Atonic or neurogenic bladder: Signs, symptoms, and causes

Atonic bladder: Signs, symptoms, and causesLiterally millions of Americans suffer from atonic or neurogenic bladder. The atonic bladder signs vary from person to person, but the worst of the neurogenic bladder symptoms is the inability to control bladder function.

Atonic bladder occurs due to a nerve signaling problem that may occur after a stroke, spinal injury, or tumor. The condition causes the bladder to be in one of three states: flaccid, spastic, or a mix of the two.


Flaccid refers to the bladder not being able to contract, resulting in urinary overflow. Spastic refers to the bladder sustaining involuntary contractions, producing feelings of wanting to urinate despite not having a full bladder. Mixed refers to having a combination of both flaccid and spastic bladder.

Atonic bladder often requires the uses of catheterization, as normal bladder control is absent. Tests involving the measurement of urine flow and imaging are often done to reach a diagnosis.

Neurogenic or atonic bladder symptoms can be linked to a destruction of nerves. Essentially, it is bladder dysfunction related to neurological damage. Atonic or neurogenic bladder can be flaccid or spastic. Flaccid means the bladder volume is large, pressure is low, and contractions are absent. Spastic refers to situations where the bladder volume is normal or small, but contractions are involuntary.

While many assume that incontinence and frequency are the primary symptoms, there are some people suffering from atonic or neurogenic bladder who are faced with urine retention problems. In some cases, people experience a mixed pattern of flaccid and spastic bladder, which means their symptoms are always changing.

Atonic or neurogenic bladder causes can be complex. While medical scientists have uncovered some valuable information about neurogenic bladder causes, research continues to help gain a better understanding of the condition. Here, we look at atonic bladder causes, as well as the signs and symptoms that many people face.

Atonic bladder or Neurogenic bladder: Causes

As mentioned, atonic bladder (neurogenic bladder) has been associated with neurological destruction. Nerves in the body control how the bladder stores and empties urine. Problems with these nerves can cause a host of difficulties with the bladder, including the signs and symptoms that doctors have come to recognize as atonic or neurogenic bladder. Many people have likely heard the terms overactive bladder (OAB) or underactive bladder (UAB), or even obstructive bladder, which means the flow of urine is blocked. These conditions can also be caused by nerve problems. However, specialists are usually able to detect when a specific neurological event has led to atonic or neurogenic bladder.

For some people, atonic bladder causes can be associated with birth defects. For example, spina bifida, which occurs when the fetus’s spine does not completely develop during early pregnancy. With this disorder, there is often paralysis that impacts how the bladder works. Sacral agenesis can also be one of the atonic or neurogenic bladder causes. With this condition, part of the lower spine is missing. Another birth defect that could lead to atonic or neurogenic bladder is cerebral palsy. This disorder limits a person’s ability to control body movement. It is usually the result of injury to the motor area of the brain.

There are some other medical conditions that have also been linked to neurogenic bladder. The following list covers some of those conditions.

Signs and symptoms of atonic bladder

Neurogenic bladder signs vary depending on whether the bladder is flaccid, which is underactive, or spastic, which is overactive. Neurogenic or atonic bladder signs with a flaccid bladder involve overflow incontinence. People retain urine and have constant overflow dribbling. Many men also suffer from erectile dysfunction. Those with spastic bladder may experience frequency, including during the night. They also may have intermittent bladder contractions that lead to urine leakage and a sense of urgency. Sometimes, spasms prevent the bladder from completely emptying.

There are other neurogenic bladder symptoms, but not everyone will experience them. They include impotence, back weakness, elbow cramps or weakness, wrist weakness, retention of urine, and emotional symptoms. It is important to keep in mind that these could also be signs of some other medical problems not associated with the bladder.

Research shows that about 55 percent of those who have atonic or neurogenic bladder complain about involuntary urination and just over 50 percent report urine retention. Neurogenic bladder symptoms that are less common, such as wrist and elbow weakness occur in about two percent of cases. The atonic bladder symptoms of impotence and urinary frequency are rather high. When it comes to urinary frequency, about 55 percent of those with the condition experience having to urinate often, while about 44 percent of men struggle with impotence.

Diagnosing atonic bladder

Urologists are usually involved in the diagnosis of bladder problems. If someone is experiencing any of the atonic bladder symptoms described above and the condition is suspected, usually tests will be conducted that can help present a better picture of what is happening with the bladder. For instance, a cystography is used to evaluate bladder capacity and detect ureteral reflux, a cystoscopy can evaluate the duration and severity of urine retention and check for any bladder outlet obstruction, and a cystometrography can help determine whether bladder volume and pressure are high or low. A test to determine urine flow can also be easily conducted by urologists.

A urinalysis is part of any bladder review, but in situations where atonic or neurogenic bladder might be suspected, further investigations such as a rectal exam, ultrasound, and prostate examination may also be conducted. Doctors will always begin with a detailed discussion with the patient or their caregiver to determine if lifestyle factors could be impacting the bladder. Once the interview process is complete, appropriate tests will be ordered. It’s important to keep in mind that most of these tests do not cause a significant amount of pain or discomfort to the patient, but can tell the doctor a lot.

Treating atonic bladder or neurogenic bladder

When atonic or neurogenic bladder is the diagnosis, there are various ways to treat the condition. Each individual is different and thus responds in a different way to the recommended treatments. Sometimes it is necessary to try a few different approaches before finding one that works well. Below is a rundown of some of the common treatments for neurogenic bladder.

  • Clean Intermittent Catheterization (CIC) – a thin, flexible tube is inserted through the urethra and into the bladder to drain urine.
  • Medications – anticholinergic drugs such as oxybutynin and tolterodine.
  • Injections – Botox injected into the bladder or urinary sphincter.
  • Bladder augmentation – surgical procedure where segments of the colon are removed and attached to the walls of the bladder to reduce bladder’s internal pressure and increase its ability to store urine.
  • Ileal conduit – part of the bowel is used to make a urine stoma. The stoma drains to a bag attached to the outside of the body.


Some people are simply advised to make lifestyle adjustments to see if that makes a difference in their atonic bladder symptoms. This could mean avoiding certain foods or drinks that can irritate the bladder. Many people find that caffeine, spicy foods, and citrus fruits aggravate the bladder. There are also cases where people lose weight, so easing the stress on their bladder seems to ease their symptoms. Lastly, there is a behavioral treatment called delayed voiding. Basically, people can try training their bladder by going to the washroom at scheduled times only throughout the day.

For able-bodied individuals – those who are up and around – having bladder function issues is a big challenge. They are often embarrassed by frequent washroom visits and nervous about potential leakage. These people tend to retreat from life, avoiding their normal social circle and physical activities. Experts say this doesn’t have to be the case. With many treatment options, as well as absorbent garments, pads, panty shields, and liners on the market today, people can prevent wetness and odors so they don’t have to worry as much about uncomfortable or embarrassing moments.

Related: Natural bladder supplements: Herbal remedies for overactive bladder


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