Neurogenic Bladder Dysfunction


Neurogenic bladder is a condition in which a person lacks bladder control due to a brain, spinal cord, or nerve condition. In the case of superficial siderosis, the iron deposition in the brain and spine can damage the nerves that control bladder function, leading to urinary incontinence or retention.

Overactive Bladder Symptoms

  • Frequent and/or urgent urination
  • Overactive nighttime urination (nocturia)
  • Incontinence (the inability to hold in urine)

Incomplete Emptying

  • Hesitancy in starting urination
  • Inability to empty the bladder completely

Management of Neurogenic Bladder

Lifestyle Changes

Lifestyle changes can play a crucial role in managing neurogenic bladder. Here are some recommendations:

  • Scheduled voiding involves going to the bathroom regularly, whether or not you feel the urge to urinate.
  • Double voiding: After urinating, wait a few minutes and try again to ensure the bladder is fully emptied.
  • Pelvic floor exercises (Kegel exercises): Strengthening the muscles that help control urination can improve symptoms.
  • Fluid management: Drink plenty of fluids to keep the urinary system functioning well but avoid drinking large amounts at once. Try to spread out fluid intake throughout the day. Also, limit fluid intake for a few hours before bedtime to help reduce nighttime urination.
  • Diet modification: Certain foods and beverages can irritate the bladder, including caffeinated and alcoholic drinks, citrus fruits, spicy foods, and artificial sweeteners. Keeping a food diary may help identify any triggers.
  • Maintain a healthy weight: Extra weight can put pressure on the bladder and contribute to symptoms.
  • Quit smoking: Coughing from smoking can cause or worsen urinary incontinence.
  • Avoid constipation: Regular bowel movements help keep the bladder in its proper place, improving urinary health. Consuming a high-fiber diet and drinking enough fluids can help prevent constipation.

These lifestyle changes can be helpful but should be combined with medical treatment and regular check-ups. Working closely with your healthcare provider to manage neurogenic bladder effectively is essential.

Management Options

  • Pelvic Floor Physical Therapy: This treatment targets the muscles attached to the pelvic bone and sacrum that control bladder function. The therapy includes biofeedback, neuromuscular stimulation, and daily home exercises to strengthen the pelvic floor muscles, improve muscle control, and promote muscle relaxation.
  • InterStim®: A small device surgically implanted under the skin that stimulates the sacral nerves to treat overactive bladder and urinary retention.
  • Percutaneous Tibial Nerve Stimulation (PTNS): A tiny needle electrode is inserted in the ankle to transmit a signal to the sacral plexus, a network of nerves controlling the bladder and pelvic floor muscles. Weekly 30-minute treatments over three months have successfully reduced urinary frequency, urgency, nighttime urination, and incontinence.
  • Intermittent Self-Catheterization (ISC): This may be needed for difficulty emptying the bladder. You or a caregiver will insert a small tube (catheter) into the urethra to empty the bladder and remove the catheter. ISC one or more times per day can help control bladder leakage, urgency, frequency, and nighttime urination for people who cannot completely empty their bladder on their own.
  • Medication: Depending on the type of bladder dysfunction, medications such as anticholinergic drugs, Botox injections into the bladder, or alpha-blockers may be useful.
  • Clean Intermittent Catheterization (CIC): This method can help empty the bladder completely, reducing the risk of urinary tract infections and kidney damage.
  • Condom Catheter: Most often used for men, it is a sheath that fits over the penis like a condom. The end of this sheath is attached to a tube that allows the drainage of urine into a collection bag. This method is non-invasive, self-administered, and can be a good alternative to traditional urinary catheters for men with chronic urinary incontinence. The equivalent is often referred to as a female urinary device or external catheter for women. They can vary in design but commonly look like a funnel or a shallow cup that fits over the vulval area. The urine is then guided away via a tube into a collection bag. These devices can be a suitable alternative for women with urinary incontinence who wish to avoid traditional catheterization methods. It should be noted that external catheters can sometimes be more challenging to fit and secure in female patients due to anatomical differences.

Surgical Option

A suprapubic catheter is a medical device used to drain urine from the bladder. It is inserted into the bladder through a small hole in the abdomen, just above the pubic bone. This can be a solution for individuals with severe neurogenic bladder secondary to superficial siderosis who cannot effectively empty their bladder through normal means. A suprapubic catheter can be beneficial in such severe cases for several reasons:

  • Long-term Management: Unlike urethral catheters, suprapubic catheters are often more comfortable for long-term use, as they don’t cause urethral discomfort or injury.
  • Reduced Infection Risk: While all catheter use comes with some risk of urinary tract infection, suprapubic catheters often have a lower risk than long-term urethral catheters.
  • Ease of Care: Suprapubic catheters are generally easier to clean and care for, and there is less likelihood of accidental removal.
  • Continuation of Sexual Activity: Since the catheter doesn’t interfere with the genital area, it allows for continuing sexual activity.
  • Improved Quality of Life: By effectively managing urinary retention, the catheter can reduce urinary tract infections, kidney damage, and incontinence, thereby improving the overall quality of life.

However, as with any medical procedure, risks and potential complications must be considered. These can include infection, bladder stones, blockage or dislodgement of the catheter, injury to the bladder or bowel during insertion, and skin irritation or breakdown around the site of the catheter. A decision to use a suprapubic catheter should involve a detailed discussion between the patient and their healthcare provider, considering all the potential benefits and risks. It should be noted that a suprapubic catheter is typically considered when other methods have been tried and found unsuccessful or unsuitable due to the patient’s specific circumstances.

Sources: Superficial siderosis is a rare neurologic disease characterized by progressive sensorineural hearing loss, cerebellar ataxia, pyramidal signs, and neuroimaging findings revealing hemosiderin deposits in the spinal and cranial leptomeninges and subpial layer. The disease progresses slowly, and patients may present with mild cognitive impairment, nystagmus, dysmetria, spasticity, dysdiadochokinesia, dysarthria, hyperreflexia, and Babinski signs. Additional features reported include dementia, urinary incontinence, anosmia, ageusia, and anisocoria. Superficial siderosis MedGen UID: 831707 •Concept ID: CN226971 •Finding Orphanet: ORPHA247245

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