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When Your Child Has Neurogenic Bladder

Your child has been diagnosed with neurogenic bladder. This is a problem with the nerves that carry signals to and from your child’s bladder. It can lead to trouble with holding or releasing urine. Neurogenic bladder can be managed. Your child’s healthcare provider will tell you more about options for your child.

Cross section of normal relaxed bladder showing urine being held in by closed sphincter.
Normally, nerve messages from the brain tell the bladder and sphincter when to hold urine in and when to release urine.

 

Cross section of bladder with thick wall. Urine is held in because of thickened bladder wall.
With neurogenic bladder, your child may have trouble releasing urine. Voiding against a closed sphincter can cause the bladder muscle to thicken.

What Is Neurogenic Bladder?

Normally, nerves carry messages back and forth between the bladder and the brain. The nerves tell the brain when the bladder is full. The brain then sends signals, telling the bladder muscles to hold or release urine. With neurogenic bladder, the messages aren’t being sent or received properly. This can lead to problems with bladder control.

What Causes Neurogenic Bladder?

Damage to nerves may be caused by the following:

  • Nerve problems that are present at birth (congenital), such as spina bifida

  • Injury to or infection of the brain or spinal cord

What Are the Signs?

  • Trouble holding or releasing urine

  • Failure to potty train

  • Urinary tract infection (UTI)

  • Swollen kidneys or other congenital urinary problems

  • Thickened bladder wall

How Is Neurogenic Bladder Diagnosed?

Neurogenic bladder is often suspected in children with conditions or injuries affecting the brain or spinal cord. Your healthcare provider will ask you about your child’s health. A physical exam will also be done to look for problems and observe urination. To help get more information:

  • Urine tests may be done to detect a UTI and protein in the urine. Protein in urine can be a sign of kidney disease.

  • You may be asked to keep a record of your child’s voiding habits.

  • A kidney and bladder ultrasound may be used to check for swelling of the kidneys and look at the bladder.

  • A urodynamics study may be done to give the healthcare provider a detailed look at how well your child’s bladder and urethra work.

How Is Neurogenic Bladder Treated?

Treatment depends on the cause of your child’s neurogenic bladder and what type of voiding problem he or she has. Your child may need one or more of the following treatments:

  • Timed voiding, which means using the toilet at regularly scheduled times. It can help your child avoid wetting accidents and protect the kidneys.

  • Intermittent catheterization to drain the bladder on a regular schedule. It involves inserting and removing a tube (catheter) through the urethra into the bladder each time it needs to be emptied.

  • Medication to relax the bladder muscles and prevent muscle spasm (involuntary tightening of muscles).

  • Surgery to protect the kidneys and allow for continence (the controlled holding in and releasing of urine and stool). Surgery may be done to:

    • Create a new opening in the belly through which a temporary catheter can be placed to empty the bladder.

    • Make the bladder larger.

    • Tighten the sphincter so it can better hold in urine.

Your child’s healthcare provider can discuss surgery with you, if it is an option.

Timed voiding

Timed voiding means urinating at scheduled times. It allows kids who are potty trained to empty their bladders on a regular basis. This helps prevent infections and avoid wetting accidents. To practice timed voiding, your child will need to visit the bathroom at set times throughout the day. His or her healthcare provider can suggest how often your child should urinate. Your child should NOT wait until the urge to urinate arises before using the toilet.

What Are the Long-Term Concerns?

Left untreated, children with this condition are likely to have bladder and kidney problems. Constipation and the inability to hold in stool may also be more likely. Steps can be taken to help with these problems. Your child’s healthcare provider can discuss your child’s condition with you and how your child is likely to progress long-term. Also, the condition may change over time so it will need to be monitored throughout your child’s lifetime.

Coping

Dealing with neurogenic bladder can be difficult for patients and families. Incontinence can also cause embarrassment and lead to self-esteem issues for your child. It’s vital for your child’s treatment and emotional development that you be supportive and patient. It takes work and time to learn how to best manage your child’s condition. Encourage your child’s success by seeing to it that he or she follows the treatment plan. In some cases, a psychological therapist can help the patient and family follow the treatment plan.

Learning More

If you have questions, talk to your child’s care team. Also, look for support materials in your local library or bookstore. These online resources can also be helpful:

  • National Association for Continence www.nafc.org

  • Spina Bifida Association www.spinabifidaassociation.org