Written by Stewart G. Eidelson, MD
Spinal disorders or injuries that cause nerve compression or damage may cause Neurogenic Bladder Disorder (NBD); also termed Bladder Dysfunction. NBD means the patient has problems with urination. The term neurogenic refers to the nerve tissues that supply and stimulate an organ or muscle to function properly. In the case of NBD, nerves that control the bladder and muscles involved in urination cause the bladder to be overactive or underactive.
NBD symptoms may include:
- Limited or no voluntary control
- Involuntary urination
- Feel sudden urge(s) to urinate
- Frequent bathroom visits
- Bladder does not completely empty
- Bladder overfills and pressure causes accidental leakage of urine
- Bladder is unable to hold urine
Bladder Nerves in the Sacral Spine
The brain and spinal cord are the central chains of command that transmit signals and messages to and from the bladder. Below the first lumbar vertebrae in the low back, the spinal cord divides into a bundle of nerves called the cauda equina (Latin term meaning tail of a horse). Below the end of the lumbar spine is the sacrum—this region is called the sacral spine. The sacrum is the backside of the pelvis (between the hip bones).
The nerves in the sacral spine branch outward beyond the spine and become part of the peripheral nervous system. These nerves supply and stimulate bladder sensation and function. When the specific nerve(s) that enables bladder sensation and function become compressed, irritated/inflamed, injured, or damaged—organ dysfunction results. Any of the neurogenic bladder disorder symptoms listed above may develop and persist.
Spine Disorders with Potential to Cause NBD
- Spinal Cord Injury (SCI) is a common cause of neurogenic bladder dysfunction. The spinal cord need not be severed to cause paralysis below the injured level of the spine (eg, neck). Bruising of the spinal cord or inadequate blood flow can damage the cord’s ability to transmit nerve signals.
- Cauda Equina Syndrome (CES) occurs when the spinal nerve roots in the lower back are compressed. Although cauda equina syndrome is a rare occurrence, it is a serious medical situation requiring urgent care.
Causes of CES include:
- Disc herniation in the low back
- Lumbar tumor
- Spinal fracture
- Spinal stenosis affecting the spinal canal (central canal stenosis)
- Violent accidents: stabbing, gun shot, fall, car collision
- Congenital (born with)
Treatment of Neurogenic Bladder Disorder
The treatment depends on the cause of NBD. The primary physician may involve a bladder specialist—such as a urologist, nephrologist, or urogynecologist to coordinate patient care throughout treatment. When bladder dysfunction is caused by a spinal nerve root compression, spine surgery is performed to decompress (take pressure off) the nerves (eg, discectomy). In some cases, NBD may persist after a surgical procedure, such as in a case of permanent nerve damage.