What is atonic, automatic and autonomous bladder?

Asked by Bromley 

To understand these terms, one need to understand the physiology of micturition reflex: https://epomedicine.com/medical-students/micturition-reflex/

1. Atonic bladder:

• Injury to dorsal root leading to deafferentation, so that bladder distension is not perceived, and the reflex contraction of detrusor is lost.
• Retention of urine and subsequent overflow incontinence (bladder filled beyond physiological capacity)
• Bladder wall is stretched and thin.
• Voluntary control of micturition is intact.

2. Autonomous bladder:

• Both the afferent and efferent parasympathetic nerve supply to the bladder is lost and the bladder is no longer under the control of the spinal cord centers.
• Initial flaccidity and distension of bladder, followed by periodic contractions of smooth muscle, leading to dribbling of urine.
• Contractions lead to bladder wall to shrink and become hypertrophied.
• Contractions are weak leading to residual urine in bladder.

3. Automatic bladder:

• Only the inhibitory control of the higher centers is lost.
• After a period of spinal shock, reflex contraction of the bladder is regained.
• Bladder empties reflexly (automatically) whenever filled because the higher center control is lost.

Reference: Lippincott Illustrated Reviews Physiology By Subhasis Das