A Holistic Approach to Managing Neurogenic Bladder

A holistic, multidisciplinary approach to treatment can improve patient outcomes related to physical and psychosocial health.

Goals of Neurogenic Bladder Management

Three essential goals of managing and treating neurogenic bladder are to:

• Decrease the risk of urinary tract infections (UTIs)
• Prevent kidney failure
• Address the quality of life goals of the patient individually (e.g., continence, independence, mobility, social interactions)

An effective care plan must also factor in the patient’s quality of life.

“What ends up happening, six months or a year down the road, is once a patient is past that initial neurological diagnosis or trauma, they want to get back to living their life. Bladder and bowel function is a major factor to these patients,” says Daniel Stein, MD, MHS, assistant professor of genitourinary reconstruction and director of the department of urology trauma residency program at The George Washington University School of Medicine and Health Sciences. “Several studies involving patients with neurogenic bladder, usually due to spinal cord injury or neurologic conditions, show that if you look at their quality of life, bladder and bowel issues come far and above many other quality of life issues.”

Effective Pharmacological Treatments

The past decades have brought significant advancements in the medical management of neurogenic bladder.

“Most physicians will know about some of the anticholinergic medications,” Dr. Stein says. “But they may not know about newer beta-3 adrenoreceptor agonists and Botox® as treatment options.”

Beta-3 adrenoreceptor agonists relax the detrusor by activating a sympathetic nerve-calming mechanism in the bladder. Their effectiveness is similar to anticholinergics but with fewer side effects. They can also be used in combination with anticholinergics.

Onabotulinumtoxin A (Botox) can be injected into the detrusor muscles to decrease contractions and is an effective treatment option for many patients. Botox injections usually need to be repeated every three to six months.

Intermittent Catheterization

While medication is useful in addressing bladder storage, it’s also essential to address emptying the bladder.

“The traditional way to empty the bladder is through an indwelling catheter, which can be uncomfortable and increase the risk of infection,” Dr. Stein says. “So intermittent catheterization has become a mainstay of neurogenic bladder management.”

Multiple types of intermittent catheters are available to meet patients’ diverse needs. Most people, including those with limited use of their hands or who cannot independently transfer from their wheelchair to a commode, can learn to self-catheterize.

The ability to self-manage this aspect of care significantly increases a person’s independence and mobility and expands options for community mobility and socialization. Intermittent self-catheterization can also open the door to addressing other personal and quality of life concerns, such as sexual health.

Taking a Patient-Centered Multidisciplinary Approach

“Physicians in other specialty areas may not ask patients about bowel and bladder function because they are focusing on different aspects,” Dr. Stein says. “Remembering to ask those questions is the first step to getting patients the right care for the problem.”

Decreased kidney functioning, urine leakage and more than one UTI per year are all signs that a patient with neurogenic bladder should make an appointment with their urologist. When the entire care team asks about bladder and bowel functioning, patients often become more open about these issues, and their concerns may be detected early before serious problems arise.

“A lot of times, it’s just about spending time talking to a patient about these things,” Dr. Stein says. “Once we’re working together, patients realize that there are a lot of ways to handle bladder issues that will help them reach their goals and improve their quality of life.”