Pediatric Neurogenic Bladder

Neurogenic bladder means the bladder doesn’t work normally because of nerve damage. It causes a child to have problems with holding or releasing urine. The muscles and nerves of the urinary system work together to hold urine in the bladder and then release it at the right time. Nerves carry messages from the bladder to the brain. And they carry messages from the brain to the bladder muscles. These messages tell the bladder muscles either to tighten or release. With neurogenic bladder, the nerves don’t work normally.

In children a neurogenic bladder may be caused by a birth defect. Or it may happen later because of a different problem. The most common causes of neurogenic bladder in a child include:

• Spina bifida. This is a defect of the spinal cord that occurs during a baby’s early growth in the uterus.
• Spinal cord injury. This is damage to the spinal cord from an accident or other injury.
• Central nervous system tumor. This is a growth on the spinal cord.

A child is more at risk for neurogenic bladder if they have a spinal cord problem.

Symptoms can be a bit different for each child. They can include:

• Urine leakage. This means urine coming out without control. This often occurs when the muscles holding urine in the bladder don’t get the right message.
• Urine retention. This means having trouble releasing urine. This happens if the muscles holding urine in the bladder don’t get the message that it is time to let go.

A child may also have:

• Urinary tract infections (UTI) that cause pain or fever
• Swollen kidneys
• Thickened bladder wall

The symptoms of neurogenic bladder can seem like other health conditions. Take your child to their healthcare provider for a diagnosis.

The healthcare provider will ask about your child’s symptoms and health history. They will give your child a physical exam. Your child may also have tests, such as:

• Urine tests. These are done to look for infection or protein in the urine. Protein in urine can be a sign of kidney disease.
• Urodynamic study. For this test, the bladder is filled with saline through a thin, flexible tube (catheter). The bladder volume and pressure are measured. This helps show how the bladder muscles are working.
• Ultrasound. This is a test that uses sound waves to create images of tissues in the body. A kidney and bladder ultrasound may be done to check for kidney swelling and look at the bladder.

You may also be asked to keep a record of your child’s urine habits. You’ll need to write down your child’s daily urinary schedule. Note how often they go and any problems that occur.

Treatment will depend on your child’s symptoms, age and general health. It will also depend on how severe the condition is. Treatment may include:

• Timed voiding. This means using the toilet at scheduled times. It can help your child prevent accidents and protect the kidneys.
• A catheter. You may need to put a thin, flexible tube in your child’s urethra and up into the bladder. This is done to empty the bladder at regular times during the day. In some cases, a more long-lasting (permanent) catheter is needed. This is called an indwelling catheter.
• Medicine. Medicine can help relax the bladder muscles and prevent muscle spasm. Antibiotic medicine may be used to reduce the chance of urinary tract infections (UTIs).
• Artificial sphincter. A small inflatable cuff is put around the neck of the bladder. It can be inflated to prevent urine leakage. And it can be deflated to empty the bladder. The child may still need a catheter from time to time to fully empty the bladder.

In some cases, your child may need surgery. Your child’s healthcare provider will discuss surgery options with you if needed. Surgery may be done to:

• Create a new opening in the belly where a short-term (temporary) catheter can be placed to empty the bladder
• Make the bladder larger
• Tighten the sphincter so it can hold in urine better

Talk with your child’s healthcare providers about the risks, benefits and possible side effects of all treatments.

Neurogenic bladder may cause:

• Damage to the kidneys. This can happen if the bladder becomes too full and urine backs up into the kidneys.
• Infection of the bladder or ureters. This can be caused by urine that is held too long before being released.

Living with a neurogenic bladder can be hard. Urine leakage can cause embarrassment. It can lead to self-esteem issues for your child. It’s vital for your child’s treatment and emotional development that you are 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 they follow the treatment plan. In some cases, a psychotherapist can help the child and family follow the treatment plan.

Call the healthcare provider if your child has:

• Symptoms that don’t get better or get worse
• New symptoms