Disturbances of bladder function

1. Big picture

Bladder dysfunction is a very important neurological symptom because it helps localize lesions in the frontal lobes, pons, spinal cord, conus medullaris, cauda equina, peripheral nerves, and autonomic system.

For the final exam, the key question is:

Is the bladder problem due to a central suprapontine lesion, a spinal suprasacral lesion, or a peripheral sacral/conus-cauda lesion?

The most dangerous pattern is:

Urinary retention with back pain, saddle anesthesia, leg weakness, or reduced anal tone = conus/cauda syndrome until proven otherwise.

Urinary symptoms are not just urological. In neurology, they may be the first sign of spinal cord compression, multiple sclerosis, stroke, normal pressure hydrocephalus, Parkinson-plus syndrome, diabetic autonomic neuropathy, or cauda equina syndrome.

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