Neurogenic Bladder Dysfunction
Overview
Neurogenic bladder occurs when nerve damage prevents proper bladder control. In patients with Superficial Siderosis (SS), this is often due to chronic iron accumulation (hemosiderin) along the brain and spinal cord, particularly affecting the lower spinal nerves and brainstem regions responsible for urinary function. This can result in urinary incontinence, retention, or both.
Common Bladder Symptoms in SS
Overactive Bladder Symptoms
- Frequent urination
- Sudden, urgent need to urinate
- Nighttime urination (nocturia)
- Involuntary leakage (urge or stress incontinence)
Incomplete Emptying
- Hesitancy starting urination
- Weak urine stream
- Feeling the bladder hasn’t emptied completely
- Straining to urinate
These symptoms can vary over time and may worsen as SS progresses.
Management of Neurogenic Bladder
Lifestyle Strategies
Patients may benefit from non-invasive approaches such as:
- Scheduled voiding: Emptying the bladder at set times to avoid accidents.
- Double voiding: Urinate, wait a few minutes, then try again.
- Pelvic floor (Kegel) exercises: These help strengthen control muscles.
- Fluid timing: Spread fluid intake throughout the day, and reduce intake before bed.
- Bladder-friendly diet: Limit caffeine, alcohol, spicy foods, citrus, and artificial sweeteners.
- Constipation prevention: Helps reduce pressure on the bladder.
- Quit smoking: Reduces chronic coughing that worsens incontinence.
- Weight management: Eases pressure on the bladder.
These steps can improve bladder function but often need to be combined with therapy or medication.
Medical & Supportive Management
- Pelvic Floor Physical Therapy
- Tailored physical therapy that includes exercises, biofeedback, and neuromuscular stimulation to restore bladder control.
- InterStim® Therapy
- A small implanted device sends mild electrical pulses to the sacral nerves, which may help regulate bladder signals and improve symptoms like urgency or retention.
- Percutaneous Tibial Nerve Stimulation (PTNS)
- A non-surgical option using gentle electrical stimulation via a tiny needle placed near the ankle to influence bladder nerves. Usually done weekly over 12 weeks.
- Intermittent Self-Catheterization (ISC)
- A sterile tube is inserted into the urethra several times a day to fully empty the bladder. This helps manage retention and reduce UTI risk.
- Clean Intermittent Catheterization (CIC)
- Similar to ISC, performed with clean (not sterile) technique. May be self-administered or caregiver-assisted.
- External (Condom or Female) Catheters
- For men: A condom-like sheath connected to a drainage bag.
- For women: External catchment devices fitted over the vulva. Designs vary but aim to collect urine non-invasively.
- Useful for those with incontinence who prefer to avoid internal catheters.
- Medications
- Anticholinergics (e.g., oxybutynin): Help calm an overactive bladder.
- Beta-3 agonists Relax the bladder muscles.
- Botox injections: Used to relax the bladder wall.
- Alpha-blockers: Improve urine flow for those with retention.
Surgical Option: Suprapubic Catheter
A suprapubic catheter is inserted through the abdomen into the bladder, bypassing the urethra. For SS patients with severe bladder dysfunction, it may provide:
- Long-term comfort
- Lower infection risk than indwelling urethral catheters
- Easier hygiene and maintenance
- Preserved sexual activity
- Reduced risk of kidney damage or bladder overdistention
It’s generally recommended only after other options are exhausted and requires careful discussion with a urologist about potential risks such as infection, stone formation, or catheter dislodgment.
Key Takeaway for SS Patients
Superficial Siderosis can silently impair bladder control over time. If you’re experiencing bladder changes—whether mild or severe—don’t ignore the signs. Early evaluation and proactive management can significantly improve the quality of life and reduce complications. Partnering with a urologist familiar with neurogenic bladders is essential.
Sources: Superficial siderosis is a rare neurologic disease characterized by progressive sensorineural hearing lossOverview In approximately 95% of superficial siderosis patie... More, cerebellar ataxiaOverview Ataxia is considered a symptom of your superficial ... More, 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 impairmentOverview Cognition is the range of high-level brain function... More, nystagmusOverview Nystagmus involves the involuntary and uncontrolled... More, dysmetria, spasticityOverview Spasticity is a condition in which individual muscl... More, dysdiadochokinesiaOverview Dysdiadochokinesia (DDK) is the medical term used t... More, dysarthriaOverview Cerebellar dysarthria is a distinct speech disorder... More, hyperreflexiaOverview Autonomic Hyperreflexia is a condition in which you... More, and Babinski signs. Additional features reported include dementiaOverview Dementia is the progressive decline of cognitive fu... More, urinary incontinence, anosmia, ageusia, and anisocoriaOverview Anisocoria, a condition characterized by unequal pu... More. Superficial siderosis MedGen UID: 831707 •Concept ID: CN226971 •Finding Orphanet: ORPHA247245