BLADDER-TYPES OF IMPAIRMENT

SUMMARY

SUPRASACRAL/INFRASACRAL
1. Suprasacral (Infrapontine): UMN lesion results in detrusor hyperreflexia (overactivity), detrusor-external sphincter dyssynergia (DESD).

2. Infrasacral Bladder: LMN lesion results in detrusor areflexia & atonia of the pelvic floor muscles; causing non-contractile bladder with leakage from overflow.

SACRAL/MIXED

3. Mixed Neurogenic Bladder (Type A): lesion in the conus medullaris with damage to sacral (parasympathetic) nucleus causes detrusor hyporeflexia (underactivity) with external sphincter hyperreflexia; causing large volume with overflow incontinence.

4. Mixed Neurogenic Bladder (Type B): lesion in the conus medullaris involving pudendal (somatic) nucleus causes detrusor hyperreflexia with external sphincter hypotonia; causing small volume, high frequency, incontinence.

Reference(s)

Cifu, D.X. (2020). Braddom’s physical medicine and rehabilitation. Elsevier. Get it on Amazon.
Cuccurullo, S. (2019). Physical medicine and rehabilitation board review. New York: Demosmedical. Get it on Amazon.
O’Young, B., Young, M.A. and Stiens, S.A. (2008). Physical Medicine and Rehabilitation Secrets. Mosby. Get it on Amazon.