In an average person, urine is produced in the kidney and stored temporarily in the urinary bladder until the person passes it with the help of the pelvic muscles through the urethra.

A small muscle in the urethra called a sphincter opens up to allow the urine to pass from the urinary bladder. The urethra is just above the vaginal opening in females and at the tip of the penis in males.

When the urinary bladder is full, the nerves send impulses to the brain, triggering an urge to urinate and empty the urinary bladder. This is followed by the relaxation of the pelvic muscles and urethral muscles while the bladder muscles tighten, allowing the urine to pass.

In Neurogenic bladder dysfunction, neural damage causes the body to lose control of the bladder. This results in an overactive bladder, incontinence, or even an underactive bladder.

For the bladder to function properly, several muscles and nerves coordinate to empty or fill the bladder. However, if nerve damage occurs, this pattern is affected and can lead to an overactive or underactive bladder.

The neural damage could be due to:

• Parkinson’s disease
• Multiple sclerosis
• Diabetic neuropathy
• Infection in the brain or spinal cord due to heavy metal poisoning
• Stroke
• Spinal cord injury
• Pelvic surgery complications
• ● Spina bifida

The symptoms differ from patient to patient, depending on the underlying cause of neural damage. The patient may have an overactive bladder or underactive bladder (some patients have both underactive and overactive bladder). People with stroke and herpes zoster may show both kinds of symptoms.

Other symptoms include:

• Urinary tract infection
• Leaking urine or urinary incontinence
• Increased frequency of overactive bladder
• Urinary retention/obstruction in bladder

Your doctor will conduct various tests to assess your condition. Initially, a thorough medical history is taken. This includes noting the patient’s symptoms and other medications if prescribed. The doctor will also ask you about your dietary habits.

The doctor then performs various physical examinations to look for the root cause of Neurogenic bladder dysfunction. In the case of women, the doctor will examine the abdomen, pelvis, and rectum, whereas, in men, the doctor examines the prostate, stomach, and rectum.

The doctor will ask you to maintain a bladder diary and note down how often you use the bathroom in a day.

A pad test may also be done where you are asked to wear a pad with a particular dye that changes colour when you leak urine.

Other tests include:

• Urine culture: This checks for any urine infection or blood in the urine.
• Bladder scan: The doctor checks if the bladder empties when the patient passes urine. If there is incomplete emptying, it causes symptoms similar to an overactive bladder. For this, the doctor prescribes an ultrasound scan after you have emptied your bladder. In some cases, the doctor may pass a catheter into the urethra, letting the bladder empty, after which the urine output is measured.
• Uroflowmetry: Uroflowmetry is used to measure the urine flow rate. The volume of urine and the speed at which you empty your bladder is calculated with this.
• Cystometry: A cystometry measures the urinary bladder’s pressure and the surrounding areas and when the urinary bladder fills up.

In this process, the doctor inserts a catheter into the urinary bladder and slowly fills the bladder with warm fluid. A sensor is then inserted into the rectum (for men) or vagina (for women).

The sensor indicates how much pressure the bladder exerts to excrete completely. This procedure suggests if there are any involuntary muscle contractions or bladder stiffness.

• ● CT scans and x-rays: Additional CT scans and x-rays may be prescribed to diagnose your condition. Your doctor may also suggest additional imaging tests of the spine and brain.

The treatment depends on the root cause of Neurogenic bladder dysfunction. However, the strategy includes:

1. Catheterisation: This could be an intermittent catheterisation or a permanent appliance attachment. In most patients, intermittent works best, but a few may require a permanent appliance attachment.

However, that may bring its own set of complications. In intermittent catheterisation, straight catheters are used to empty the bladder several times a day.

2. Medications: Anticholinergic drugs are prescribed to reduce bladder contractions by blocking the receptors.

Common side effects of these drugs include dry eyes and dry mouth. Constipation is also quite common. Your doctor might recommend taking sips of water or sucking on sugar candies to combat the side effects. A few over-the-counter Biotene products can also help.

3. Botox injections: These injections give temporary relief for up to six months. They temporarily relax the muscles.
4. Neuromodulation: Several non-surgical and minimally invasive therapies can also be tried, including transurethral electric bladder stimulation, sacral neuromodulation, and reconfiguration of the sacral nerve root.
5. Surgery:

• Urinary diversion: A stoma is created to bypass the urethra to empty the bladder directly through a skin opening.
• Urethral stents: This reduces bladder pressure.
• Urethral slings
• Artificial urinary sphincters.
• Bladder neck closure

Though surgery is the last resort to manage Neurogenic bladder dysfunction, most patients recover completely after surgery and can perform everyday activities. However, as in any surgery, there are a few risks, including:

• Infection
• Bleeding
• Pain
• Problems related to anaesthesia
• ● Urine leakage