Neurogenic bladder is a condition that affects how the bladder stores and empties urine. Ideally, a child’s bladder stores urine until it is full and then empties. In a normal bladder, the urine is stored at a safe, low pressure and the bladder can empty completely without assistance.
Children with neurogenic bladder lack the muscle tone and/or nerve supply to empty their bladders by contracting and relaxing the correct muscles. This dysfunction may cause increased pressure in the bladder leading to leakage of urine, urinary tract infection and possible kidney damage.
At Riley at IU Health, we help children with neurogenic bladder dysfunction achieve three goals:
- Improve or manage continence
- Reduce risk of urinary tract infection
- Avoid possible kidney damage related to impaired bladder function
Who Gets Neurogenic Bladder?
Neurogenic bladder is usually a congenital condition that stems from a primary health problem. Most children who have neurogenic bladder are born with spina bifida—a birth defect that causes incomplete development of the spinal cord and the protective covering around them. It may also be found in children with cerebral palsy or any other disorder with abnormal development of the pelvic or spinal cord anatomy. Neurogenic bladder may be acquired later in life through spinal cord trauma, transverse myelitis or diseases of the central nervous system.
Symptoms of Neurogenic Bladder
Neurogenic bladder has a wide spectrum of symptoms, which vary in severity including:
- No symptoms
- Continuously leaking urine
- Urinary tract infections caused by inability to empty the bladder
One of the most serious health consequences for children who have neurogenic bladder is the possibility of kidney damage.
Diagnosis of Neurogenic Bladder
Through advances in ultrasound technology and magnetic resonance imaging (MRI), infants can be diagnosed with conditions that may cause a neurogenic bladder while they are still in the womb. These tests allow our expert physicians to check for abnormalities in the formation of the spine during the first 18 to 35 days of a baby’s development. Although treatment of spinal cord abnormalities usually does not begin until after a baby is born, these early diagnostic tools allow physicians to anticipate neurogenic bladder and other complications resulting from a congenital birth defect.
When babies are born with neurogenic bladder, our pediatric urologists use several tests to determine how well their bladders store and empty urine. These tests are typically performed within the first 12 months and throughout the rest of your child’s life. Common diagnostic tools include:
- Renal bladder ultrasound looks at the anatomy of your child’s kidneys and bladder.
- Voiding cystourethrogram further evaluates bladder anatomy and checks for vesicoureteral reflux (urine backing up into kidneys).
- Fluoro-urodynamic or video-urodynamic studies measure the capacity and pressure of your child’s bladder to see how well it stores and empties urine.
Our multidisciplinary team of experts works together to define treatments based on each child’s health circumstances and test results.
In most cases, there is no cure for neurogenic bladder, but our pediatric urologists offer advanced treatments that help children maintain a degree of continence, protect their kidneys and make life better.
Treatment is determined by several factors such as:
- The age of the child
- Other health conditions
- Health history
- Diagnostic tests that show how well each child’s bladder stores and empties urine
Our pediatric urologists are experienced specialists who offer a range of treatments for children with neurogenic bladder dysfunction. Among the options are:
- Training. In many cases, our Pediatric Continence Program can help children manage neurogenic bladder by teaching them how to empty their bladders on a certain schedule.
- Medications. Anticholinergic drugs may be used to help the bladder relax and store urine at lower pressure. Other medications stimulate nerve activity to enhance continence.
- Catheterization. Some children cannot empty their bladders unless they are catheterized at regular intervals through the genitals (through their urethra).
- Bladder Augmentation and Catheterizable Channels. A small subset of children have such unsafe bladders that the only way to avoid kidney damage is to increase the size of the bladder. We can expand the bladder to hold more urine using pieces taken from the bowel. This procedure is also known as enterocystoplasty. Expanding the bladder’s size lowers the pressure, increases its ability to handle urine and sometimes relieves painful bladder spasms. Afterwards, children almost always need to be catheterized to empty their bladders. A catheterizable channel is another way to catheterize the bladder. This involves a surgery that uses a piece of bowel or appendix to make a channel that connects skin to the bladder. The channel can be used to empty the bladder.
- Bladder injections. The use of Botox® or botulinum toxin has been used to relax the bladder in patients with neurogenic bladder. This medication can delay or avoid a surgical procedure, but it may need to be repeated every six to nine months to remain effective.
Depending on the cause of neurogenic bladder, your child may need to be closely monitored throughout life. With conditions such as spina bifida, for example, the bladder may do well for a while and then deteriorate. The Spina Bifida Program at Riley at IU Health supports children through a range of ongoing health complications related to their condition, including neurogenic bladder dysfunction.
Riley at IU Health is home to one of the nation’s top ranked programs for pediatric urinary care, including reconstructive surgeries and bladder augmentation. Our world-renowned surgeons are expertly qualified to treat your child for neurogenic bladder dysfunction.
Key Points to Remember
Key Points to Remember
- Neurogenic bladder dysfunction prevents children from storing urine and emptying the bladder normally.
- There is no permanent solution for neurogenic bladder, but pediatric urologists can help children manage their condition.
- In children, neurogenic bladder is almost always caused by a primary condition they have at birth.
- Treatments for neurogenic bladder are necessary to protect kidney function and improve continence.
Support Services & Resources
Support Services & Resources
Riley at IU Health offers a broad range of supportive services to make life better for families who choose us for their children's care.
This National Institutes of Health website offers information and links related to health conditions, including neurogenic bladder dysfunction.
This organization has ties to the American Urological Association and advances research and education in urological care, working with healthcare providers, patients and caregivers. Their website provides recent information on conditions such as neurogenic bladder dysfunction.
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