Bladder Care Options for Neurogenic Bladder

Understanding Your Bladder Care Options

At Aurie, we know how much of an impact having neurogenic bladder can have on your daily life, independence, and long-term health.[1] Choosing the right way to manage your bladder helps protect the kidneys, reduce infections, support continence, and improve quality of life.[2][3]

There is no single solution that works for everyone. The best option depends on physical ability, anatomy, lifestyle, and personal goals.

Intermittent Catheterization: The Preferred Option When Possible

Clean intermittent catheterization (IC) is the most commonly recommended way to manage neurogenic bladder when a person is able to do it.[2][4] The American Urological Association strongly recommends IC over leaving a catheter in all the time because it leads to fewer complications.[2]

With IC, the bladder fills and empties several times a day, which is closer to how the bladder normally works. This may help keep the bladder muscle healthier and may even support recovery of bladder control in some people.[1] Studies show that people using IC are more than twice as likely to regain some voluntary bladder control compared with those using indwelling catheters.[1]

The benefits of IC include:

• Fewer urinary tract infections, bladder stones, and kidney problems compared with indwelling catheters[2][4][5]
• Less damage to the urethra, especially when hydrophilic (low-friction) catheters are used[2]
• Better quality of life, particularly for people who can catheterize themselves[2][6]

IC does have challenges. It requires enough hand strength, coordination, and memory to catheterize on a schedule—usually four to six times per day.[4] It may not work well for people with certain urethral problems (such as scarring or strictures), very high fluid intake, or symptoms like sudden blood pressure spikes caused by bladder filling.[4] UTIs can and still do occur (which is why catheter choice can be an important factor in avoiding infection), and in some cases, daily antibiotics may be considered after carefully weighing the risks and benefits.[2]

Indwelling Urethral Catheters: When Other Options Don’t Work

Indwelling urethral catheters stay in place and drain urine continuously into a leg bag or some other kind of receptacle. They may be necessary for people who cannot perform IC due to limited hand function or lack of caregiver support.[1] Some patients report fewer bladder symptoms with indwelling catheters, but this varies from person to person.[6]

Over time, however, indwelling catheters are linked to more problems. These include more frequent UTIs, bladder stones, damage to the urethra, infections of nearby tissues, and kidney damage.[3][4] Having a catheter in place constantly can irritate the bladder lining and cause long-term changes to bladder tissue.[1]

Because the bladder never fills normally, the bladder muscle can weaken over time, which may reduce the chance of regaining bladder control.[1] Overall, people using indwelling catheters tend to report lower quality of life compared with those using IC.[2]

Suprapubic Catheters: A Better Long-Term Indwelling Choice

If long-term catheter use with continuous drainage is needed, suprapubic catheters are usually preferred over urethral catheters.[2][4] These catheters enter the bladder through the lower abdomen instead of the urethra, which helps prevent permanent urethral injury and related infections.[4]

Suprapubic catheters are often recommended for people with:

• Urethral damage or narrowing
• Skin breakdown in the genital area
• Ongoing discomfort from urethral catheters[4]

One downside is a higher chance of bladder stone formation compared with IC.[2] Placement requires a minor procedure, often done with local anesthesia.[4] Studies comparing infection rates between suprapubic catheters and indwelling catheters show mixed results, but expert guidelines favor suprapubic catheters over indwelling because they cause fewer serious long-term problems overall.[2][5]

External Catheters: Helpful in Select Situations

External catheters (such as condom catheters or external suction systems) can be an option for some people who are able to urinate on their own if the bladder still has some ability to squeeze.[7] Before using one, bladder testing is needed to make sure bladder pressures are safe (since high pressure emptying of the bladder with external catheters can cause longstanding bladder and kidney damage).[7]

These devices may help:

• Manage urine leakage
• Improve comfort

However, they do not fully empty the bladder and are not appropriate for people with urinary retention or high bladder pressure. Problems can include skin irritation, leaking, leftover urine, and UTIs.[7]

Surgical Options: The Mitrofanoff Procedure

For people who cannot catheterize through the urethra, the Mitrofanoff procedure offers another option.[8] This surgery creates a small channel from the bladder to the skin of the abdomen, often near the belly button, allowing catheterization through a small opening.[8][9]

This approach can be life-changing for people with limited hand or arm movement. It allows independent catheterization and can support living more independently.[8] Studies show good bladder control, high satisfaction, and fewer bladder symptoms compared with standard IC in spinal cord injury patients.[6][8]

Possible complications include narrowing of the channel or leakage, which may require additional procedures.[8] Newer robotic techniques can reduce pain, improve appearance, and shorten recovery time.[9] Because it is major surgery, this option is usually considered only after other methods are not successful or practical – it is significantly more invasive and complex compared to the procedure to put a suprapubic catheter in place.

Key Takeaways

Bladder care for neurogenic bladder should be tailored to each person. Intermittent catheterization is widely regarded as the safest and most effective option for many people and offers the best chance for maintaining bladder health and independence – though the risk of infections is far from zero! When IC is not possible, suprapubic catheters are generally safer than urethral catheters for long-term use. External catheters have a limited role for select patients, and surgical options like the Mitrofanoff can restore independence for people who cannot catheterize through the urethra.

The right choice is the one that fits a person’s body, abilities, and daily life—and that choice may change over time.

References

1. Catheterization Method and Functional Recovery of Neurogenic Bladder in Spinal Cord Injury. Aude CA, Dishong DM, Menta A, et al. JAMA Network Open. 2025;8(7):e2522030. doi:10.1001/jamanetworkopen.2025.22030.

2. The AUA/SUFU Guideline on Adult Neurogenic Lower Urinary Tract Dysfunction: Treatment and Follow-Up. Ginsberg DA, Boone TB, Cameron AP, et al. The Journal of Urology. 2021;206(5):1106-1113. doi:10.1097/JU.0000000000002239.

3. Non-Surgical Urologic Management of Neurogenic Bladder After Spinal Cord Injury. Romo PGB, Smith CP, Cox A, et al. World Journal of Urology. 2018;36(10):1555-1568. doi:10.1007/s00345-018-2419-z.

4. Best Practices Guidelines Spine Injury. Gregory D. Schroeder MD, Alexander R. Vaccaro MD PhD MBA, William C. Welch MD FACS FAANS FICS FAANOS, et al. American College of Surgeons (2022).

5. The Impact of Catheter-Based Bladder Drainage Method on Urinary Tract Infection Risk in Spinal Cord Injury and Neurogenic Bladder: A Systematic Review. Kinnear N, Barnett D, O'Callaghan M, et al. Neurourology and Urodynamics. 2020;39(2):854-862. doi:10.1002/nau.24253.

6. Patient Reported Bladder Related Symptoms and Quality of Life After Spinal Cord Injury With Different Bladder Management Strategies. Myers JB, Lenherr SM, Stoffel JT, et al. The Journal of Urology. 2019;202(3):574-584. doi:10.1097/JU.0000000000000270.

7. A Primary Care Provider's Guide to Management of Neurogenic Lower Urinary Tract Dysfunction and Urinary Tract Infection After Spinal Cord Injury. Milligan J, Goetz LL, Kennelly MJ. Topics in Spinal Cord Injury Rehabilitation. 2020;26(2):108-115. doi:10.46292/sci2602-108.

8. Intermittent Self-Catheterization by Quadriplegic Patients via a Catheterizable Mitrofanoff Channel. Sylora JA, Gonzalez R, Vaughn M, Reinberg Y. The Journal of Urology. 1997;157(1):48-50.

9. Robotic Bladder Neck Reconstruction With Mitrofanoff Appendicovesicostomy in a Neurogenic Bladder Patient. Rodriguez MV, Wallace A, Gundeti MS. Urology. 2020;137:206-207. doi:10.1016/j.urology.2019.11.023.