Abnormal function of the nerves innervating the bladder and urethra = Over/under activity of the detrusor muscle of the bladder and the urethral sphincters

Types:

• Spastic bladder (UMN bladder)
  • Usually from brain damage or cord damage above T12 (MS, trauma, syringomyelia)
  • Bladder fills - signal to spinal cord but cannot ascend. Bladder is not in control of higher functions and detrusor muscle is reflexively overactive = Urinary frequency and incontinence
  • Bladder automatically evacuates upon stretching
  • Normal bladder sensation
• Flaccid (hypotonic LMN) bladder
  • Damage Cord below T12, causes: Lesions, tumour, venous angioma
  • Bladder filling is not recognised, distends and fills = overflow incontinence

Key causes are:

• Multiple sclerosis
• Diabetes
• Stroke
• Parkinson’s disease
• Brain or spinal cord injury
• Spina bifida

Neurogenic bladder can result in a variety of problems, including:

• Urge incontinence
• Increased bladder pressure
• Obstructive uropathy

PC