder to maintain correct tone and function.

Negative outcomes of a neurogenic bladder can be frequent infections, urine backing up into the kidneys (vesicoureteral reflux), and uncontrollable high blood pressure (autonomic dysreflexia).

There are a lot of different ways this can happen, but it should be clear when you are diagnosed why you have a neurogenic bladder. Some causes are listed below.

Symptoms of a neurogenic bladder

  • Bladder is flaccid (soft and floppy) or spastic (tense and clenched)
  • Overflow incontinence (the bladder doesn’t empty properly and urine leaks out)
  • High frequency of urination
  • Urinary urgency (needing to urinate quite urgently)
  • Urge incontinence (a sudden urge to urinate)
  • Urinary retention (ischuria, where you can’t fully empty the bladder)

Some known causes of a neurogenic bladder in women

These causes involve the central nervous system.

  • Stroke
  • Injury to the spine
  • Meningomyelocele
  • Amyotrophic lateral sclerosis
  • Peripheral nerves from diabetes, alcoholism or b12 deficiency neuropathy, herniated disc, damage from surgery
  • Parkinson’s disease
  • Multiple sclerosis
  • Syphilis

When the bladder is flaccid…

The bladder fills with urine, but the pressure is low, so the normal sensations (contractions) of the bladder just aren’t there. This means the urge to urinate may not come.

In some spinal cord injuries, this can return to normal, or it may stay flaccid, or become spastic (tense). The main symptom here is leaking urine due to overflow.

When the bladder is spastic…

The bladder has trouble filling with urine, with low amounts of liquid able to be held. This is combined with involuntary contractions of the bladder, resulting in urine coming out (incontinence).

The severity of this will vary between people, as the damage could be extensive. The bladder contracts, but the external urinary sphincter isn’t in time (coordinated), resulting in what’s called detrusor-sphincter dyssynergia (DSD)

DSD causes problems between the contractions of the bladder to expel the urine, and the action of the outer sphincters to allow the urine to pass. The main symptom here is frequency of urination in the day and night, and may have leakage and urgency (unless sensation is gone). Those with DSD may be unable to completely empty the bladder.

When it’s both flaccid and spastic…

Mixed patterns can be caused by syphilis, diabetes mellitus, tumours of the brain or spinal cord, strokes, a ruptured intervertebral disc, and myelin-related conditions like multiple sclerosis and amyotrophic lateral sclerosis.

Diagnosis of a neurogenic bladder

Specific tests will be done to establish the exact causes of a neurogenic bladder, with the amount of urine left in the bladder after you’ve urinated being one such test, along with ultrasounds and tests of the kidneys, and other blood tests. Your neurologist or doctor will explain these tests to you.

Treatment of a neurogenic bladder

Catheterisation is a suitable solution, since it keeps the bladder drained of urine so the leaking can’t happen. Increasing fluids is also used as part of treatment, and surgery (including to insert a mechanically-controlled sphincter) may be considered if other treatments don’t work.

If the kidneys have been damaged, kidney support will be required. Urinary tract infections are really common with neurogenic bladders, so prevention and treatment of those may be part of ongoing management.

Urinary calculi (stones in the urinary tract) can also complicate things somewhat. Treatment very much depends on the person’s situation and ability to urinate as normally as possible on their own.

How natural medicine can help a neurogenic bladder

If the cause of a neurogenic bladder is neurological damage, then undoing that damage is not an option in most cases. This doesn’t mean there aren’t ways to help using natural medicine and natural medicine practitioners.

Support and management are often the only reasonable outcome, but this isn’t always the case. Sometimes the body can be supported in healing itself, in particular minor or reversible nerve damage.

The practitioners you choose to support the body will vary depending on what is wrong, but there are some overarching ideas that can be harnessed to support the nervous system.

  • Herbal medicine to improve microcirculation to the brain and/or nervous system, such as Centella asiatica (gotu kola)
  • Herbal medicine to help prevent and treat urinary tract infections
  • Herbal medicine to improve the performance of blood vessels and nerve conduction
  • Diet modifications to ensure your body has everything it needs to heal
  • Therapies such as acupuncture, reflexology, and other pressure point therapies to stimulate the body’s repair mechanisms
  • Physical therapy, massage, myotherapy, chiropractic, osteopathy to help align the bone, muscles, tendons and fascia to promote proper function and healing
  • A naturopath who specialises in neurological conditions is a great place to start, and may be able to recommend other useful therapies

There is no one size fits all when it comes to neurological problems that result in a neurogenic bladder, but there are plenty of supportive treatments that can at minimum make a person more comfortable and improve function.

Natural medicine isn’t an either-or situation with conventional treatments, and can work very well alongside any other treatment. It’s important to inform all your practitioners of any medications, supplements and other treatments you are undertaking to ensure safety.

Natural doesn’t mean safe. Herbs, for example, can interact with medications and may speed up liver detoxification, causing the medication to be excreted quicker than expected.

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Jessica Lloyd - Vulvovaginal Specialist Naturopathic Practitioner, BHSc(N)

Jessica is a degree-qualified naturopath (BHSc) specialising in vulvovaginal health and disease, based in Melbourne, Australia.

Jessica is the owner and lead naturopath of My Vagina, and is a member of the:

  • International Society for the Study of Vulvovaginal Disease (ISSVD)
  • International Society for the Study of Women's Sexual Health (ISSWSH)
  • National Vulvodynia Association (NVA) Australia
  • New Zealand Vulvovaginal Society (ANZVS)
  • Australian Traditional Medicine Society (ATMS)