A patient with herniated nucleus pulposus presents with low back pain accompanied by hypoesthesia, weakness, and diminished deep tendon reflexes in both legs. Which type of incontinence is most likely associated?

A patient with herniated nucleus pulposus presents with low back pain accompanied by hypoesthesia, weakness, and diminished deep tendon reflexes in both legs. Which type of incontinence is most likely associated?

• A. Urge
• B. Overflow
• C. Stress
• D. Functional

Answer: (B)

When a herniated disc compresses the lumbosacral nerve roots, especially enough to involve the cauda equina, you get lower motor neuron-type signs in the legs (hypoesthesia, weakness, diminished reflexes). The bladder is innervated by sacral nerves; if they’re affected, the detrusor muscle may become underactive and fail to empty the bladder effectively. As a result, urine cannot be expelled completely, the bladder overfills, and leakage occurs—overflow incontinence. This pattern fits neurogenic bladder from cauda equina involvement more than other types. Urge incontinence would involve detrusor overactivity with a sudden urge to void and leakage. Stress incontinence results from pelvic floor weakness allowing leakage with pressure. Functional incontinence comes from inability to reach the bathroom due to mobility or cognitive issues, not from a neurogenic bladder.

When a herniated disc compresses the lumbosacral nerve roots, especially enough to involve the cauda equina, you get lower motor neuron-type signs in the legs (hypoesthesia, weakness, diminished reflexes). The bladder is innervated by sacral nerves; if they’re affected, the detrusor muscle may become underactive and fail to empty the bladder effectively. As a result, urine cannot be expelled completely, the bladder overfills, and leakage occurs—overflow incontinence.

This pattern fits neurogenic bladder from cauda equina involvement more than other types. Urge incontinence would involve detrusor overactivity with a sudden urge to void and leakage. Stress incontinence results from pelvic floor weakness allowing leakage with pressure. Functional incontinence comes from inability to reach the bathroom due to mobility or cognitive issues, not from a neurogenic bladder.