Treatment for neurogenic bladder will depend on the underlying cause of your condition. Because symptoms of neurogenic bladder look similar to other conditions, your doctor will take a full medical history, perform a physical exam, use imaging techniques or urine cultures, and may ask you to keep a “voiding diary” to keep track of how often you urinate. Once other conditions are ruled out, neurogenic bladder can be treated with behavioral therapy, catheterization, medication and surgery.

Behavioral Therapy for Neurogenic Bladder

Your doctor can work with you to regain control of your bladder using behavioral therapy.

A bladder training schedule will help you get used to holding your urine for longer periods of time by putting you on a voiding schedule, gradually increasing the time between voiding until you can hold your urine for several hours at a time.

Kegel exercises, otherwise known as pelvic flood muscle exercises, will teach you to relax and contract the muscles that control urination. Many patients find that performing Kegels regularly helps them to minimize leakage or more completely empty their bladder.

Biofeedback uses a monitor and electrodes on your skin to increase your awareness of urinary tract activity and other sensations which contribute to urination. Biofeedback is often used in conjunction with Kegel exercises to help you gain control of the muscles involved in urination. Continued use of a voiding diary may also help you become aware of the need to empty your bladder.

Medical Therapy and Devices for Neurogenic Bladder

Several medications are available to help leakage and other symptoms associated with a neurogenic bladder.

Anticholinergic drugs relax the muscles of the bladder which decreases overactivity and bladder spasms. This results in a decrease in leakage and urgency. Antispasmodic drugs also relax the muscles of the bladder, which increases the capacity of the bladder and decreases voiding frequency.

Both antispasmodic drugs and anticholinergic drugs can interfere with mental alertness and physical coordination. Talk to your doctor about driving safety or operating heavy machinery if you are taking these drugs.

Antidepressants such as tricyclics are not approved by the Food and Drug Administration (FDA) specifically for neurogenic bladder treatment, but many doctors find that tricyclics effectively treat the condition.

Botulinum toxin (Botox) can be injected directly into the bladder to paralyze the muscles of the bladder and control overactivity. Botox injections need to be re-administered every six to eight months.

Sometimes a urinary catheter is used to help a person with a neurogenic bladder void. The catheter can be left in place (indwelling catheter) or re-inserted four to six times a day (intermittent catheterization). Some people insert the catheter on their own, and some people have a healthcare provider insert the catheter. Ongoing catheterization can cause infection, urinary tract injury, bladder spasm, and/or allergic reaction to the catheter tube.

Surgery for Neurogenic Bladder

If behavioral therapy, medications and medical devices are ineffective, your doctor may consider surgery.

An artificial sphincter can be surgically implanted into your bladder to prevent urine leakage. The artificial sphincter is controlled by a pump which is used to inflate the device to prevent urine leakage, or the sphincter can be deflated to allow the urine to flow out of the bladder.

A piece of synthetic mesh or tissue can be placed under the urethra in bladder neck sling surgery to increase resistance in the urethra and prevent incontinence.

In bladder augmentation surgery (enterocystoplasy) the bladder is expanded using a section of the bowel. After bladder augmentation a patient will need to relieve themselves using a catheter. When bladder augmentation is not possible, urinary diversion surgery may be performed to bypass the bladder.

Each of the many types of urinary diversion surgery involve diverting the path of urine from the bladder, either by using a piece of bowel to create a pouch to hold urine inside the body, or by redirecting the flow of urine through a stoma, a small permanent hole in the skin of the belly.

Talk to your doctor about what treatment options are right for you.