Lesions from the brain down through the cervicothoracic spinal cord cause an upper motor neuron (ie, spastic) bladder phenotype. Damage to sacral nerve roots leads to a lower motor neuron (ie, flaccid) phenotype. Sacral spinal cord lesions may cause mixed bladder phenotypes, with spastic and flaccid components.
Neurogenic bladder may result from diverse lesions such as multiple sclerosis, parkinsonism, spinal cord injuries, neural tube defects, cerebrovascular accidents, brain tumors, and peripheral neuropathy in the setting of type 2 diabetes mellitus and AIDS. Neurogenic bladder is often suspected clinically in patients with characteristic symptoms and a predisposing condition. A thorough history and urodynamic testing can confirm the diagnosis.
Symptoms are variable and include urinary incontinence, small urinary volume, difficulty initiating urinary stream, incomplete bladder emptying, changes in urinary frequency or urgency, inability to sense bladder fullness, and dysuria.
N31.9 – Neuromuscular dysfunction of bladder, unspecified
398064005 – Neurogenic bladder
Differential Diagnosis & Pitfalls
- Urinary tract infection (UTI)
- Benign prostatic hyperplasia
- Stress incontinence
- Diabetes mellitus / diabetes insipidus
- Urethral stricture
- Anterior prolapse (cystocele)
- Herniated disk (see lumbar radiculopathy)
- Diuretic use
- Renal dysfunction
- Excess consumption of fluids, caffeine, or alcohol