Types of Bladder Dysfunction in SCI

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There are two main types of neurogenic bladder dysfunction in SCI: 1) hyperreflexic bladder represented by overactive, reflexic or spastic detrusor muscle activity, usually associated with external sphincter dysynergia (Detrusor External Sphincter Dyssynergia, DESD); and 2) areflexic or flaccid bladder, represented by underactive detrusor activity. Occasionally, detrusor overactivity secondary to SCI is seen without associated sphincter dysynergia, but this can also result in difficulty with continence. Methods to improve continence in those with or without DESD are often similar and are addressed in the sections on enhancing bladder volumes in DESD.