Diabetic autonomic neuropathy commonly causes what type of bladder dysfunction?

• A. Neurogenic bladder with detrusor underactivity and impaired sensation
• B. Detrusor overactivity
• C. Urinary obstruction from BPH
• D. Stress incontinence

Answer: (A)

Autonomic neuropathy from diabetes disrupts the nerves that control the bladder, leading to a neurogenic bladder with detrusor underactivity and impaired bladder sensation. The detrusor muscle relies on parasympathetic signals to contract during voiding; when these signals are weakened, the bladder cannot generate strong contractions, causing poor emptying and residual urine. At the same time, impaired sensory pathways dull the sensation of bladder fullness, so voiding cues are delayed or missed. Clinically this often presents with hesitancy, weak urinary stream, and high post-void residual, and can lead to overflow incontinence or recurrent infections.

This differs from detrusor overactivity, which produces urgency and urge incontinence from involuntary detrusor contractions; urinary obstruction from BPH is a mechanical blockage of outflow rather than a neural control issue; and stress incontinence arises from pelvic floor weakness rather than autonomic nerve damage.