Clinical Update: Spinal Cord Impairments

Lower urinary tract dysfunction may result from a variety of neurologic disorders, including traumatic spinal cord injury, head injury, a cauda equina syndrome, or trauma to the peripheral lumbosacral nerves. Urinary incontinence can be divided into five categories: stress incontinence, urge incontinence, mixed incontinence, overflow incontinence, and total incontinence. A table lists each type, provides a description, and gives both common and neurological examples. Evaluation of voiding dysfunction should not be based on symptoms alone, and urodynamic evaluation is required also. Indeed, urodynamic evaluation is the only means to establish a functional interrelationship of the components of the lower urinary tract. Most ratings of neurogenic bladder dysfunction are performed using Section 4.3d, Urinary Bladder Dysfunction, and Table 17, Criteria for Neurologic Impairment of the Bladder in the AMA Guides to the Evaluation of Permanent Impairment. Ratings for whole-person permanent impairment depend on symptomatology (ie, urgency, dribbling, or incontinence), voluntary control, and bladder reflex activity. If problems with urinary system dysfunction are related to a combination of neurologic and urologic pathology, including pathology in the upper urinary tract, ratings from both sections can be combined using the Combined Values Chart.