What is neurogenic bladder?
Neurogenic bladder is when the nerves between the bladder and the brain are not working well, causing the bladder to not fill or empty properly. The bladder is like a balloon that holds urine. It has muscles that relax and tighten so the urine can be stored and released. Children who have neurogenic bladder have trouble controlling this system.
Outcomes of neurogenic bladder
- Frequent urination (urinating more than is normal)
- Having sudden urges to urinate immediately
- Urine might leak out of the bladder when it shouldn't
- Bladder does not empty well, which increases the risk of urinary tract infections (UTI)
- Pressure from unreleased urine can build up and hurt the kidneys
What is neurogenic bowel?
Just like the bladder, the bowels can also be affected by nerve problems. This is called neurogenic bowel.
Monitoring your child’s bladder and bowel
Monitoring your child’s bladder and bowel function is an important part of diagnosing and managing their symptoms. If their bladder does not function properly, it can lead to:
- urinary tract infections (UTIs)
- kidney damage
- urine leaks, leading to wet clothes or diapers.
If their bowel does not function properly, it can lead to:
- constipation
- soiling
How are the bladder and bowel monitored?
Your child’s bladder function can be monitored using different tests at different ages:
- Bladder and bowel diary
- Ultrasound
- Blood tests measuring creatinine and cystatin C levels
- Flow rate test
- Video urodynamic study (VUDS), used to measure bladder pressure, filling and emptying
- Voiding cystourethrogram (VCUG)
- Abdominal X-ray
What causes neurogenic bladder and bowel?
Most children with neurogenic bladder and/or bowel have a condition that affects the spinal cord. This can include the following conditions:
- Disorders of the spinal cord
- Spina bifida (myelomeningocele)
- Tethered cord syndrome
- Spinal cord injury
- Spina bifida (myelomeningocele)
- Disorders of the brain
Neurogenic bladder treatment
Clean intermittent catheterization (CIC)
Clean intermittent catheterization (CIC) is a technique for children who need to use a catheter to empty their bladder. CIC is necessary when your child is unable to empty their bladder on their own, when their bladder leaks urine or when very high pressure has developed in the bladder. CIC should be performed several times per day. This treatment can be as infrequent as once per day or through an indwelling catheter overnight. It can be started in the first few days after birth and can be done through the urethra or a small surgical opening in the abdomen that leads to the bladder (mitrofanoff).
CIC can help keep the bladder from stretching too much, reduce pressure on the bladder, stop urine from backing up into the kidneys, and prevent infections.
See CIC: Instructions for children with male anatomy and CIC: Instructions for children with female anatomy for step-by-step instructions on how to perform CIC at home.
Medicines
There are several medications that can help your child have better control over their bladder function:
- Anticholinergic and beta 3 agonist medications help calm the bladder muscles, stopping them from contracting too frequently.
- Alpha blockers can help urine flow if there is a blockage in your child’s bladder.
Preventing infections
- Oral antibiotics may be started to help prevent infections for some children.
- Intravesical treatments (medications directly injected into the bladder) may also be used (e.g., saline bladder irrigation, intravesical antibiotics, N-acetylcysteine, hyaluronic acid).
Surgery
Some children may benefit from certain procedures:
| Procedure | What it does | Why it’s done |
|---|---|---|
| Botox injection of the bladder | Relaxes the bladder muscle | Reduces bladder pressure and stops urine leaks |
| Botox injection of the sphincter | Relaxes the sphincter muscle | Improves bladder emptying |
| Mitrofanoff | Makes a small opening in the abdomen that leads to the bladder for a catheter to drain urine | Makes catheterization easier for frequent access |
| Vesicostomy | Makes a small opening from the bladder to the abdomen just below the belly button |
Helps protect the kidneys of children who cannot do CIC Usually a temporary solution to allow urine to continuously drain into a diaper |
| Bladder augmentation (enlargement) | Uses the bowel to make the bladder bigger, to improves its capacity and ability to hold urine | Fixes small, stiff, or high-pressure bladders |
| Sling or artificial sphincter | Implants a device that provides more control over the flow of urine | Used to stop urine leakage for teens with stress incontinence (involuntary urination) |
| Bladder neck reconstruction | Repairs or reconstructs the bladder neck, allowing for better control of the muscles at the bladder opening | Used to stop urine leakage for children with serious leaking or high post void residual (PVR) volume (the amount of urine remaining in the bladder after urination) |
Neurogenic bowel treatment
Children with neurogenic bowel can benefit from the following treatment:
- Diet changes that increase their fibre and fluid intake
- Toileting routines and timed sitting
- Oral medications that relieve constipation like magnesium citrate, polyethylene glycol (PEG) 3350, sennosides, or bisacodyl
- Rectal treatments like glycerin liquid, suppositories and enemas
- Anal irrigation systems (e.g., cone irrigation or Peristeen)
- Antegrade continence enema (ACE) through appendicostomy or cecostomy
How to support your child with neurogenic bladder and bowel
Children with neurogenic bladder and bowel need support in managing their condition. You can help your child as they grow by encouraging them to participate in their own care early on, before they start school. This includes performing their own CIC and bowel routines, understanding their medications and what those medications do.
This process of independently managing their own health is called transitional care. Your child will usually move to adult care by 18 years of age and will attend adult hospitals thereafter.
Your child’s health-care team will help your child with this transition process.
Tips for families
- Keep a diary about your child’s urination and bowel movements to help with treatment
- Stick to a daily CIC and bowel routine
- Use latex-free supplies (this is important for children with spina bifida who are at risk of developing a latex allergy)
- Ask the health-care team about help for school plans, supplies, and support groups
- Engage your child’s school early (four to six months before the beginning of the school year)
- Attend your child’s regularly scheduled ultrasounds, bladder tests, and lab tests