Merck Manual

Please confirm that you are not located inside the Russian Federation

honeypot link

Neurogenic Bladder


Patrick J. Shenot

, MD, Thomas Jefferson University Hospital

Reviewed/Revised Nov 2023
Topic Resources

Neurogenic bladder is lack of bladder control because of a nerve problem such as a stroke, spinal cord injury, or tumor.

  • Uncontrollable loss of urine (urinary incontinence) is the primary symptom.

  • Bladder catheterization, imaging, and tests to measure urine flow are done.

  • Treatment is aimed at periodic emptying of the bladder (for example, by intermittent catheterization).

Neurogenic bladder may be

  • Flaccid: A flaccid bladder does not contract and the bladder fills up until it overflows. Then urine dribbles out.

  • Spastic: The person has involuntary bladder contractions and feels the need to urinate even when there is little or no urine in the bladder. Bladder contractions are typically poorly coordinated with the muscle that closes the opening of the bladder (urinary sphincter).

  • Mixed: Some people have elements of both flaccid and spastic bladder.

The Ureters, Bladder, and Urethra

Any condition that damages or interferes with nerves that control the bladder or the bladder outlet can cause neurogenic bladder.

Common causes include stroke Overview of Stroke A stroke occurs when an artery to the brain becomes blocked or ruptures, resulting in death of an area of brain tissue due to loss of its blood supply (cerebral infarction). Symptoms occur suddenly... read more , spinal cord damage or injury Injuries of the Spinal Cord and Vertebrae A spinal cord injury is damage to the bundle of cells and nerves that carry incoming and outgoing messages between the brain and the rest of the body. Most spinal cord injuries result from motor... read more Injuries of the Spinal Cord and Vertebrae , amyotrophic lateral sclerosis Amyotrophic Lateral Sclerosis (ALS) and Other Motor Neuron Diseases (MNDs) Motor neuron diseases are characterized by progressive deterioration of the nerve cells that initiate muscle movement. As a result, the muscles stimulated by these nerves deteriorate, become... read more (ALS), Parkinson disease Parkinson Disease (PD) Parkinson disease is a slowly progressive degenerative disorder of specific areas of the brain. It is characterized by tremor when muscles are at rest (resting tremor), increased muscle tone... read more , multiple sclerosis Multiple Sclerosis (MS) In multiple sclerosis, patches of myelin (the substance that covers most nerve fibers) and underlying nerve fibers in the brain, optic nerves, and spinal cord are damaged or destroyed. The cause... read more , diabetic neuropathy Nerve damage in diabetes People with diabetes mellitus have many serious long-term complications that affect many areas of the body, particularly the blood vessels, nerves, eyes, and kidneys. (See also Diabetes Mellitus... read more Nerve damage in diabetes , and nerve damage caused by pelvic surgery.

Symptoms of Neurogenic Bladder

The primary symptom is urinary incontinence Urinary Incontinence in Adults Urinary incontinence is involuntary loss of urine. Incontinence can occur in both men and women at any age, but it is more common among women and older adults, affecting about 30% of older women... read more Urinary Incontinence in Adults . People continually release small amounts of urine. Men tend to have erectile dysfunction Erectile Dysfunction (ED) Erectile dysfunction (ED) is the inability to attain or sustain an erection satisfactory for sexual intercourse. (See also Overview of Sexual Dysfunction in Men.) Every man occasionally has... read more . Some people with spastic neurogenic bladder also need to urinate frequently, often urgently, with a need to get up during the night to do so. People with spastic neurogenic bladder may have damage to other nerves that causes weakness, muscle spasms, and/or loss of sensation in the legs.

Diagnosis of Neurogenic Bladder

  • Measurement of the amount of urine left in the bladder after urination

  • Ultrasonography of the urinary tract

  • Sometimes more detailed studies such as cystography

Doctors may suspect neurogenic bladder in people with nerve disorders who have incontinence. Usually, doctors measure the amount of urine remaining in the bladder after the person urinates (postvoid residual volume) by inserting a catheter into the bladder or using ultrasonography. Ultrasonography of the entire urinary tract is also done to detect abnormalities, and some blood tests are done to assess kidney function (see Imaging Tests of the Urinary Tract Imaging Tests of the Urinary Tract There are a variety of tests that can be used in the evaluation of a suspected kidney or urinary tract disorder. (See also Overview of the Urinary Tract.) X-rays are usually not helpful in evaluating... read more ).

Further tests may be needed depending on the person's condition. More detailed studies of the urinary tract (for example, cystography Cystography and cystourethrography There are a variety of tests that can be used in the evaluation of a suspected kidney or urinary tract disorder. (See also Overview of the Urinary Tract.) X-rays are usually not helpful in evaluating... read more , cystoscopy, and cystometrography) may be done to check bladder function or to help determine the duration and cause of neurogenic bladder.

Treatment of Neurogenic Bladder

  • Catheterization (with intermittent catheterization over the long term)

  • Maintenance of fluid intake

  • Surgery, rarely

Prompt treatment can help prevent permanent dysfunction and kidney damage. Catheterization or techniques to trigger urination can help prevent urine from remaining too long in the bladder. For example, some people with spastic bladder can trigger urination by pressing their lower abdomen or scratching their thighs. When urine remains in the bladder for too long, the person is at risk of urinary tract infections Overview of Urinary Tract Infections (UTIs) In healthy people, urine in the bladder is sterile—no bacteria or other infectious organisms are present. The tube that carries urine from the bladder out of the body (urethra) contains no bacteria... read more . Inserting a catheter into the bladder periodically is usually safer than leaving a catheter in continuously.

Sometimes medications given to treat urge incontinence can be helpful (see table Some Medications Used to Treat Urinary Incontinence Some Drugs Used to Treat Urinary Incontinence Some Drugs Used to Treat Urinary Incontinence ). Rarely, people need surgery to create another way for urine to leave the body.

More Information

The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.

  • Urology Care Foundation: Current, comprehensive urologic health information, including a patient magazine (Urology Health extra®) and research updates

quiz link

Test your knowledge

Take a Quiz!