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Neurourology + neurogenic bowel · UK

Neurogenic bladder and bowel management, by a specialist MDT.

Comprehensive, lifelong management for bladder and bowel dysfunction caused by spinal cord injury, spina bifida, MS, stroke, Parkinson’s and autonomic neuropathy - urodynamics, medication, botox, catheterisation, irrigation and surgery, decided by a proper team.

See indicative pricing
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What specialist neurourology and bowel care costs in the UK.

NHS specialist spinal and neurourology centres fund most of this for eligible patients.

In short

£250–£500, urodynamics and imaging usually within 1–2 weeks.

Assessment or procedure Indicative range
Neurourology consultation £250–£500
Video urodynamics + upper tract US £900–£1,600
Intravesical botulinum toxin (200U) for NDO £1,000–£2,200
Suprapubic catheter insertion £1,200–£2,500
Transanal irrigation set-up (Peristeen / Navina) NHS-prescribed
Malone antegrade continence enema (MACE) £8,000–£14,000
Mitrofanoff catheterisable channel £14,000–£22,000
Ileocystoplasty (bladder augmentation) £15,000–£25,000
Artificial urinary sphincter (AUS) £14,000–£18,000

Prices vary by clinic, by which consultant does the case, by whether inpatient stay is needed, and by the specific implant or device.

The problem

The right team, the right investigations, the right paired plan.

Neurogenic bladder and bowel is usually managed one specialist at a time - urology this month, colorectal next year - with the kidneys quietly deteriorating in the background. It needs the whole team round the table.

  • Bladder and bowel, together

    They share nerves, timing and quality-of-life goals. A plan that fixes one and ignores the other is a half plan.

  • Kidney protection first

    Video urodynamics and upper tract imaging drive the plan - because silent high-pressure storage is what damages kidneys.

  • The full menu on the table

    Medication, botox, CIC, SPC, Peristeen, MACE, Mitrofanoff, augmentation, AUS, SNM - all of it should be discussed, not just the one the surgeon likes.

When it helps

When specialist neurogenic bladder and bowel care is the right step.

The situations that come up most, plus the one red flag that means an emergency rather than an appointment.

  • Spinal cord injury

    Traumatic or non-traumatic SCI at any level - bladder and bowel patterns depend on level and completeness. T6 and above brings autonomic dysreflexia risk.

  • Spina bifida and tethered cord

    Congenital or acquired - lifelong bladder and bowel management, often from childhood. Upper tract protection is the priority.

  • Multiple sclerosis

    Urgency, frequency, retention and constipation are common as MS progresses. Patterns change over time and need re-assessment.

  • Stroke, Parkinson’s, cerebral palsy

    Central neurological disease often produces detrusor overactivity, urgency incontinence and slow-transit constipation.

  • Autonomic and peripheral neuropathy

    Diabetic or other autonomic neuropathy can cause a large, poorly emptying bladder and sluggish bowel - often quietly, until infections or stones present.

  • Cauda equina and pelvic nerve injury

    Post-surgical, post-radiotherapy or traumatic pelvic nerve injury - retention, incontinence and faecal incontinence in combination.

  • Refractory neurogenic detrusor overactivity

    Antimuscarinics and mirabegron have failed or are not tolerated - intravesical botulinum toxin is the next NICE-recommended step.

  • Red flag: autonomic dysreflexia

    Sudden headache, sweating and hypertension in a spinal cord–injured patient is a medical emergency - usually a blocked catheter or a full bowel. Call 999.

Management options

The full menu - bladder and bowel.

What each option actually involves - and which fits which pattern of neurogenic dysfunction.

  • Antimuscarinics + mirabegron

    First-line medical therapy for detrusor overactivity - oxybutynin, solifenacin, tolterodine, mirabegron. Titrated against side effects and post-void residual.

  • Intravesical botulinum toxin (200U)

    NICE-approved for neurogenic detrusor overactivity refractory to medical therapy. Cystoscopic injection under LA or GA, repeated every 6–9 months.

  • Clean intermittent self-catheterisation

    The gold-standard for a bladder that will not empty - taught by a specialist continence advisor and protective of the upper tracts.

  • Suprapubic catheter

    A long-term drainage option when CIC is not feasible. Lower urethral complication rate than long-term urethral catheters.

  • Mitrofanoff and bladder augmentation

    A catheterisable channel - often with an ileocystoplasty - creates a continent, low-pressure reservoir that empties on your terms.

  • Artificial urinary sphincter / male sling

    For neurogenic sphincter deficiency with adequate bladder capacity - mechanical continence when medical therapy is not enough.

  • Transanal irrigation (Peristeen, Navina)

    Pump-assisted rectal irrigation transformed neurogenic bowel management - highly effective, NHS-prescribed, huge quality-of-life gain.

  • MACE and sacral neuromodulation

    Malone antegrade continence enema for antegrade bowel flushing, or SNM for refractory bladder and bowel dysfunction where anatomy allows.

Safety and long-term care

What to plan for over the long term - honestly.

Neurogenic bladder and bowel is a lifelong condition. The things worth planning are kidney protection, sensible antibiotic use, red-flag awareness and quality-of-life goals that get tracked.

  • Upper tract protection is the point

    A high-pressure bladder damages kidneys silently. Urodynamics and regular upper tract imaging are non-negotiable, whatever else the plan looks like.

  • UTIs are common, and often over-treated

    Bacteriuria on a catheter or CIC regimen is expected. Symptomatic infection is treated, not the dipstick - antibiotic stewardship matters.

  • Autonomic dysreflexia is a medical emergency

    For SCI at T6 and above, a blocked catheter or full bowel can trigger a hypertensive crisis. Sit up, remove the trigger, call 999 if it does not settle.

  • Reservoir stones and metabolic issues

    Augmented bladders and continent reservoirs need long-term surveillance for stones, mucus and electrolyte changes.

  • Skin around catheters and stomas

    SPC exit sites, MACE stomas and pad-related skin need proactive care - a specialist nurse makes a real difference.

  • Bowel programme first, surgery later

    A properly implemented bowel programme with transanal irrigation resolves most neurogenic bowel - MACE and colostomy are for genuine failure of conservative care.

  • Quality of life is a legitimate goal

    Continence, dignity, sleep and time off the toilet are worth measuring. They should be tracked as seriously as the imaging.

  • The plan changes as the disease changes

    MS, Parkinson’s and long-term SCI shift over time. Re-assessment every one to two years - sooner if things change - is standard.

  • Red flags

    Sudden retention, haematuria, flank pain, fever, or autonomic dysreflexia symptoms warrant same-day urgent review - not a routine appointment.

Reading your MDT letter

Your MDT letter in four parts. Read the last one first.

Whichever combination of treatments was agreed, the MDT letter you receive keeps to the same shape.

A UK consultant reviewing a patient’s neurourology and colorectal MDT notes

A quiet reminder

Neurourology language is precise and can read coldly - ask for anything unclear to be put in plain English.

If you would like the letter talked through before your next appointment, just ask your clinician.

  1. 01 Header

    Neurological diagnosis and bladder/bowel type

    Underlying diagnosis, level and completeness (for SCI), and the urodynamic classification - detrusor overactivity, underactivity, dyssynergia, sphincter deficiency.

  2. 02 Findings

    Investigations and upper tract status

    Video urodynamics numbers, renal function, upper tract imaging, anorectal manometry - the objective evidence the plan is built on.

  3. 03 Plan

    Bladder and bowel management strategy

    The paired plan: medication, catheterisation regimen, botox schedule, irrigation, surgical options - with who does what and when.

  4. 04 Impression

    Surveillance, red flags and QoL goals

    Read this first: how often the kidneys are re-imaged, when to seek urgent help, and the continence and quality-of-life goals being tracked.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Cover for neurourology and neurogenic bowel management varies by insurer and by specific intervention - botox, implants and reconstructive surgery are usually funded when medically indicated.

Frequently asked

Everything patients commonly ask about neurogenic bladder and bowel management.

Quick answers on urodynamics, botox, irrigation, MACE, Mitrofanoff and autonomic dysreflexia.

  • What is neurogenic bladder and bowel dysfunction?

    It is bladder and bowel dysfunction caused by a neurological condition - spinal cord injury, spina bifida, MS, stroke, Parkinson’s, cerebral palsy, cauda equina or autonomic neuropathy. The pattern depends on the level and nature of the nerve problem, and it usually needs a lifelong, individualised plan.

  • Why is urodynamics so important?

    Because how a neurogenic bladder behaves under pressure decides the plan - and the risk to your kidneys. A bladder that stores at high pressure will damage the upper tracts silently. Video urodynamics shows whether the priority is to relax the bladder, empty it, or both.

  • What is intravesical botulinum toxin, and does it work?

    It is 200 units of botulinum toxin injected into the bladder wall through a cystoscope. NICE recommends it for neurogenic detrusor overactivity that has not responded to antimuscarinics or mirabegron. It works well - most patients regain continence - and is repeated every six to nine months.

  • What is transanal irrigation (Peristeen, Navina)?

    A small pump gently instils warm water into the rectum via a soft catheter or cone, which then evacuates the lower bowel in a controlled, predictable way. It is life-changing for neurogenic bowel and is NHS-prescribed for eligible patients.

  • What is a Mitrofanoff, and who is it for?

    A Mitrofanoff is a catheterisable channel - typically the appendix - from the bladder (often with an augmentation) to a small stoma at the umbilicus. It lets you catheterise on your own terms when the urethral route is not workable, and can be combined with bladder neck closure for continence.

  • What is a MACE?

    A Malone antegrade continence enema uses the appendix (or a Monti tube) as a catheterisable channel from the caecum to the abdominal wall. You flush the bowel antegrade - usually daily or alternate days - and become reliably continent between flushes. Excellent option for severe neurogenic bowel.

  • What is autonomic dysreflexia and why does it matter?

    In spinal cord injury at T6 and above, a stimulus below the level of injury - a blocked catheter, a full bowel, a pressure sore - can trigger a sudden dangerous rise in blood pressure with headache and sweating. It is a medical emergency: sit up, remove the trigger, and call 999 if it does not settle.

  • How much does specialist neurourology and bowel management cost privately?

    A consultation is £250–£500. Video urodynamics with upper tract US is £900–£1,600. Intravesical botox is £1,000–£2,200. MACE is £8,000–£14,000, Mitrofanoff £14,000–£22,000, bladder augmentation £15,000–£25,000, AUS £14,000–£18,000. NHS specialist spinal and neurourology centres cover most of this for eligible patients.

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