Neurogenic Bladder

Overview

• Neurogenic bladder means a problem in the brain, spinal cord or nerves affects the way your bladder stores or empties urine
• Normally, nerves carry signals back and forth between your bladder and brain, so you feel when your bladder is full and your bladder muscle squeezes at the right time; in neurogenic bladder, this signalling does not work properly
• Neurogenic bladder cannot be cured, but it can be managed well with the right care, so you stay healthy, comfortable and protect your kidneys

How Common is a Neurogenic Bladder?

• Neurogenic bladder is found in about 40–90% of people with multiple sclerosis
• It is found in about 37–72% of people with Parkinson’s disease
• About 15% of stroke patients develop it
• About 70–84% of people with a spinal cord injury develop some degree of bladder dysfunction

Who is Commonly Affected?

• People with a spinal cord injury
• People with multiple sclerosis
• People with Parkinson’s disease
• People who have had a stroke
• People with long-standing diabetes
• People born with spina bifida
• People who have had major pelvic surgery

What Causes Neurogenic Bladder?

Neurogenic bladder happens when the nerves that control the bladder are damaged or interrupted. This damage can be in the brain, the spinal cord or the smaller nerves that connect to the bladder.

Common causes include:

• Stroke
• Spinal cord injury
• Multiple sclerosis
• Parkinson’s disease
• Spina bifida (a condition present from birth)
• Long-standing, poorly controlled diabetes
• Major surgery in the pelvic area or a slipped (herniated) disc

Types of Neurogenic Bladder

• Overactive (spastic) bladder: The bladder muscle squeezes too often or too soon and causing urgency, frequent urination and leaking
• Underactive (flaccid) bladder: The bladder muscle does not squeeze enough or at all and causing difficulty passing urine, a feeling of incomplete emptying and overflow leaking
• Some people have a mixture of both patterns, depending on which nerves are affected

Symptoms of Neurogenic Bladder

• Frequent urinary tract infections: Often the very first sign of neurogenic bladder
• Urine leaks (incontinence): This can range from a few drops to a large amount and may happen during sleep
• Difficulty passing urine: A slow or weak stream or straining to start
• Feeling of incomplete emptying: Feeling as if the bladder is never fully empty
• Changes in how often you go: Passing urine very often or much less often than usual
• Loss of bladder sensation: Not feeling when your bladder is full

Warning Signs: See a Doctor without Delay

• Fever, chills or pain in your back or lower tummy (may mean a kidney infection)
• Blood in your urine
• Sudden inability to pass any urine at all
• Severe lower abdominal pain with a swollen, hard tummy

Diagnosis and Investigations

• History and examination: The Doctor will review your health history and examine your brain, spinal cord and bladder function
• Urine test: To check for infection
• Bladder diary: To track how often you pass urine and any leaks, over a few days
• Ultrasound scan: Checks the kidneys and bladder and measures urine left behind after you pass urine
• X-rays of the skull and spine: Used to look at the nerve pathways affecting the bladder
• Cystoscopy: A thin tube with a camera is passed into the bladder through the urethra, to look for structural problems
• Urodynamic tests: Special tests done by filling the bladder, which measure the pressure inside it

What to Expect

• Your doctor will build a full picture using your history, examination and test results before agreeing a management plan with you
• The main aim of treatment is to protect your kidneys from long-term damage, prevent infection and reduce leaks or difficulty passing urine
• Your treatment plan may need to be reviewed and adjusted over time, as neurogenic bladder can change

Treatment Options

Lifestyle Measures and Bladder Training

• Passing urine at set times during the day (timed voiding), rather than waiting for an urge
• Pelvic floor exercises, which may help some types of leakage
• Keeping a healthy fluid intake, not too much, not too little

Medicines

• Antimuscarinic tablets or newer medicines such as mirabegron can help calm an overactive bladder
• These medicines are less helpful for an underactive bladder, where emptying is the main problem

Intermittent Self-Catheterisation (CISC)

• A thin tube (catheter) is passed into the bladder a few times a day to drain urine completely
• This is considered the gold-standard way to manage a bladder that does not empty well, especially after spinal cord injury
• Most people are taught to do this themselves and it does not need to stop you from working, travelling or socializing

Other Treatments

• Indwelling catheter: A catheter left in place, used only when other options are not possible or suitable
• Botox injection into the bladder wall: Helps calm an overactive bladder that has not responded to tablets
• Surgery: Rarely needed and only considered in severe, difficult cases to protect the kidneys or improve bladder capacity

Living with Neurogenic Bladder

• Have regular follow-up appointments to check on your kidneys and bladder health
• Learn the early symptoms of a urine infection or bladder stones, such as recurrent infections, catheter blockages or blood in urine and see a doctor promptly
• Keep a bladder or catheter diary to help your healthcare team fine-tune your care
• Talk to your doctor or specialist nurse about any changes in your symptoms, however small they seem

When to Contact a Doctor

• Fever, chills or pain in your back or lower tummy
• Blood in your urine
• Recurrent urinary tract infections or catheter blockages
• Sudden difficulty passing urine or inability to pass urine at all
• Any new or worsening symptoms after starting treatment

References

1. Urology Care Foundation. Neurogenic Bladder: Symptoms, Diagnosis & Treatment [online]. Available from https://www.urologyhealth.org/urology-a-z/n/neurogenic-bladder. Accessed on 16 July 2026
2. Cleveland Clinic. Neurogenic Bladder: Causes, Symptoms & Management [online]. Available from https://my.clevelandclinic.org/health/diseases/15133-neurogenic-bladder. Accessed on 16 July 2026
3. Johns Hopkins Medicine. Neurogenic Bladder [online]. Available from https://www.hopkinsmedicine.org/health/conditions-and-diseases/neurogenic-bladder. Accessed on 16 July 2026
4. National Institute for Health and Care Excellence (NICE). Urinary incontinence in neurological disease: assessment and management. NICE guideline CG148 [online]. Available from https://www.nice.org.uk/guidance/cg148. Accessed on 16 July 2026
5. Ginsberg D. The epidemiology and pathophysiology of neurogenic bladder. Am J Manag Care. 2013;19(10 Suppl):s191–s196. Available from https://www.ajmc.com/view/ace012_jul13_ngb_ginsberg1_s191. Accessed on 16 July 2026
6. Patient.info. Neurogenic Bladder [online]. Available from https://patient.info/doctor/neurology/neurogenic-bladder. Accessed on 16 July 2026
7. Leslie SW, Tadi P, Tayyeb M. Neurogenic Bladder and Neurogenic Lower Urinary Tract Dysfunction. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026. Available from https://www.ncbi.nlm.nih.gov/books/NBK560617/. Accessed on 16 July 2026
8. Panicker JN. Neurogenic bladder: epidemiology, diagnosis, and management. Semin Neurol. 2020;40(5):569–579. Available from https://pmc.ncbi.nlm.nih.gov/articles/PMC9715349/. Accessed on 16 July 2026
9. University Hospitals Plymouth NHS Trust. Clean Intermittent Self-Catheterisation for Adults [online]. Available from https://www.plymouthhospitals.nhs.uk/display-pil/pil-clean-intermittent-selfcatheterisation-for-adults-7831/. Accessed on 16 July 2026