Three different types of nerves control how your bladder functions. Your bladder serves as a sort of vessel to hold the urine that your kidneys make after they have filtered the blood. The kidneys filter the blood and send the blood and blood cells back into circulation. The waste products are collected in the urine, which is sent to the bladder until it is eliminated from the body. The bladder can expand to hold more and more urine until you feel the urge to urinate. One type of nerve sends a message to your brain when your bladder is full and your brain tells you to go to the toilet.
Another type of nerve causes your bladder to contract to push the urine out. A third type of nerve controls the sphincter muscle of the bladder. This muscle opens to allow you to urinated and closes when are finished. Damage to any of these nerves can cause problems with the way the bladder functions and with the way you urinate. This type of problem is often called bladder neuropathy, bladder dysfunction, or neurogenic bladder
The symptoms of neurogenic bladder depend on which nerves are damaged. You might find that you feel the need to urinate less often, have difficulty completely emptying your bladder, have a weak urinary stream, find it difficult to start urinating and may dribble afterwards, experience urinary incontinence, find it difficult to wait to urinate once you feel the need, or develop frequent urinary tract infections. The symptoms of a urinary tract infection include a frequent need to urinate even though you may not void much urine each time, pain or burning when you urinate, being unable to expel any urine even though you feel the urge, or discolored urine.
What You Should Do
If you have any of the symptoms of bladder neuropathy, talk to your doctor about what you can do to alleviate the problem. If you have symptoms of a urinary tract infection, talk to your doctor at once. If left untreated, urinary tract infections can cause damage to the kidneys. Urinary tract infections are usually cured rapidly with antibiotics. Even if you have no other signs of neuropathy, frequent urinary tract infections can be an early sign of neurogenic bladder. This happens when the urine is not completely expelled and sits in the bladder for extended periods of time, allowing bacteria to grow. This is especially true for people with diabetes, who may have large amounts of glucose in their urine, providing the bacteria with the nutrients they need to grow.
Your doctor may suggest medications to help with your problem, but there are also several steps you can take yourself to alleviate the symptoms of bladder neuropathy. Because your bladder nerves cannot sense when you need to urinate, you may have to take on the job yourself. Drink plenty of fluids, and instead of waiting until your bladder feels full, try urinating according to a timetable, say every hour or every 2 hours. If you are having problems starting to urinate or completely expelling all your urine, try pushing on your bladder to start the urine flowing and again when you are finished (this is called double voiding). Men may find it easier to urinate sitting down. If you are having problems completely emptying your bladder, try urinating again 5 to 10 minutes after your first attempt.
If timed voiding or double voiding does not alleviate the symptoms of bladder neuropathy, your doctor may want to try a drug therapy, catheterization, or surgery. Your doctor may suggest placing a catheter through your urethra to completely remove the urine from your bladder. A permanent catheter can cause problems, especially in men, including inflammation of the urethra and surrounding tissue. It can also be quite cumbersome.
You and your doctor may decide it is preferable to try intermittent self-catherization. In this case, you doctor or nurse educator will show you how to insert a catheter yourself. You can then do this four to six times a day to empty your bladder, removing the catheter after each voiding. This is especially useful if you have a contracted sphincter, which makes it difficult to expel urine.
Drugs such as bethanechol have had limited success in initiating urine flow, but they may nevertheless help some people. However, these drugs do not help if you are having problems fully emptying your bladder. Other medications, such as terazosin or doxazosin, can relax the sphincter to help you empty your bladder. However, these drugs can cause side effects such as dry mouth and constipation and are not generally helpful for people with neurogenic bladder.
Another approach is surgery. Your doctor may suggest bladder neck surgery, which will relieve the spasm of the internal sphincter that prevents emptying of the bladder. The external sphincter is left intact, thus preventing urine leakage.
Your best bet in avoiding bladder problems is to take steps to prevent neuropathy from occurring in the first place or to delay its onset. This includes keeping your blood glucose levels under tight control, avoiding alcohol and smoking, exercising regularly and keeping your weight under control.
Sources and References
The Diabetes Problem Solver—Quick Answers to Your Questions About Treatment and Self-Care by Nancy Touchette
Management of Neurogenic Bladder by V Sripathi and A Mitra
Diagnosis and clinical evaluation of neurogenic bladder by Gerard Amarenco, Camille Chesnel et al