What is neurogenic bladder in children?

Neurogenic bladder means the bladder doesn’t work normally because of nerve damage. It causes a child to have problems with holding or releasing urine. The muscles and nerves of the urinary system work together to hold urine in the bladder and then release it at the right time. Nerves carry messages from the bladder to the brain. And they carry messages from the brain to the bladder muscles. These messages tell the bladder muscles either to tighten or release. With neurogenic bladder, the nerves don’t work normally.

What causes neurogenic bladder in a child?

In children a neurogenic bladder may be caused by a birth defect. Or it may happen later because of a different problem. The most common causes of neurogenic bladder in a child include:

• Spina bifida.  This is a defect of the spinal cord that occurs during a baby’s early growth in the uterus.

• Spinal cord injury. This is damage to the spinal cord from an accident or other injury.

• Central nervous system tumor. This is a growth on the spinal cord.

Which children are at risk for neurogenic bladder?

A child is more at risk for neurogenic bladder if they have a spinal cord problem.

What are the symptoms of neurogenic bladder in a child?

Symptoms can be a bit different for each child. They can include:

• Urine leakage.  This means urine coming out without control. This often occurs when the muscles holding urine in the bladder don’t get the right message.

• Urine retention.  This means having trouble releasing urine. This happens if the muscles holding urine in the bladder don’t get the message that it is time to let go.

A child may also have:

• Urinary tract infections (UTI) that cause pain or fever

• Swollen kidneys

• Thickened bladder wall

The symptoms of neurogenic bladder can seem like other health conditions. Take your child to their healthcare provider for a diagnosis.

How is neurogenic bladder diagnosed in a child?

The healthcare provider will ask about your child’s symptoms and health history. They will give your child a physical exam. Your child may also have tests, such as:

• Urine tests. These are done to look for infection or protein in the urine. Protein in urine can be a sign of kidney disease.

• Urodynamic study.  For this test, the bladder is filled with saline through a thin, flexible tube (catheter). The bladder volume and pressure are measured. This helps show how the bladder muscles are working.

• Ultrasound. This is a test that uses sound waves to create images of tissues in the body. A kidney and bladder ultrasound may be done to check for kidney swelling and look at the bladder.

You may also be asked to keep a record of your child’s urine habits. You’ll need to write down your child’s daily urinary schedule. Note how often they go and any problems that occur.

How is neurogenic bladder treated in a child?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how bad the condition is. Treatment may include:

• Timed voiding. This means using the toilet at scheduled times. It can help your child prevent accidents and protect the kidneys.

• A catheter. You may need to put a thin, flexible tube in your child’s urethra and up into the bladder. This is done to empty the bladder at regular times during the day. In some cases, a more long-lasting (permanent) catheter is needed. This is called an indwelling catheter.

• Medicine. Medicine can help relax the bladder muscles and prevent muscle spasm. Antibiotic medicine may be used to reduce the chance of urinary tract infections (UTIs).

• Artificial sphincter.  A small inflatable cuff is put around the neck of the bladder. It can be inflated to prevent urine leakage. And it can be deflated to empty the bladder. The child may still need a catheter from time to time to fully empty the bladder.

In some cases, your child may need surgery. Your child’s healthcare provider will discuss surgery choices with you if needed. Surgery may be done to:

• Create a new opening in the belly where a short-term (temporary) catheter can be placed to empty the bladder

• Make the bladder larger

• Tighten the sphincter so it can hold in urine better

Talk with your child’s healthcare providers about the risks, benefits, and possible side effects of all treatments.

What are possible complications of neurogenic bladder in a child?

Neurogenic bladder may cause:

• Damage to the kidneys.  This can happen if the bladder becomes too full and urine backs up into the kidneys.

• Infection of the bladder or ureters.  This can be caused by urine that is held too long before being released.

How can I help my child live with neurogenic bladder?

Living with a neurogenic bladder can be hard. Urine leakage can cause embarrassment. It can lead to self-esteem issues for your child. It’s vital for your child’s treatment and emotional development that you are supportive and patient. It takes work and time to learn how to best manage your child’s condition. Encourage your child’s success by seeing to it that they follow the treatment plan. In some cases, a psychotherapist can help the child and family follow the treatment plan.

When should I call my child’s healthcare provider?

Call the healthcare provider if your child has:

• Symptoms that don’t get better, or get worse

• New symptoms

Key points about neurogenic bladder in children

• Neurogenic bladder means the bladder doesn’t work normally because of nerve damage. It causes a child to have problems with holding or releasing urine.

• The most common causes of this condition in a child are problems with the spinal cord.

• It can be diagnosed with urine tests, a urodynamic study, or an ultrasound.

• Treatment may include using the toilet at scheduled times, using a catheter, medicine, or surgery.

• Over time, it may harm the kidneys or cause infections.

• Living with this condition can be hard. Urine leakage can cause embarrassment and self-esteem issues for your child. You must be supportive and patient.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.

• Before your visit, write down questions you want answered.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.

• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.

• Ask if your child’s condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if your child does not take the medicine or have the test or procedure.

• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your child’s healthcare provider after office hours, and on weekends and holidays. This is important if your child becomes ill and you have questions or need advice.