ABSTRACT
Introduction Normal bladder function requires coordinated interaction of sensory and motor components of both the somatic and autonomic nervous systems. The micturition reflex is a finely tuned neurological event that requires integration of most levels of the nervous system to regulate voiding function, so that damage to any one of the many neurological mechanisms involved affects urination. In particular, bladder contraction and reflex control depends on an intact neural axis – specifically, an undamaged sacral spinal cord together with its afferent and efferent connections.1 Spinal cord injury (SCI), by contrast, generally results in absent sensation below the level of the lesion and, although patients with upper motor neuron lesions can have a local reflex of bladder contraction, it is often opposed by smooth and striated muscle dyssynergia in the sphincters controlling bladder voiding. Neurogenic bladder problems are therefore a near universal feature of spinal cord injury.
