Understanding Neurogenic Bladder
Understanding Neurogenic Bladder
Bladder dysfunction, bowel dysfunction and sexual dysfunction are highly prevalent, but often under-addressed, issues for people living with neurological conditions. As allied health professionals working in neuro rehab, early screening and timely referral can significantly influence continence, comfort, dignity, and quality of life.
This blog provides an overview of key considerations when supporting clients with neurogenic bladder, bowel dysfunction, and sexual dysfunction, along with practical clinical insights from our therapy team.
Neurological injuries (e.g., SCI, MS, stroke, spina bifida) can disrupt the neural pathways regulating bladder and bowel control. This may result in:
- Incontinence (urinary or faecal)
- Urgency and frequency
- Overactive or underactive bladder presentations
- Constipation or loose bowels
- Recurrent urinary tract infections (UTIs)
- Reduced pelvic floor function
- Sexual dysfunction and challenges with intimacy
These symptoms affect participation in therapy, self-esteem, daily routines, and relationships. Early recognition of symptoms helps therapists guide clients towards the right supports.
Anatomy/Physiology
Anatomy involved in urination involves:
- Kidneys – filter blood and remove waste
- Ureters – Transport urine from kidneys to bladder
- Bladder – stores urine until ready to release
- Urethra – tube that urine passes through to exit body
Urination is supported by muscles like the detrusor muscle, which sits in the wall of the bladder and sphincters that regulate urine storage and release.
Recognising Overactive vs Underactive Bladder Dysfunction
Overactive bladder may present as:
Sudden urinary urgency
Leakage during activity, transfers, or coughing
Frequent voiding
UTIs secondary to incomplete emptying
Underactive bladder may present as:
- Difficulty initiating voiding
- Overflow incontinence or passive leakage
- Increased reliance on catheterisation
- Limited sensation of bladder filling
During the training session, case examples were discussed of clients experiencing leakage during exercises, particularly around core work. Some of the key considerations discussed included:
- Activities such as coughing, leaning forward, sit to stand and picking up heavy items can increase intra-abdominal pressure and risk leakage
- Long-term catheter use can contribute to pelvic floor muscle atrophy
- Sensory deficits reduce awareness of leakage
- Separating core activation from mechanical pressure (e.g. working in supine) may reduce in-session leakage
- Ensuring catheterisation or going to bathroom immediately prior to therapy may help manage symptoms
Understanding these mechanisms helps differentiate between overactive vs underactive bladder presentations and informs treatment planning.
Bowel Dysfunction in Neuro Clients
Loose bowels, constipation, faecal urgency, and faecal incontinence are common in neurogenic bowel. These symptoms often coexist with bladder dysfunction and significantly impact therapy engagement and community participation.
Encouraging clients to maintain bowel regimes, optimise seating posture, and engage in regular pelvic floor activation can improve function. For complex presentations, referral pathways are essential.
Practical Clinical Tips
- Use external targets: Encourage reaching for objects to enhance proprioceptive feedback.
- Vary visual input: Incorporate eyes-closed tasks or shifting gaze away from the floor.
- Mirror feedback: Support amplitude and movement precision during exercises.
- Change body position: Incorporate multi-directional stepping and reaching.
- Vary surfaces: Use foam pads, Bosu balls or inclines to increase proprioceptive demand.
- Add dual tasks: Cognitive or manual challenges to increase complexity.
Sexual Dysfunction and Intimacy in Neurological Conditions
Sexuality can be a crucial part of wellbeing and often disrupted following neurological injury. Clients may experience:
- Reduced sensation
- Erectile or lubrication difficulties
- Pain
- Anxiety around dating or intimacy
- Communication challenges
- Difficulty navigating sex with mobility or continence considerations
The Royal Rehab Sexuality Service is an excellent multidisciplinary resource (psychosexual therapists, speech pathologists, OTs, physios, nurses) supporting individuals aged 16+ with illness, injury, or disability. Services include help with communication, intimacy, equipment, and adaptive strategies.
Referral Pathways and External Supports
ARC therapists regularly collaborate with specialist continence services, including:
Edwina at Coloplast – Clinical Nurse Consultant, Continence Care
- Provides free consultations for clients
- Supports assessment, guidance, and tailored continence strategies
- Has a clinic at ARC and can see clients in the community
- Useful referral for urgency, incontinence, faecal incontinence, and catheter-related concerns
Spinal Cord Injury Australia (SCIA)
- Free continence support
- Fact sheets and resources
- Information sessions on bowel/bladder management (e.g. travelling with a strict regime)
Therapists should maintain awareness of local and national continence services to ensure optimal interprofessional care.
Practical Clinical Tips for Therapists
- Screen early for bladder, bowel, and sexual concerns—even if the client does not raise them spontaneously
- Observe leakage patterns during therapy to identify triggers (e.g. pressure, exertion, position)
- Modify exercises to reduce mechanical pressure (e.g. train core in supine)
- Encourage pre-session catheterisation where relevant
- Employ pelvic floor-focussed interventions when appropriate
- Collaborate with continence nurses or sexual health services for complex presentations
Reflection Questions for Clinicians
- How confident am I in differentiating between overactive vs underactive bladder presentations in my neuro clients?
- What screening questions could I routinely incorporate into my assessment regarding bladder, bowel, and sexual function?
- Am I aware of local referral pathways and do I use them proactively when red flags arise?
Responses