February 12, 2010
Dear Mayo Clinic:
This past year, my healthy 54-year-old husband was diagnosed with a neurogenic bladder, which requires him to self-catheterize four to five times per day. It has made the things he used to love doing much more difficult, and it is taking its toll on him emotionally. Are there other options for his condition other than self-cathing?
First, it's important to know what led to the discovery of this problem with his bladder. Was he having urinary symptoms, such as urinary tract infections or incontinence? If so, intermittent catheterization can help these symptoms and may be an appropriate long-term solution. Intermittent catheterization can reduce the risk of kidney disease when the bladder works poorly and if the storage pressures in the bladder are high.
But, it is possible that other treatment options may be available for your husband. If he hasn't already seen a sub-specialist in voiding disorders, I'd advise him to seek a second opinion from a urologist who has interest and experience in treating people with poor bladder function to have his diagnosis confirmed and to review his treatment plan.
The urologist can identify if your husband does, indeed, have a neurogenic bladder. Normally, nerves carry messages from your brain to your bladder muscles, directing those muscles to tighten or relax. If the nerves or brain are damaged â€” from a stroke, pressure on the spinal cord from disk disease, multiple sclerosis, or other neurologic injury â€” the bladder may not empty normally. This condition, associated with a neurologic disease, is termed a neurogenic bladder. The description 'neurogenic' applies only if the bladder isn't functioning due to a neurologic condition. People usually have other signs of neurologic disease or injury along with a neurogenic bladder, but not always.
Sometimes, consultation with a neurologist who may order imaging of the spine and/or brain is appropriate to confirm the diagnosis of a neurologic disorder causing the bladder dysfunction. Your husband should discuss these possibilities with the urologist, particularly if he also has recently developed bowel or erection difficulties.
In many cases, poor bladder function isn't related to nerve damage, but instead may result from an undiagnosed obstruction. In men, the prostate often obstructs the bladder. That can cause poor bladder emptying and should be treated. If an obstructed bladder remains untreated for a long time, and the bladder is forced to continually push against the obstruction, eventually, the muscles of the bladder may weaken. Bladder failure caused by muscle weakness is called a myogenic bladder.
To find out the likely cause of your husband's bladder function problem the urologist may perform urodynamic studies of his bladder while it is filling, along with a voiding study. With these diagnostic tests, the urologist can measure bladder storage pressures. The tests also measure voiding efficiency to determine how well bladder muscles are working. Looking into the bladder with a small lighted flexible instrument, called a cystoscope, will help determine where the blockage is. If an obstruction is detected, additional treatment options, including surgery, may be available.
If an obstruction isn't detected, other treatment alternatives might be appropriate, depending on your husband's overall health and other medical conditions. For example, some people with chronically poor bladder emptying without obstruction will respond to sacral nerve stimulation (neuromodulation). Sacral nerve stimulation works by continuously sending small, electrical impulses to the nerves that control urination. The impulses are generated by a small, pacemaker-like device surgically placed under the skin. The device sends impulses to the sacral nerves via a thin, electrode-tipped wire.
Even in the absence of other treatment options, some non-emptying bladders will improve with intermittent catheterization over time, although most chronically distended bladders will not.
If your husband needs to continue self-catheterization, he should be assured that it is a very safe and clean technique that effectively empties the bladder. Intermittent catheterization doesn't make the bladder lazy. With time, self-catherization usually becomes easier to perform and evolves into a routine. In addition, he should be reassured that, even if his bladder has been permanently weakened, intermittent self-catheterization should easily replace the vital function of bladder emptying. If he continues to struggle with self-catheterization, I would encourage him to ask his urologist about strategies to make the process smoother.
â€” Deborah Lightner, M.D., Urology, Mayo Clinic, Rochester, Minn.