Figure 3

Mechanisms of the BCR in control and neurogenic (NDO) bladders. Diagram of proposed mechanisms of the bladder cooling reflex and pain in patient sub-groups during the ice water test (IWT). In neurologically normal adults and older children (> 4 years), the segmental spinal reflex pathway is normally inhibited by descending signals from higher centres (a). There is loss of central inhibition and increased afferent activation in neurogenic detrusor overactivity (NDO) patients (b), resulting in a positive IWT.