Spina bifida with lesion at T12 or higher typically presents with which type of bladder?

• A. Flaccid bladder with dribbling
• B. Spastic (neurogenic) bladder with involuntary emptying
• C. Mixed detrusor function with sphincter dyssynergia
• D. Normal bladder function

Answer: (B)

When a spinal lesion is at or above T12, the bladder control pathways from the brain to the sacral reflex arc are disrupted, so the detrusor becomes hyperactive and contracts reflexively. This produces a spastic (neurogenic) bladder. Because the detrusor contracts without coordinated relaxation of the external sphincter, there is detrusor-sphincter dyssynergia, leading to involuntary bladder contractions and often unintended emptying or leakage. In contrast, a flaccid bladder results from lower motor neuron damage to the sacral segments (S2–S4) that innervate the detrusor, causing poor detrusor tone and dribbling—not the pattern seen with higher-level lesions. Normal bladder function would require intact supraspinal and spinal pathways.