Intimate Wellness Institute

Neurogenic Voiding Dysfunction

What is voiding dysfunction?

Voiding dysfunction refers to a range of issues related to the process of urination (voiding) that can lead to difficulties or abnormalities in emptying the bladder. It can manifest in various ways and can affect women of all ages. Voiding dysfunction can encompass both overactive and underactive bladder conditions, as well as problems with the coordination of the bladder muscles and the urinary sphincters (muscles that control the release of urine).

Here are some common types of voiding dysfunction:

  • Urinary Retention: This occurs when the bladder is unable to empty fully, leading to a feeling of incomplete voiding. It can be caused by various factors, including bladder muscle weakness, nerve problems, or obstructions in the urinary tract.
  • Dysfunctional Voiding: This is a condition often observed in women with pelvic floor disorders where there is improper coordination between the bladder and the pelvic floor muscles. Women with dysfunctional voiding may strain while urinating, have intermittent flow, or exhibit other abnormal voiding behaviors.
  • Neurogenic Bladder: Neurological conditions, such as spinal cord injuries, multiple sclerosis, or stroke, can disrupt the normal nerve signals that control bladder function. This can lead to problems with bladder control, emptying, and sensation.  See below.
  • Interstitial Cystitis (Painful Bladder Syndrome): This is a chronic condition characterized by bladder pain and discomfort, often accompanied by urinary urgency and frequency. It can lead to voiding dysfunction due to the associated discomfort and sensitivity. (Read more, link)
  • Voiding Postponement: Some women may intentionally postpone urination due to various reasons, including social situations or psychological factors. This can lead to negative effects on bladder function over time.  

Diagnosing voiding dysfunction often involves a comprehensive assessment of your medical history, symptoms, physical examination, and specialized tests such as urodynamic studies, bladder ultrasound, and cystoscopy. Treatment options depend on the underlying cause of the dysfunction and can include lifestyle modifications, behavioral therapies, medications, pelvic floor exercises, and in some cases, surgical interventions.

The Intimate Wellness Institute is the most expert center region at diagnosing and treating female voiding dysfunction.  If you are experiencing difficulty emptying your bladder or having related symptoms such as chronic UTIs schedule a consultation and evaluation.

What is neurogenic bladder?

Your bladder is a hollow organ located in your pelvis or lower abdomen. One of the main jobs of your bladder is to store urine (pee). The other is to remove urine from your body in response to signals from your spinal cord and brain.

Neurogenic bladder is the term for what happens when neurological (nervous system) conditions affect the way your bladder works. There are two major types of bladder control problems linked to neurogenic bladder. Depending on the nerves involved and the nature of the damage, your bladder becomes either overactive (spastic or hyper-reflexive) or under-active (flaccid or hypotonic).

How common is neurogenic bladder?

Neurogenic bladder dysfunction is very common among people with spinal cord injuries, affecting more than 90% of them. About 95% of people with spina bifida have neurogenic bladder dysfunction. The condition also affects 50% to 80% of people who have multiple sclerosis. Neurogenic bladder affects people with stroke and Parkinson’s disease and many other types of nervous system conditions. Conditions that damage nerves like advanced diabetes can also cause neurogenic bladder.


What causes neurogenic bladder?

Neurogenic bladder can be congenital (present at birth). Birth defects that can cause neurogenic bladder include:

Spina bifida (myelomeningocele): This disorder occurs when the spine doesn’t completely develop during the first month of pregnancy. Babies born with myelomeningocele often have paralysis or weakness that affects how their bladder works.

Sacral agenesis: This is a condition in which parts of the lower spine are missing.

Cerebral palsy: Cerebral palsy refers to a group of chronic (long-term) disorders that weaken a person’s ability to control body movement and posture. These disorders result from injury to the motor areas of their brain. The problem causing cerebral palsy may occur while during development or after birth. Cerebral palsy isn’t always found during a child’s first year of life.

Medical conditions that involve the nervous system can cause neurogenic bladder. Common causes include:

  • Stroke.
  • Parkinson’s disease.
  • Multiple sclerosis.
  • Central nervous system tumors.
  • Other conditions include:
  • Spinal cord injuries and spine surgeries.
  • Degenerative Back Disease
  • Trauma/accidents.

What are the symptoms of neurogenic bladder?

The most common symptom of neurogenic bladder is being unable to control urination. Other neurogenic bladder symptoms include:

  • A weak or dribbling urinary stream.
  • Frequent urination (urinating eight or more times daily).
  • Urgency (a feeling or need to urinate immediately).
  • Painful urination, which may mean there is a urinary tract infection.
  • Urinary leakage.
  • Chronic bladder infections


How is neurogenic bladder diagnosed?

If we suspect neurogenic bladder, we will do an exam and probably order several tests of the nervous system and the bladder. Tests may include:

Urodynamic studies: These bladder function tests measure how much urine your bladder can hold, the pressure within your bladder, how well urine flows, and how well your bladder empties when it is full. Special sensors may be placed on your skin near your urethra (the tube through which urine passes) or rectum to see if the muscles and nerves in those parts of your body are working properly.

Cystoscopy: Your provider may perform this procedure to examine the inside of your bladder and urethra with the use of a small telescope (cystoscope).

Other tests include:

  • Ultrasound tests.
  • X-rays.
  • Computed tomography (CT) scans.
  • Magnetic resonance imaging (MRI) scans.


Can neurogenic bladder be cured?

There is no cure for neurogenic bladder. However, symptoms of neurogenic bladder can be successfully managed.

How is neurogenic bladder treated?

The IWI team will work with you to decide on a treatment plan that is appropriate for what is causing neurogenic bladder. Some neurogenic bladder treatment options include:

Lifestyle changes: These might include avoiding certain foods or drinks that can irritate your bladder. These include alcohol, certain caffeinated drinks like coffee and soda. Good blood glucose management for people with diabetes and constipation management can also help.

Clean intermittent catheterization (CIC): Catheters are thin, flexible tubes that can be inserted through your urethra and into your bladder to drain urine. You can learn how to do this yourself so that you can empty your bladder on your schedule.

Continuous catheterization: This method calls for a catheter to be worn at all times. The catheter is a small tube that can be placed through your urethra or through the lower abdominal wall (suprapubic tube).

Drugs: Medications that treat neurogenic bladder include oxybutynin, tolterodine, mirabegron, solifenacin succinate and others.

Injections of botulinum A toxin (Botox®): Botox is placed into your bladder or urinary sphincters to relax the muscles.

Sacral nerve stimulation: If there is any residual nerve function this may be an option. Dr. Guerette surgically implants a small device (neurotransmitter) under the skin just above your buttocks (butt). The device sends mild electrical impulses to the sacral nerve through a wire under the skin. This device can help reduce urinary urgency and leakage, and can help empty the bladder more effectively. IWI has the most experience with sacral nerve stimulation in the Mid-Atlantic region.

Bladder augmentation (augmentation cystoplasty): In this surgery, a surgeon removes segments of your intestine (sigmoid colon) and attaches them to the walls of your bladder. This reduces the bladder’s internal pressure and increases its ability to store urine.

Ileal conduit: Part of the small bowel is used to make a urine stoma. This stoma drains to a bag attached to the outside of the body.

Absorbent undergarments, pads, panty shields, panty liners and adult diapers can help prevent wetness and odors while protecting skin and clothing. Bed pads can protect sheets and mattresses.

What complications are related to neurogenic bladder?

People who have neurogenic bladder are at higher risk for other urological problems, including repeated infections, kidney damage, vesicoureteral reflux and stones that form in the urinary tract.

People with bladder control conditions such as neurogenic bladder may experience quality of life issues. It’s important to recognize these issues and get help with them.

Non Neurogenic Voiding Dysfunction

Women who have non-neurogenic voiding dysfunction can’t completely empty their bladder. They may leak urine, pee often or have a strong urge to pee. Medications, bladder training and pelvic floor therapy can help.

What is the difference between non-neurogenic and neurogenic voiding dysfunction?

Neurogenic voiding dysfunction, also called neurogenic bladder, is a nervous system disorder in which brain, nerve or spinal cord problems affect bladder control.

Non-neurogenic voiding dysfunction has no neurologic (nervous system) cause and is usually related to a weak bladder muscle, a blockage in the flow of urine, pelvic floor muscle dysfunction or habits that have developed over time.

How common is non-neurogenic voiding dysfunction?

Non-neurogenic voiding dysfunction is very common. It can affect all genders but is more common in women. More than 6% of women over 40 have non-neurogenic voiding dysfunction.

What causes non-neurogenic voiding dysfunction?

Your bladder is part of the urinary system. It’s a hollow muscular organ that holds urine until you pee. People with non-neurogenic voiding dysfunction have difficulty fully emptying their bladder due to either a weak bladder muscle, pelvic floor dysfunction, a blockage in the flow of urine, or behavioral problems or habits that develop over time.

Behavioral problems or habits may lead to non-neurogenic voiding dysfunction. These factors may also play a role:

  • Constipation.
  • Infections, such as urinary tract infections (UTIs).
  • Ignoring the urge to urinate until the bladder becomes too full.
  • Overactive bladder.
  • Underactive bladder that doesn’t trigger an urge to pee.
  • Blockage in the flow of urine.
  • What are the symptoms of non-neurogenic voiding dysfunction?
  • Taking a while for urination to start, straining to pee, slow urine stream or flow that starts and stops.
  • Having to push with the stomach muscles, or push on the lower abdomen with the hands, in order to urinate.
  • Feeling like the bladder is never fully empty.
  • Constipation.
  • Frequent urination (more than six times a day) infrequent urination (fewer than three times a day) or leaking urine (urinary incontinence).
  • Nocturia (urinating more than once per night).
  • Strong, sudden need (urge) to urinate.


How is non-neurogenic voiding dysfunction diagnosed?

The IWI team will take your history and perform a physical exam. This may include a pelvic exam. You may be asked to keep a bladder diary to track daily urinating habits.

You may get one or more of these tests:

  • Blood test
  • Urinalysis: A urinalysis checks for infections, such as a UTI.
  • Cystoscopy: We will use a small flexible cystoscope, hollow tube with a lens, through the urethra (tube that carries urine out of the body). Your provider views the inside of the bladder to check for problems.
  • Ultrasound: A bladder or renal (kidney) ultrasonography test assesses the amount of urine left in the bladder after you pee. Test results can show a voiding problem.
  • Urodynamic testing: Urodynamic tests measure how much urine the bladder holds, and how well the muscles in the bladder, urethra, and pelvis work together.


What are the complications of non-neurogenic voiding dysfunction?

When you can’t empty your bladder, bacteria in the remaining urine can cause an infection, such as a UTI. You or your child may be more prone kidney stones or bladder stones. If the problem is severe, it can lead to kidney damage.

How is non-neurogenic voiding dysfunction managed or treated?

Treatments for non-neurogenic voiding dysfunction in adults vary depending on the underlying cause. Treatments include:

Bladder training: You can retrain the muscles in your bladder to help them hold urine longer or urinate more easily.

Pelvic floor therapy: An IWI specialized physical therapist can teach you to relax the muscles in your pelvic floor to urinate more easily.

Emsella Advanced Pelvic Floor Therapy: this a revolutionary treatment using electromagnetic stimulation to re-train your bladder and pelvic muscles to function correctly. Emsella is a FDA-approved revolutionary treatment for bladder issues. The BTL EMSELLA treatment uses High Intensity Focused ElectroMagnetic Energy (HIFEM) to stimulate and strengthen ALL the pelvic floor muscles, not just the subset that can be exercised with voluntary contractions (Kegel exercises).  These stronger pelvic floor muscles restore continence and the confidence to enjoy normal daily activities without fear of losing bladder control. During each 28-minute session you sit comfortably on the Emsella chair while it generates thousands of supramaximal pelvic floor muscle contractions.  Each session is equivalent to doing 11000 pelvic floor exercises but without the hard work! The procedure is non-invasive, and you remain fully clothed throughout. No drugs are required and the most you will feel is a slight tingling during the treatment. With no recovery time needed you can leave immediately after each session and resume normal daily activity. The majority of people need a course of six sessions over a period of three weeks to see optimum results, with most people seeing and feeling results after just two or three treatment sessions. Dr. Guerette and the IWI team have been pioneers in the development of Emsella. IWI had the second Emsella machine in North America and has the most experience with Emsella. Dr. Guerette has been the lead investigator on the studies to evaluate Emsella.

Medications: Several medications improve voiding problems. Alpha blockers such as tamsulosin (Flomax®) may help. Or you may try drugs for overactive bladder, such as oxybutynin (Ditropan®) and tolterodine (Detrol®) if you have bad urinary urgency or leakage.

Botulin toxin (Botox®) injections: Dr. Guerette may inject botulin toxins into the bladder to relax muscles, if you also have urge incontinence (strong urge to pee).

Percutaneous tibial nerve stimulation (PTNS): PTNS takes place in the IWI office. An electrode is placed near the tibial nerve in the ankle. A stimulator device sends mild electrical signals to the sacral nerve in the pelvis. This nerve controls urinary sphincter muscles, the bladder and pelvic floor muscles and this therapy can help regain control over your bladder

Sacral nerve stimulation: Dr. Guerette surgically implants a small device (neurotransmitter) under the skin just above your buttocks (butt). The device sends mild electrical impulses to the sacral nerve through a wire under the skin. This device can help reduce urinary urgency and leakage, and can help empty the bladder more effectively. IWI has the most experience with sacral nerve stimulation in the Mid-Atlantic region.

Self-catheterization: You may use a catheter (thin hollow tube) to drain urine from the bladder throughout the day. Your provider will show you how to perform self-catheterization.


How can I prevent non-neurogenic voiding dysfunction?

Lifestyle and dietary changes can lower your risk of voiding dysfunction. You can improve bladder function with these techniques:

Cut back on foods that irritate the bladder. These include caffeinated beverages, citrus fruits and juices, spicy foods and acidic (tomato-based) foods and drinks. Adults should minimize alcohol consumption.

Get more fiber in your diet. Constipation can lead to voiding dysfunction or make the problem worse. You can increase the amount of fiber in your diet by choosing whole-grain products, beans and fresh fruits and vegetables. You may also use a stool softener (laxative).

Maintain a healthy weight. Excess weight can squeeze the bladder, causing urine to leak. Weight control can help.

Stop smoking. Nicotine irritates the bladder muscle. Plus, smokers are more likely to have a chronic cough that puts pressure on the bladder. You can take steps to quit smoking.


What is the prognosis (outlook) for people who have non-neurogenic voiding dysfunction?

Excellent. Working with the IWI team this issue can nearly always be improved.