What is neurogenic urinary retention?

We spoke to urologist, Dr Amanda Chung, about neurogenic bladder, a broad term for problems storing urine or emptying the bladder caused by disrupted nerve signals between the bladder, spinal cord and brain.

One form of neurogenic bladder is neurogenic urinary retention which means the bladder does not empty properly and people struggle to do a wee.

When you urinate (do a wee), the bladder muscle squeezes (contracts) while the bladder neck, pelvic floor and urinary sphincter relax, allowing urine to flow through the urethra (tube that wee comes out of). With neurogenic urinary retention, these nerve messages are disrupted.

“It’s essentially one of two things stopping the bladder emptying,” Dr Chung explains. “Either the nerve signals that sense the bladder being full and tell the bladder muscle to contract are disrupted, or the bladder outlet controlled by the bladder neck, pelvic floor muscles and urinary sphincter does not relax properly. It can also be a discoordination between the two functions.”

“Bladder sensation can also change significantly. Some patients don’t get that bursting sensation you’d normally expect with retention,” explained Dr Chung. “They may just feel bloated, uncomfortable, or sometimes nothing at all.”

What is a neurological condition?

A medical problem that affects your brain, spinal cord or nerves that connect to the rest of your body (your nervous system). Think of it as a problem with the electric circuit that controls messages going backwards and forwards between your body and your brain.

What are the symptoms of neurogenic urinary retention?

Symptoms can range from mild to severe and are often unpredictable. Some people may be completely unable to pass urine and go into full urinary retention, while others can partially empty their bladder but still retain significant amounts of urine.

For some, urination may become very slow or difficult to start. This is called urinary hesitancy. Others experience a stop-start or ‘staccato’ flow and may need to double or triple void in order to empty properly.

Neurogenic urinary retention can occur at any age and is linked to neurological conditions including multiple sclerosis (MS), stroke, spinal cord injury and spina bifida. In some cases, urinary retention may even be the first sign of an undiagnosed health condition.

How is neurogenic urinary retention diagnosed?

The process of diagnosis typically begins by checking for reversible causes, such as a urinary tract infection (UTI), using a midstream urine sample. Once infections are ruled out, anatomical scans can be used to see if there is a physical obstruction, says Dr Chung.

“These tests could include an ultrasound or CT scan of the urinary tract, or a cystoscopy, which involves using a small camera to look inside the urethra and bladder for physical narrowing,” she says.

A key test is a urodynamic study, which assesses how the bladder functions during filling and emptying. Small sensors measure bladder pressure, activity and sensation to help identify where the problem comes from. If a neurological cause is suspected, patients may also undergo MRI scans and neurological assessment.

How can neurogenic urinary retention be treated?

Treatment depends on the cause and severity of symptoms. Some patients benefit from pelvic floor physiotherapy or medications to help relax the bladder outlet. For others, sacral neuromodulation (SNM), also known as sacral nerve stimulation (SNS), can be life-changing.

“It’s essentially like a pacemaker for the bladder,” Dr Chung says. The treatment uses a small, implanted device to regulate the activity in nerves that control the bladder. One major advantage is that patients can trial the treatment before committing to a permanent implant. For many patients, SNS can significantly reduce, or even eliminate, the need for catheterisation, which is another treatment method.

Also in this edition

• Carer of the Year
• Mad about materials
• Finding a group to support you
• A day in the life of someone with neurogenic urinary retention
• Looking after your bowels in hospital
• Disabilities: talking to your GP about incontinence
• Is health advice from TikTok or ChatGPT better?
• Alcohol and incontinence – what’s the connection?