How Pelvic Floor Therapy Treats Neurogenic Bladder: A Pelvic Floor Therapist’s Perspective

As a pelvic floor therapist, one of the most rewarding aspects of my work is helping patients regain control over their bodies, particularly when they face conditions like neurogenic bladder. This condition, caused by nervous system dysfunction, can lead to significant bladder control issues and affect daily life. Fortunately, pelvic floor therapy offers effective, non-invasive treatments that help patients manage their symptoms and regain a sense of normalcy.

In this blog post, I’ll walk you through what neurogenic bladder is, how it impacts the pelvic floor, and how pelvic floor therapy can play a transformative role in improving bladder function.

What is Neurogenic Bladder?

Neurogenic bladder is a condition in which the nerves controlling the bladder and urinary system are damaged, leading to bladder dysfunction. In a healthy bladder, the brain sends signals through the spinal cord to the bladder, telling it when to store urine and when to release it. When these signals are disrupted due to nerve damage, bladder control issues arise.

Common causes of neurogenic bladder include:

• Spinal cord injuries
• Multiple sclerosis (MS)
• Parkinson’s disease
• Stroke
• Diabetes
• Pelvic surgeries or trauma
• Congenital conditions like spina bifida

Neurogenic bladder can manifest as either overactive bladder (OAB) or underactive bladder (UAB), both of which have distinct effects on bladder function and the pelvic floor.

Overactive Bladder (OAB) in Neurogenic Bladder

In cases of overactive bladder, the bladder muscle (detrusor) contracts too frequently or inappropriately, often causing a sudden, urgent need to urinate, even when the bladder isn’t full. This may lead to urge incontinence, where the urge to urinate is so strong and sudden that leakage occurs before reaching the bathroom.

The pelvic floor muscles often try to compensate for these sudden bladder contractions by tightening in response. This tension can lead to a chronic state of pelvic muscle tightness, which not only aggravates bladder dysfunction but may also result in pelvic pain and discomfort.

Underactive Bladder (UAB) in Neurogenic Bladder

In contrast, underactive bladder occurs when the bladder muscle cannot contract properly, leading to difficulties in fully emptying the bladder. Individuals with UAB may experience urinary retention, feeling as though they can’t completely void, which can lead to over-distension of the bladder and other complications.

With UAB, the pelvic floor muscles may weaken or become uncoordinated, further exacerbating difficulties with bladder emptying. This can also result in overflow incontinence, where the bladder overfills and leaks small amounts of urine as the pressure builds up.

The Role of Pelvic Floor Therapy in Treating Neurogenic Bladder

Pelvic floor therapy is a cornerstone in treating both overactive and underactive bladder dysfunction caused by neurogenic bladder. The aim of therapy is to restore balance, improve coordination, and regain control over bladder and pelvic floor function.

Here’s how we, as pelvic floor therapists, approach treatment:

1. Pelvic Floor Muscle Training (PFMT)

Pelvic floor muscle training is one of the most effective tools we use to improve bladder control. The pelvic floor muscles play a critical role in both holding urine and assisting with voiding, so strengthening these muscles is essential.

• For OAB, we focus on relaxation techniques in addition to traditional strengthening. Many patients with overactive bladder have overly tight pelvic floor muscles that contract in response to the bladder’s hyperactivity. We work on teaching these muscles to relax at appropriate times, which can alleviate urgency and frequency of urination.
• For UAB, we emphasize strengthening and coordination. Weak or uncoordinated pelvic floor muscles may fail to support effective bladder emptying, so targeted exercises can help restore muscle tone and improve bladder emptying.

We tailor pelvic floor exercises (like Kegels) based on each patient’s needs, helping them find the right balance of strength and relaxation in their pelvic floor.

2. Biofeedback

Biofeedback is a powerful tool in pelvic floor therapy, allowing patients to see real-time feedback on how their pelvic floor muscles are functioning. This technique helps them become more aware of their muscle contractions and relaxations, improving muscle coordination over time.

For patients with neurogenic bladder, biofeedback can help retrain the nervous system to send more appropriate signals to the bladder and pelvic floor. Whether we are working on strengthening or relaxation, biofeedback provides an invaluable guide for patients to better understand and control their bodies.

3. Electrical Stimulation

In some cases, particularly when there is significant nerve damage, we may incorporate electrical stimulation into therapy. This involves using gentle electrical impulses to stimulate the pelvic floor muscles, encouraging them to contract and relax appropriately.

This can be especially helpful for patients with underactive bladder or weak pelvic floor muscles. Over time, electrical stimulation can help retrain the muscles and improve bladder control, even when the nervous system is impaired.

4. Bladder Retraining and Timed Voiding

In addition to muscle training, bladder retraining is a key part of managing neurogenic bladder. Bladder retraining involves gradually increasing the time between urination to help the bladder hold more urine and reduce frequent urges.

We may also use timed voiding, where patients follow a set schedule for urination, which can be helpful for both overactive and underactive bladder. This structured approach helps the bladder re-establish regular, predictable voiding patterns, reducing symptoms like urgency, frequency, and retention.

5. Lifestyle and Behavioral Modifications

Pelvic floor therapy isn’t just about exercises—it’s about lifestyle and behavioral changes as well. We work with patients to identify dietary triggers (such as caffeine or acidic foods), hydration habits, and other behaviors that might be exacerbating their bladder symptoms.

For example, patients with OAB might benefit from reducing irritants in their diet, while those with UAB could focus on timed fluid intake to support healthy bladder function. Integrating these changes into daily life can significantly improve the effectiveness of pelvic floor therapy.

Multidisciplinary Care for Neurogenic Bladder

Treating neurogenic bladder often requires collaboration between different healthcare providers, including urologists, neurologists, and primary care physicians. As pelvic floor therapists, we frequently work within this multidisciplinary team to ensure our patients receive comprehensive care that addresses all aspects of their condition.

Final Thoughts

Neurogenic bladder can be a challenging and frustrating condition, but with the right approach, significant improvements are possible. Pelvic floor therapy provides a non-invasive, effective way to restore bladder control, improve pelvic floor function, and enhance quality of life. If you or someone you know is struggling with neurogenic bladder, consider seeking out specialized pelvic floor therapy. With a combination of muscle training, biofeedback, and personalized care, we can help you take back control and regain confidence in your bladder health.