What Causes Neurogenic Bladder
Neurogenic bladder is caused by damage to or disease of the nervous system—specifically the brain, spinal cord, or peripheral nerves—that disrupts normal bladder control mechanisms. 1, 2
Underlying Neurological Disorders
The fundamental requirement for neurogenic bladder is an underlying neurological disorder affecting the neural pathways that control bladder function 2. The most common causative conditions include:
Central Nervous System Disorders
- Spinal cord injury is a major cause, with nearly all patients historically developing some degree of bladder dysfunction 1, 3
- Stroke (cerebrovascular accidents) disrupts cortical control of micturition 2, 4
- Multiple sclerosis causes demyelination affecting bladder control pathways 2, 4
- Parkinson's disease impairs basal ganglia regulation of voiding 2, 4
- Spinal cord tumors compress or infiltrate neural pathways 4
Congenital Conditions
- Spina bifida (myelomeningocele) causes developmental abnormalities of spinal cord innervation, with approximately 26% of these patients developing renal failure 1
Peripheral Nerve Disorders
- Diabetes mellitus causes peripheral neuropathy affecting bladder innervation 1
- Radical pelvic surgery can damage pelvic nerves, leading to neurogenic bladder with overflow incontinence 1, 2
Other Systemic Conditions
- Chronic alcohol use may cause neuropathy affecting bladder function 1
- AIDS can result in neurological complications affecting voiding 1
Anatomical Basis of Dysfunction
The neurogenic bladder results from disruption of critical neural control centers 5:
- Pontine micturition center (located in the mediodorsal pons) coordinates bladder contraction and sphincter relaxation 5
- Onuf's nucleus (sacral micturition center at S2-S4) provides direct motor control 5
- Damage between these centers or to motor neurons connecting them produces various patterns of dysfunction 5
Common Pitfall
The location and extent of neurological damage determines whether the bladder becomes overactive (spastic, with detrusor overactivity) or underactive (atonic, with impaired contractility) 4, 5. This distinction is critical because treatment differs fundamentally between these two patterns—prescribing anticholinergics for an underactive bladder would worsen retention 6.
Progressive Nature
Many neurological disorders causing neurogenic bladder are inherently progressive 6. This means:
- Initial evaluation may not predict long-term dysfunction 1
- Risk stratification must be repeated when patients experience new or worsening symptoms 1
- Regular monitoring is essential even in asymptomatic patients with relevant neurological conditions 1
The key clinical implication is that neurogenic bladder is not simply a bladder problem—it is a manifestation of nervous system pathology that requires ongoing neurological and urological assessment 1, 2.