Neurogenic bladder treatment in Salt Lake City
Neurogenic bladder means that a neurologic condition or nerve injury affects how the bladder stores or releases urine. It follows multiple sclerosis, spinal cord injury, Parkinson's disease, stroke, long-standing diabetes, and spina bifida, and it affects women and men alike. Elisabeth Ferlic, MD, is a board-certified urologist whose fellowship included neuro-urology, the study of how the nerves and the bladder work together. Her practice in the Salt Lake Valley manages them.
Elisabeth Ferlic, MD
Board-certified urologist · Fellowship-trained in voiding dysfunction and female pelvic medicine
In this guide
- Neurogenic bladder symptoms
- What is neurogenic bladder?
- Why see Dr. Ferlic for neurogenic bladder
- What are my options?
- Neurogenic bladder treatment options
- What causes neurogenic bladder
- Urinary retention: when the bladder doesn't empty
- How neurogenic bladder is diagnosed
- What to expect from long-term care
- Managing neurogenic bladder day to day
- Benefits and risks, side by side
- What happens at the first visit?
- Frequently asked questions
Neurogenic bladder symptoms
Symptoms depend on which nerves are affected, so two people with the same diagnosis can have opposite problems.
When the bladder is overactive
- Sudden, strong urges to urinate
- Urinating eight or more times a day
- Leaking before you reach a bathroom
When the bladder is underactive
- Trouble starting, a weak stream, or dribbling
- A feeling that the bladder is never empty
- Leaking without any urge, because the bladder is overfull
- Not being able to tell when your bladder is full
Repeated urinary tract infections are common with both types, and an infection is often the first sign that something is wrong.
When to seek emergency care
Go to an emergency room right away if you can't urinate at all, especially with pain or swelling in your lower belly. Sudden urinary retention is an emergency, and draining the bladder protects it and your kidneys. Get same-day care for a fever with back pain or for blood in your urine.
What is neurogenic bladder?
Your bladder does two jobs. It stores urine, and it empties when you decide the time is right. Both depend on messages that travel between the bladder, the spinal cord, and the brain. When an illness or injury interrupts those messages, the bladder stops following instructions. That condition is called neurogenic bladder.
The problem usually takes one of two forms, and some people have both:
- An overactive bladder. The bladder muscle squeezes without warning, so you feel sudden urges, go often, and sometimes leak.
- An underactive bladder. The bladder muscle doesn't squeeze well enough, or the muscle that holds urine in doesn't relax, so the bladder doesn't empty. Doctors call that urinary retention.
It needs attention even when the symptoms seem manageable. Pressure inside a bladder that doesn't store or empty well can, over years, damage the kidneys. Protecting the kidneys is the first goal of treatment. Staying dry and comfortable is the second.
Why see Dr. Ferlic for neurogenic bladder
Many people with neurogenic bladder are referred back and forth between neurology and urology without anyone taking responsibility for the bladder.
Dr. Ferlic is a board-certified urologist and fellowship-trained in voiding dysfunction and female pelvic medicine. That fellowship included neuro-urology. Her practice includes evaluation and long-term management of neurogenic bladder in women and men.
She also welcomes young adults with spina bifida and other congenital conditions who have aged out of pediatric urology.
Because she sets her own schedule, a visit lasts as long as the problem requires. Learn more about Dr. Ferlic, or see the practice's care for men and women. Referring clinicians can start on the for physicians page.
What are my options?
A starting point for the conversation, not a prescription. Your evaluation decides what fits.
Sudden urges, frequent trips, and leaking
The bladder muscle squeezes without warning
Bladder habits and medication
Timed voiding, less caffeine, and medicine to relax the bladder
A bladder that doesn't empty
A weak stream, or a bladder that never feels empty
Clean intermittent catheterization
You empty the bladder with a thin tube, with no bag to wear
Leaking from a bladder that holds too little
And you use a catheter or are willing to learn
Bladder Botox
Relaxes the bladder muscle; the effect typically lasts six months or longer
High pressure that nothing else controls
A small number of people reach this point
Reconstructive surgery
Enlarging the bladder or rerouting urine, after specialist assessment
Neurogenic bladder treatment options
Neurogenic bladder usually can't be cured, because the nerve condition remains. It can be managed, and most people don't need surgery. Neurogenic bladder treatment is stepped: the least invasive option that protects your kidneys and fits your life comes first.
Bladder habits and timed voiding
Urinating on a schedule, before the bladder is overfull, prevents many leaks. Double voiding (waiting a minute after you finish, then trying again) helps a slow bladder empty more fully. Cutting back on caffeine and alcohol calms urgency for some people, and so does treating constipation.
Pelvic floor therapy
A pelvic floor physical therapist can teach you to strengthen the muscles that hold urine in, or to relax muscles too tight to let it out.
Medication
Some medications relax an overactive bladder muscle, and others relax the bladder outlet so urine flows more freely. Treatment for a bladder that cannot empty often needs a drainage plan in addition to medication. Side effects are common, and Dr. Ferlic stops a prescription that isn't helping.
Clean intermittent catheterization
If your bladder doesn't empty on its own, you can empty it yourself several times a day with a thin, flexible tube. It sounds daunting, but it's a skill you can learn. It lets you drain your bladder on your own schedule, with no bag to wear. When hand function or mobility makes that impractical, the alternative is a catheter that stays in place, through the urethra or through a small opening in the lower belly.
Bladder Botox
Botox injected into the bladder muscle through a small scope relaxes it, which lowers pressure, increases how much the bladder holds, and reduces leaking. The effect typically lasts six months or longer, and the treatment can be repeated. Botox can keep the bladder from emptying fully for a time, so it suits people who already use a catheter or are willing to learn. Read more about bladder Botox.
Nerve stimulation
Nerve stimulation is an option for selected patients, and suitability depends on the neurologic diagnosis and bladder findings. Sacral neuromodulation uses an implant; PTNS uses sessions at the ankle. Neither approach fits every neurologic condition or form of retention. Read more about sacral and tibial nerve stimulation.
Surgery
A small number of people need reconstructive surgery, such as enlarging the bladder with a segment of intestine or rerouting urine. These operations are reserved for bladders with dangerously high pressures that nothing else has controlled. These operations need specialist assessment. Ask whether the care belongs within this practice or needs referral to a reconstructive team.
Contact the practice to ask which visit types are available and when in-person appointments and procedures can be scheduled. Reach out.
| Medication | Clean intermittent catheterization | Bladder Botox | |
|---|---|---|---|
| What it does | Relaxes an overactive bladder muscle, or relaxes the bladder outlet so urine flows more freely | Empties the bladder several times a day through a thin, flexible tube | Relaxes the bladder muscle, lowers pressure, helps the bladder hold more, and reduces leaking |
| How it's done | A prescription; Dr. Ferlic stops one that isn't helping | You do it yourself, on your own schedule; it's a skill you can learn | Injected into the bladder muscle through a small scope, and can be repeated |
| Things to know | Side effects are common | When hand function or mobility makes it impractical, a catheter can stay in place | Can keep the bladder from emptying fully for a time |
| Often paired with | A drainage plan, when the bladder cannot empty | Scheduled emptying through the day | A catheter, which you already use or are willing to learn |
Medication
- What it does
- Relaxes an overactive bladder muscle, or relaxes the bladder outlet so urine flows more freely
- How it's done
- A prescription; Dr. Ferlic stops one that isn't helping
- Things to know
- Side effects are common
- Often paired with
- A drainage plan, when the bladder cannot empty
Clean intermittent catheterization
- What it does
- Empties the bladder several times a day through a thin, flexible tube
- How it's done
- You do it yourself, on your own schedule; it's a skill you can learn
- Things to know
- When hand function or mobility makes it impractical, a catheter can stay in place
- Often paired with
- Scheduled emptying through the day
Bladder Botox
- What it does
- Relaxes the bladder muscle, lowers pressure, helps the bladder hold more, and reduces leaking
- How it's done
- Injected into the bladder muscle through a small scope, and can be repeated
- Things to know
- Can keep the bladder from emptying fully for a time
- Often paired with
- A catheter, which you already use or are willing to learn
What causes neurogenic bladder
Any condition that affects the brain, the spinal cord, or the nerves to the pelvis can change how the bladder works. The most common causes are:
- Multiple sclerosis (MS)
- Spinal cord injury
- Parkinson's disease and stroke, which tend to cause urgency, frequency, and leaking
- Long-standing diabetes, which can dull the sense of fullness and weaken emptying
- Spina bifida, cerebral palsy, and other conditions present from birth
- A herniated disk, a brain or spinal tumor, or nerve injury from major pelvic surgery
Sometimes bladder symptoms appear before the neurological condition has a name. If testing points to the nerves and you don't have a diagnosis, Dr. Ferlic works with your primary care doctor or a neurologist to find out why.
Urinary retention: when the bladder doesn't empty
Urinary retention means urine stays in the bladder after you try to empty it. It can come on suddenly, which is the emergency described above. More often it builds slowly, and many people don't know they have it. The clues are a slow stream, frequent small trips to the bathroom, a need to go again minutes after finishing, and leaking with no warning.
Nerve problems are one cause; a blockage is the other. In men, that's most often an enlarged prostate. In women it can be pelvic organ prolapse or a very tight pelvic floor. Some medications also slow the bladder, including certain antihistamines, decongestants, and antidepressants.
Urinary retention treatment depends on the cause, so it starts with testing. A blocked bladder needs the blockage addressed. A bladder too weak to squeeze needs a reliable way to empty.
How neurogenic bladder is diagnosed
The first visit is mostly conversation. Dr. Ferlic reviews your neurological history, your medications, how you empty your bladder, and what you've already tried. If you can, bring a bladder diary: a few days of what you drank, when you urinated, and when you leaked.
Testing then answers specific questions:
- Urine test. Checks for infection and blood.
- Bladder scan. A quick ultrasound that measures how much urine is left after you go.
- Cystoscopy. A look inside the bladder with a small camera, used when Dr. Ferlic suspects stones or a blockage.
- Kidney imaging. An ultrasound or CT scan checks that the kidneys are draining well.
You might not need every test. The plan depends on your symptoms and on what earlier records show.
What to expect from long-term care
Neurogenic bladder is managed over years, and the plan changes as your condition does. A bladder that behaves one way early in MS or Parkinson's disease can behave differently later.
That's why follow-up continues even when you feel fine. Visits typically include a review of your symptoms and infections, a check of how well the bladder empties, and periodic kidney imaging. Kidney damage from high bladder pressure can go unnoticed for a long time, and regular monitoring is how it gets caught early.
Dr. Ferlic shares findings with your neurologist, rehabilitation physician, or primary care doctor.
Managing neurogenic bladder day to day
Daily care follows your individual bladder plan. These habits can support that plan:
- Empty your bladder on schedule, whether by voiding or by catheter.
- Spread your fluids through the day, and ease off in the evening if nights are the problem.
- Notice which foods and drinks bother your bladder, and cut back on them.
- Keep your bowels regular.
- If you have diabetes, keep your blood sugar in range.
- Don't smoke. Smoking irritates the bladder and raises the risk of bladder cancer.
Contact your clinician about changes such as more leaking, fever, pain, difficulty passing a catheter, or bleeding. Cloudy or strong-smelling urine alone does not prove an infection.
Benefits and risks, side by side
Every treatment has trade-offs. Your history and your goals decide which ones matter most.
What treatment can address
- Protecting the kidneys from high bladder pressure
- Staying dry and comfortable
- Urgency, frequent trips, and leaking
- A bladder that doesn't empty on its own
What to weigh first
- It usually can't be cured, because the nerve condition remains
- Your neurologic diagnosis and bladder test findings
- Hand function, mobility, and whether you can use a catheter
- Follow-up continues even when you feel fine
What happens at the first visit?
The visit starts with what has changed and what you want help with. Any treatment and follow-up plan is specific to you.
Talk through your symptoms
Bring your concerns, medication list, and relevant medical history.
Decide what needs checking
Testing depends on your symptoms and history, and some concerns need a separate workup.
Discuss a plan and follow-up
Review benefits, risks, alternatives, and what to watch for.
Before you schedule
Ask which appointments are available and whether your concern suits a video visit or needs an in-person evaluation.
Here’s what our great patients say
Can neurogenic bladder be cured?
Usually not, because the nerve condition that causes it remains. It can be managed well. Most people control their symptoms and protect their kidneys with bladder habits, medication, catheterization, Botox, or nerve stimulation, and most never need surgery.
What kind of doctor treats neurogenic bladder?
A urologist treats it, ideally one with training in neuro-urology, the part of urology that deals with how the nerves control the bladder. Dr. Ferlic's fellowship in voiding dysfunction and female pelvic medicine included that training. She works alongside your neurologist or rehabilitation physician, who continues to manage the underlying condition.
Is neurogenic bladder dangerous?
It can be if it goes unmonitored. High pressure in the bladder and urine that doesn't drain can lead to repeated infections, bladder and kidney stones, and gradual kidney damage that causes no symptoms at first. Regular follow-up and testing exist to catch those problems early.
What is the difference between neurogenic bladder and overactive bladder?
The symptoms can look the same: urgency, frequency, and leaking. Overactive bladder describes those symptoms when no nerve disease is behind them. Neurogenic bladder means a neurological condition is the cause, which changes the testing, the treatment choices, and the need to monitor the kidneys. Read more about overactive bladder.
Will I need to use a catheter?
Only if your bladder doesn't empty well enough on its own. Many people with an overactive neurogenic bladder never need one. If you do, intermittent catheterization a few times a day lets you empty on your own schedule, and it doesn't require wearing a bag.
Do I need a referral, and can I be seen before the clinic opens?
Contact the practice to ask which visit types are available and when in-person appointments and procedures can be scheduled.
Talk with a urologist who treats neurogenic bladder
If you or someone you care for has a bladder problem tied to MS, a spinal cord injury, Parkinson's disease, stroke, diabetes, or spina bifida, this practice manages it. Call 435-344-4760 or request an appointment, and ask about the next step. Core Urology and Pelvic Health serves women and men across the Salt Lake Valley.
This page is for general education and is not medical advice.