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Bladder and urethra

Neurogenic bladder: bladder dysfunction caused by the nerves

The bladder in spina bifida and other nervous system conditions: protecting the kidneys, catheterization, medication, botulinum toxin, surgery.

Written by: Dr. Parviz Hajiyev, pediatric urologist.

Quick answers

Main goal
Protect the kidneys first, then stay dry.
When to start?
Right after birth, in the first weeks.
Main treatment
Intermittent catheterization and medication that relaxes the bladder.
Who follows the child?
A pediatric urologist, neurosurgeon, nephrologist and rehabilitation specialist together.

What is neurogenic bladder?

Filling and emptying of the bladder are controlled by the brain and spinal cord. When the nerve pathways are damaged, the bladder either contracts too much and creates high pressure, or contracts weakly and does not empty completely, while the sphincter does not open at the right time. This is called neurogenic bladder.

In children, the most common cause is spina bifida (myelomeningocele). Other causes: congenital anomalies of the spinal cord (tethered cord), sacral anomalies, spinal cord injury and tumors.

Why is it dangerous?

The main problem is not wetting but high pressure in the bladder. When the bladder is stiff and does not empty completely, this pressure is transmitted through the ureters to the kidneys. The result can be hydronephrosis, reflux, recurrent infections and, over the years, loss of kidney function.

The good news is that with treatment started early, most of these complications can be prevented.

Tests

  • Ultrasound: the kidneys, the thickness of the bladder wall, the urine left after peeing.
  • Urodynamics: measures bladder capacity, the pressure that builds up during filling and sphincter function. It is the main test for planning treatment.
  • VCUG (voiding cystourethrogram): to see reflux and the shape of the bladder.
  • DMSA scan: to see whether there are scars in the kidneys.

Treatment

Clean intermittent catheterization

The bladder is emptied with a thin catheter 4–6 times a day. This lowers the pressure and removes residual urine. Parents learn to do this first, and later the child learns to do it alone.

Medication

Medications that relax the bladder (antimuscarinics, for example oxybutynin) lower the pressure and allow the bladder to hold more urine.

Botulinum toxin

When medication is not enough, botulinum toxin is injected into the bladder wall through a cystoscope. The effect lasts about 6–9 months and can be repeated.

Surgical treatment

  • Bladder enlargement (augmentation): the bladder is enlarged using a section of bowel.
  • Mitrofanoff channel: a small channel is created from the belly button to the bladder, and the child can easily insert the catheter through it on their own.
  • Bladder neck operations: to strengthen the sphincter if urine leaks constantly.

Bowel routine

Constipation and stool leakage are frequent companions. A regular bowel routine and, when needed, enema systems improve both quality of life and bladder function.

Follow-up

Neurogenic bladder requires lifelong follow-up. As the child grows, especially during growth spurts, bladder function can change. Regular ultrasound, urodynamics and kidney function checks make it possible to adjust treatment in time.

When to seek urgent care

If any of the following is present, do not wait for a routine appointment: call the doctor or go to the nearest emergency department.

  • Fever, especially with back pain or vomiting
  • When urine cannot be drained with the catheter
  • Blood in the urine, or lethargy together with cloudy or foul-smelling urine
  • Headache, vomiting or drowsiness in a child with a shunt

Note for pediatricians and family doctors

In a newborn with spina bifida, bladder status should be assessed in the first weeks: ultrasound, post-void residual measurement and, when possible, urodynamic study. A high-pressure, poorly compliant bladder is the main risk factor for the kidneys; in these children, intermittent catheterization and antimuscarinic treatment should be started early. Treating constipation is an integral part of bladder management.

What happens at the visit?

  1. Kidney and bladder ultrasound and measurement of the urine left in the bladder after peeing.
  2. A urodynamic study assesses bladder capacity, pressure and sphincter function.
  3. Parents are taught intermittent catheterization, and medication and a bowel routine are planned.
  4. As the child grows, an individual plan is made for staying dry and for independent catheterization.
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Frequently asked questions

Does catheterization hurt the child or cause infection?

With a properly taught clean technique, catheterization is almost painless. Germs are often found in the urine, but if there are no symptoms this usually does not need treatment. Catheterization actually protects the kidneys and reduces the number of serious infections.

Will my child ever be able to hold urine?

With the right treatment, most children can stay dry during the day by school age. Some need operations for this, such as enlarging the bladder or creating a catheterization channel through the belly button.

Related topics

Sources

  • EAU Guidelines on Paediatric Urology, 2025: Management of neurogenic bladder.
  • Bauer SB et al. International Children's Continence Society recommendations for initial diagnostic evaluation and follow-up in congenital neuropathic bladder and bowel dysfunction. Neurourol Urodyn, 2012.

This page is for education. Decisions about your child’s treatment are made together with the doctor after an examination.

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