It’s not unusual for children to have occasional wetting accidents. But when accidents happen frequently—or your child never fully potty-trains—talk to a pediatric urologist about it.

One condition your doctor may look into is called pediatric neurogenic bladder. It’s caused by nerve damage that prevents the bladder's muscles and nerves from communicating properly with the brain.

Children with medical conditions such as a stroke, multiple sclerosis, spinal cord injury or spina bifida often have neurogenic bladders and need specialized care. The good news is, there are many ways to help.

“It’s very difficult for children to deal with neurogenic bladder issues, but there are effective treatments that can help children cope and enjoy normal lives,” says Angela Arlen, MD, a Yale Medicine pediatric urologist.

Yale Medicine’s Spina Bifida Program provides coordinated, team-based care. Here, children can see a variety of specialists (pediatric urologists, orthopedists, physical therapists and neurologists, as well as nutrition experts and social workers) all in the same location and on the same day.

Pediatric neurogenic bladder is a bladder dysfunction in children caused by damage to the body’s central nervous system.

For most children and adults, the muscles and nerves of the urinary system work together to carry messages from the brain to the bladder. But sometimes these communications break down due to a developmental malformation or physical injury to the nervous system or other impairment. When this happens, a child may experience incomplete bladder emptying or incontinence, caused by neurogenic bladder. Other potential related problems include kidney or bladder stones.

Neurogenic bladder is almost always related to another medical condition. Most commonly the problem stems from a birth defect of the spinal cord or brain such as:

• Spina bifida
• Cerebral palsy
• Encephalitis
• Multiple sclerosis
• Parkinson's disease
• Spinal cord injury
• Spinal cord tumors

Because the symptoms may vary from one extreme to the other, it can be difficult to determine if a child has a neurogenic bladder. Children with this problem may need to urinate frequently (overactive bladder) or don’t go often enough (an underactive bladder).

Here are some common symptoms of pediatric neurogenic bladder associated with overactive bladder:

• Urinating frequently in small amounts
• Problems emptying all the urine from the bladder
• Loss of bladder control
• Urgency

Here are some common symptoms of pediatric neurogenic bladder associated with underactive bladder:

• Leaking urine
• Inability to tell when the bladder is full
• Problems starting to urinate or emptying all the urine from the bladder
• Urinary retention
• Urinary tract infections

If your child is having continence issues and has a medical condition that could cause neurogenic bladder, talk to a pediatric urologist. Treatment varies depending on the child’s age, overall health, medical history, bladder symptoms and the cause of the nerve damage or neurologic condition.

Some common treatments include:

• Bladder training: A non-surgical approach helps patients learn skills and exercises (such as Kegels) to strengthen the pelvic floor muscles. Some children may be asked to keep a diary recording the time of urination and amount passed, in order to establish a more manageable pattern for urination.
• Anticholinergic therapy: Medications can help relax overactive bladder muscles.
• Sacral neuromodulation: In this relatively new approach, small electrodes and a stimulator are inserted near nerves related to bladder function. The stimulator delivers the electrical impulses that the body would normally receive if the nerves were undamaged.
• Surgery: Some children benefit from surgical reconstruction to increase bladder capacity, prevent urinary leakage, and/or create a channel for a catheter (tube used to release urine).
• Catheterization: Patients or caregivers are taught how to insert a small catheter tube in order to empty the bladder at regular intervals.

We are leading researchers in the field of pediatric incontinence, and we offer the most advanced treatment options available for neurogenic bladder.

Yale Medicine’s Spina Bifida Program allows for a coordinated, team-based approach to patient care. Children seen in this clinic are able to see a variety of specialists—all in the same location and during the same visit.

“Working together to create an individualized treatment plan can help children with neurogenic bladders achieve independence, which helps them lead happier, healthier lives—free from embarrassing wetting accidents,” says Dr. Arlen.