Neurogenic bladder and bowel management

Overview

Neurogenic bladder and bowel management includes treatments to help control when you urinate or have a bowel movement.

A spinal cord injury sometimes interrupts communication between the brain and the nerves in the spinal cord that control bladder and bowel function. This can cause bladder and bowel dysfunction known as neurogenic bladder or neurogenic bowel. People with multiple sclerosis or spina bifida might have similar problems.

Signs and symptoms of neurogenic bladder may include:

• Loss of bladder control
• Inability to empty the bladder
• Urinary frequency
• Urinary tract infections.

Signs of neurogenic bowel include:

• Loss of bowel control
• Constipation
• Bowel frequency
• Lack of bowel movements.

There are treatment options and other ways to manage neurogenic bladder, such as:

• Lifestyle changes. Regularly scheduled bathroom breaks, avoiding foods and drinks that can irritate the bladder, and exercises to strengthen the bladder muscle can all help improve bladder control.
• Medications. Your doctor may prescribe medications to improve bladder function. These medications might help reduce the bladder contractions that give you the urge to urinate, lower urinary frequency, improve loss of bladder control, increase bladder storage or help to more fully empty the bladder.
• Botulinum toxin (Botox) injections. Injecting this drug into the bladder muscle can help reduce the frequency of bladder contractions. These injections wear off over time and may need to be repeated about every 6 months.
• Clean intermittent catheterization (CIC). In CIC, you or a health care professional inserts a thin tube through the urethra and into your bladder several times during the day to empty your bladder.
• Continuous catheterization. A health care professional may insert a catheter through your urethra or abdominal wall and into your bladder to continuously empty your bladder.
• Stimulation therapy. These treatments include sacral neuromodulation (SNS) therapy and percutaneous tibial nerve stimulation (PTNS). They're often used when medications and lifestyle changes can't manage neurogenic bladder symptoms. Both of these techniques involve connecting devices to nerves that affect bladder control. These devices send electrical impulses to control the bladder.
• Surgery. Doctors trained in bladder management may perform bladder reconstructive surgery that may resolve or improve bladder symptoms. There are several different surgeries that could be performed, including creating an artificial sphincter, bypassing the bladder, increasing bladder size, and removing the weakened section of the sphincter.

Bowel management options for people with neurogenic bowel include:

• Lifestyle changes. Dietary changes and keeping a journal of foods and drinks that worsen your symptoms can help improve bowel control. Regularly scheduled bowel movements each day can also help.
• Medications. Your doctor may prescribe medications to manage timing and consistency of bowel movements.
• Anal irrigation. Anal irrigation is a newer conservative bowel management therapy. Fluid is inserted through a catheter with an inflatable balloon to reduce constipation and assist in effective bowel movement and management.
• Biofeedback therapy. This treatment involves using a machine to perform exercises that can strengthen pelvic floor muscles and improve bowel control.
• Nerve stimulation. A small battery-operated device provides electrical stimulation to the sacral nerves that control the bowels.
• Surgery. Surgeons trained in bowel surgery may perform reconstructive surgery to resolve difficulties in bowel management.

The Spinal Cord Injury Rehabilitation Program at Mayo Clinic's campus in Minnesota offers several bladder and bowel management options for people with neurogenic bladder or bowel.