In diabetic patients, what bladder dysfunction may result from autonomic neuropathy?

• A. Neurogenic bladder with detrusor underactivity and impaired sensation
• B. Urge incontinence due to detrusor overactivity
• C. Stress incontinence due to pelvic floor weakness
• D. Bladder outlet obstruction from BPH

Answer: (A)

Autonomic neuropathy from diabetes disrupts the nerves that control the bladder, especially the parasympathetic input that drives detrusor contraction and the sensory pathways that signal filling. When these nerves are impaired, the detrusor becomes underactive and the bladder sensation is blunted, so the bladder fills to a larger capacity and empties incompletely. This combination defines a neurogenic bladder with detrusor underactivity and impaired sensation. Clinically, patients may have weak urinary streams, difficulty initiating voiding, and residual urine with potential overflow leakage. This pattern is distinct from urge incontinence (detrusor overactivity), stress incontinence (pelvic floor weakness), or bladder outlet obstruction from BPH, which are not typically caused by diabetic autonomic neuropathy.