CMScript 5 of 2025: Focus on Neurogenic Bladder Dysfunction

Living with a chronic health condition can be overwhelming, especially when it affects something as personal as bladder control. Neurogenic Bladder Dysfunction is one such condition that can have a significant impact on daily life, independence, and emotional well-being.

Around the world, NBD affects about 1 in 5 people with nerve-related conditions. In South Africa, exact numbers are not well known, but it is a common problem in people with spinal cord injuries and other nervous system disorders. This edition of CMScript unpacks what you need to know about Neurogenic Bladder Dysfunction, how it can be managed, and what support you are entitled to through your medical scheme.

What is Neurogenic Bladder Dysfunction?

Neurogenic bladder disorder happens when the nerves that control the bladder are damaged.  Normally, your nerves signal to the bladder when it’s time to hold urine and when it’s time to let it go. But if those nerves are damaged, the signals can get mixed up, causing the bladder to release urine unexpectedly or making it difficult to empty fully.

Common symptoms of NBD include frequent urination, a sudden urge to urinate, a weak urine stream, or a constant feeling that the bladder is not empty. Some people also get frequent bladder infections or wake up several times during the night to urinate.

How is it diagnosed?

Your doctor may recommend:

• A physical exam and medical history.
• Bladder function tests to assess how well the bladder stores and releases urine.
• Bladder scans or ultrasounds to measure how much urine remains in the bladder after urinating.
• Urine and blood tests to check for infections or kidney damage.
• Specialised investigations, like abdominal X-rays, if symptoms are complex or if complications are suspected.

How to treat or manage the condition?

Treatment depends on the type and severity of the bladder problem. It may include:

• Lifestyle changes: Regular urination, fluid and dietary management, pelvic floor exercises.
• Medication: To relax or stimulate the bladder, or catheterisation (inserting a thin tube to drain urine).
• Surgery: In severe cases.
• Mental health support: Since bladder issues can affect self-esteem and independence, mental health screening and support should be part of your care.

What is covered under PMB level of care?

Neurogenic Bladder Dysfunction is covered under Prescribed Minimum Benefits (PMBs), and your medical scheme must pay for diagnosis, treatment, and ongoing care if:

1. It is due to a non-progressive neurological condition or spinal injury: It is included in the PMB Regulation under “Difficulty in breathing, eating, swallowing, bowel, or bladder control due to non-progressive neurological (including spinal) condition or injury” or;
2. It is caused by a progressive neurological condition on the Chronic Disease List (CDL), like Multiple Sclerosis or Parkinson’s disease.

PMB regulations prescribe that the diagnosis, treatment, and care costs of PMB conditions must be funded irrespective of the member’s benefit option when a designated service provider (DSP) is used. Medical schemes must pay for in and out-of-hospital costs in full if the services were obtained from a DSP. In cases of involuntary use of a non-DSP, healthcare services must still be paid in full.

If you are experiencing any signs or symptoms, do not wait for them to get worse. Read the full CMScript to better understand Neurogenic Bladder Dysfunction and how to manage it.

Download the full CMScript here.