Neurogenic Bladder vs. Overactive Bladder: How They're Related – Healthline

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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:
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 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 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 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 is a term for a bladder that functions overactively, with abnormally frequent and strong muscle contractions, often leading to urge incontinence.
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.
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:
People with underactive bladder may experience difficulty passing urine or even inability to pass urine. Others may experience
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.
Overactive bladder can be caused by:
Common causes of underactive bladder include:
The risk factors for overactive and underactive bladder are similar. They include:
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:
Making lifestyle changes, sometimes along with medical and surgical treatments, may help reduce the symptoms of overactive and underactive bladder.
These include:
Sometimes, lifestyle changes do not effectively or fully alleviate overactive bladder symptoms. In these cases, medical treatments are sometimes used to further reduce symptoms:
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.
When lifestyle changes do not greatly improve underactive bladder symptoms, sometimes further treatment is needed. Some common additional treatments for underactive bladder include:
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:
Having a neurogenic bladder can feel like:
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.
Last medically reviewed on September 2, 2022
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