Neurogenic bladder is a term is used to describe two issues affecting the muscles and nerves in the bladder that control how your body stores or empties urine.

Neurogenic bladder issues affect millions of people in the United States. It’s especially common in people also affected by:

  • multiple sclerosis
  • Parkinson’s
  • AIDS
  • diabetes
  • syphilis
  • polio
  • major pelvic surgery
  • herpes zoster
  • spinal cord injury
  • stroke

It can also be congenital, such as when urethral valves cause an outlet obstruction in utero (before birth).

Overactive bladder is one type of neurogenic bladder condition that often results in urinary incontinence. It’s not a condition but the name for a group of urinary symptoms. Overactive bladder affects more than 30 million people in the United States every year.

Another type of neurogenic bladder condition is called underactive bladder, which can make it difficult to empty your bladder. Again, this is not a condition but a group of symptoms affecting bladder function.

Your bladder’s activity is controlled by the body’s nervous system. When your bladder is full of urine, your brain should signal your bladder muscles to squeeze and force urine out of your body. Then muscles around your urethra (part of your body where urine exits) relax to allow urine to exit.

Neurogenic bladder issues can arise when the bladder’s nerves and muscles no longer work in synch. Sometimes these changes happen with age, while other times neurogenic bladder issues are caused by illness or injury.

Overactive bladder

Overactive bladder causes the bladder muscles to squeeze overactively and before the bladder is filled with urine.

For some people with overactive bladder, their bladder muscle (detrusor) contracts spontaneously and without inhibition, with force sufficient to overcome the urethral sphincter, resulting in incontinence.

Underactive bladder

Underactive bladder causes slow bladder emptying or an inability to completely empty the bladder in a reasonable amount of time. This can happen when the bladder does not empty completely, and the detrusor muscle gets stretched, thinned, and weak.

In other cases, the muscles around the urethra may not function correctly and stay tight rather than loosening when you try to empty your bladder.

Lastly, urinary obstruction can cause underactive bladder by blocking the flow of urine through the urinary system due to medical conditions, such as:

If you’re experiencing bladder issues, it can be tricky to choose the correct terms to describe your experience. Here’s a rundown of some common terms and definitions:

Urge incontinence

Urge incontinence is a type of urinary incontinence causing sudden and strong urges to empty the bladder that causes involuntary leakage of urine. It can cause leakage of any amount of urine and is often accompanied by a feeling of intense abdominal pressure.

Overactive bladder

Overactive bladder is a term for a bladder that functions overactively, with abnormally frequent and strong muscle contractions, often leading to urge incontinence.

Underactive bladder

Underactive bladder describes weakened contractions during bladder emptying, which can result in reduced strength of urine stream, prolonged bladder emptying time, and an inability to fully empty the bladder.

The symptoms of neurogenic bladder vary depending on which neurogenic bladder condition a person is experiencing.

Symptoms of overactive bladder

People with overactive bladder typically feel a frequent urge to urinate, and when this urge hits, they may leak small or large amounts of urine before they’re able to reach the bathroom. Such leakage can also happen during sleep.

The frequent urination experienced by people with overactive bladder is defined by going to the bathroom more than eight times in 24 hours. Other symptoms include:

  • waking up two or more times during the night to urinate
  • feeling the need to urinate even if you’ve just used the bathroom
  • taking many trips to the toilet each day

Symptoms of underactive bladder

People with underactive bladder may experience difficulty passing urine or even inability to pass urine. Others may experience

  • very light streams of urine
  • interrupted urine stream
  • blood in urine
  • abdominal pain and swelling

It’s important to treat underactive bladder promptly as this condition may lead to kidney failure if left untreated.

Neurogenic bladder has a wide range of causes, from injuries to illnesses, as well as aging. In many cases, neurogenic bladder is caused by nerve, brain, or spinal cord damage.

Overactive and underactive bladder are not individual conditions but terms used to describe a range of symptoms that have a range of potential causes.

Causes of overactive bladder

Overactive bladder can be caused by:

  • estrogen deficiency after menopause
  • excess alcohol and caffeine intake
  • excess weight
  • infections, such as urinary tract infection, which can irritate the bladder’s nerves
  • medications that interfere with nerve function
  • nerve damage from pelvic or back surgery, herniated disc, multiple sclerosis, Parkinson’s disease, radiation, or stroke
  • wakened pelvic muscles caused by pregnancy and childbirth

Causes of underactive bladder

Common causes of underactive bladder include:

  • aging
  • bladder outlet obstruction from enlarged prostate, bladder or kidney stones, and other causes
  • diabetes
  • infectious diseases like herpes zoster, AIDS, and syphilis
  • neurological disorders
  • nervous system injury to spinal cord

The risk factors for overactive and underactive bladder are similar. They include:

  • cancer and tumors (especially of the bladder)
  • changing hormones
  • conditions affecting the brain and spinal cord
  • injury to the brain, spinal cord, or urinary tract
  • medication side effects
  • neurologic disorders interfering with the signals between your brain and bladder
  • spasms or weakness of the pelvic muscles
  • urinary tract infection

One or more treatments might be used to reduce or eliminate the symptoms of neurogenic bladder and prevent kidney or other damage to the urinary tract and body.

The type of treatment course someone might take to address their neurogenic bladder depends on its cause and whether their bladder is overactive or underactive.

Both overactive and underactive bladder usually respond well to treatment with lifestyle changes:

Lifestyle changes

Making lifestyle changes, sometimes along with medical and surgical treatments, may help reduce the symptoms of overactive and underactive bladder.

These include:

  • limiting intake of foods and drinks that irritate the bladder and act as diuretics (encourage your body to make more urine), such as coffee, tea, alcohol, soda, tomato-based foods, citrus, and spicy foods
  • recording your bathroom trips in a “bladder diary” to help track the progress of your symptoms
  • double voiding, or emptying your bladder twice in one trip to the bathroom
  • delayed voiding, or waiting before you go to the bathroom (even if you have to go) in increasing increments to train your bladder to better hold urine
  • using timed urination, or following a set bathroom schedule instead of using the bathroom only when you get the urge
  • doing exercises to relax your bladder muscle, such as quick flicks (alternately squeezing and relaxing your pelvic floor) and biofeedback

Treating overactive bladder

Sometimes, lifestyle changes do not effectively or fully alleviate overactive bladder symptoms. In these cases, medical treatments are sometimes used to further reduce symptoms:

  • bladder botox injections, which relax the bladder’s muscle wall to slow urinary urgency and stop urge incontinence (these treatments are administered by a trained urologist or a female pelvic medicine and reconstructive surgeon)
  • prescription medications, such as antimuscarinics and beta-3 agonists, which prevent your bladder muscles from squeezing unless your bladder is full (these often are prescribed as pills, gels, or transdermal patches)
  • nerve stimulation (neuromodulation therapy), which involves sending electrical pulses to nerves connected to the bladder to help improve bladder control. (including percutaneous tibial nerve stimulation (PTNS) and sacral neuromodulation (SNS))

In rare cases of overactive bladder, a medical professional may recommend surgery to further treat overactive bladder symptoms. Augmentation cytoplasty is used to enlarge the bladder.

Another surgery, urinary diversion, re-routs your body’s flow of urine.

Both surgeries come with risks and are only recommended for severe cases of overactive bladder.

Treating underactive bladder

When lifestyle changes do not greatly improve underactive bladder symptoms, sometimes further treatment is needed. Some common additional treatments for underactive bladder include:

  • catheter to help prevent urine buildup and potential damage
  • medications like parasympathomimetics, which stimulate nerve receptors in the bladder muscles and urethra and alpha-antagonists that relax urethra muscles to stimulate the flow of urine
  • antibiotics to prevent infection
  • electrical devices to stimulate urine flow

In severe unresponsive cases of underactive bladder with chronic retention, a doctor may teach you to catheterize yourself (intermittent catheterization) to empty the bladder on a schedule.

If you experience changes in your bathroom habits, have trouble urinating or holding urine, or feel a frequent urge to use the bathroom, set up an appointment with a doctor. It’s possible that you’re experiencing neurogenic bladder.

A medical history, physical exam, bladder diary, urine test, bladder scan, and other tools for diagnosis can help determine what’s causing overactive or underactive bladder symptoms.

Identifying the cause can help a medical professional to develop an effective, appropriate treatment plan.

In some cases, a doctor will order an endoscopy of the urethra and bladder.

Read on to learn the answers to two common questions about neurogenic bladder:

What does having neurogenic bladder feel like?

Having a neurogenic bladder can feel like:

  • your bladder feels full when it’s not, with the feeling that you have to relieve yourself when you don’t (in the case of overactive bladder)
  • your bladder is full, but you can’t empty it, causing pain in your abdomen (in the case of underactive bladder)

Can you pee with a neurogenic bladder?

You can pee with neurogenic bladder, but your bathroom habits and urinary function will appear irregular.

While it’s possible to pass urine with neurogenic bladder, it’s important to treat the cause of your neurogenic bladder in addition to nurogenic bladder itself in order to prevent damage to your urinary tract and other potential complications.

Neurogenic bladder is a term used to describe several bladder issues related to impairments in the ways nerves and muscles affect the function of the bladder. This miscommunication between the nerves and muscles results in either overactive or underactive bladder.

Overactive and underactive bladder describe two sets of symptoms caused by a variety of injuries and conditions.

With treatment, overactive and underactive bladder can be managed, with symptoms minimized.