When you sustain a spinal cord injury, the disruption of the body’s signals to the brain effects more than sensory and motor function. Most people with SCI will experience neurogenic bladder dysfunction. That just means the damage to the nervous system causes the bladder difficulty draining properly. The bladder may retain or leak urine instead. The level of SCI determines bladder dysfunction. Depending on your symptoms, there may be surgical procedures to help manage the neurogenic bladder.
Types of neurogenic bladder dysfunction
Spastic Bladder
- Also known as an upper motor neuron (UMN) bladder or overactive bladder
- Occurs with injuries at or above the T12 level
- Voiding reflex is intact though involuntary
- Frequent, low-volume urination
- Bladder spasms as it fills
- Limited/no ability to feel bladder fullness
- Limited/no control of the sphincter muscle to hold urine
- Incomplete bladder emptying
- In some patients detrusor sphincter dyssynergia (DSD) may also be present, in which the bladder contracts to void, but the sphincter remains tight, which can result in urine being forced back up to the kidney, increasing risk of kidney damage
Flaccid Bladder
- Also known as lower motor neuron (LMN) bladder or underactive bladder
- Occurs with injuries below the T12 level
- Voiding reflex is not intact
- Frequent overfilling of the bladder (urinary retention)
- Limited/no ability to feel bladder fullness
- Sphincter muscle can be relaxed, causing urine to leak
- Patients with underactive bladder are at a higher risk of developing a urinary tract infection (UTI) because of retention
People with the most severe spinal cord injuries are at risk of experiencing a condition where different urinary tract muscles are overactive or underactive known as mixed neurogenic bladder.
Treatment for neurogenic bladder
Most people with SCI use catheterization to manage the bladder, the majority using intermittent catheters, with others using indwelling catheters and various surgical procedures.
Researchers of neurogenic bladder dysfunction view surgical procedures as a final option, if medications and catheterization is insufficient.
Spastic bladder management
Injecting small doses of some strains of botulinum toxin (BOTOX) can help to reduce muscle spasms and over-activity in the bladder wall muscle, which causes accidents and leaking.
If Botox and medications aren’t working, bladder augmentation surgery may be recommended to increase the capacity of the bladder to hold urine.
Other surgical procedures to treat a leaky, spastic bladder include using an artificial urinary sphincter, abdominal sling, or transobturator tape.
Flaccid bladder management
These methods seek to prevent overfilling and increased pressure in the bladder as well as leaking. Medications such as alpha-adrenergic blockers may relax the sphincter muscles to allow urine to flow.
A transurethral sphincterotomy may be performed, making an incision in the urinary sphincter muscle to improve urine flow and relieve urinary retention.
Talk to your urological provider about the symptoms you experience, and discuss your options for bladder management. Making sure the bladder empties properly is critical in patients with SCI. It’s more than a matter of staying dry. Kidney disease is the fourth-leading cause of death for SCI patients.
Phone: