Systematic Review of the Relationship Between Bladder and Bowel Function

Implications for Patient Management

S. A. Kaplan; R. Dmochowski; B. D. Cash; Z. S. Kopp; S. J. Berriman; V. Khullar

Disclosures

Int J Clin Pract. 2013;67(3):205-216. 

In This Article

Abstract and Introduction

Abstract

Background: The complex relationship between bladder and bowel function has implications for treating pelvic disorders. In this systematic review, we discuss the relationship between bladder and bowel function and its implications for managing coexisting constipation and overactive bladder (OAB) symptoms.

Methods: Multiple PubMed searches of articles published in English from January 1990 through March 2011 were conducted using combinations of terms including bladder, bowel, crosstalk, lower urinary tract symptoms, OAB, incontinence, constipation, hypermotility, pathophysiology, prevalence, management and quality of life. Articles were selected for inclusion in the review based on their relevance to the topic.

Results: Animal studies and clinical data support bladder-bowel cross-sensitization, or crosstalk. In the rat, convergent neurons in the bladder and bowel as well as some superficial and deeper lumbosacral spinal neurons receive afferent signals from both bladder and bowel. On a functional level, in animals and humans, bowel distention affects bladder activity and vice versa. Clinically, the bladder-bowel relationship is evident through the presence of urinary symptoms in patients with irritable bowel syndrome and bowel symptoms in patients with acute cystitis. Functional gastrointestinal disorders, such as constipation, can contribute to the development of lower urinary tract symptoms, including OAB symptoms, and treatment of OAB with antimuscarinics can worsen constipation, a common antimuscarinic adverse effect. The initial approach to treating coexisting constipation and OAB should be to relieve constipation, which may resolve urinary symptoms.

Conclusions: The relationship between bladder and bowel function should be considered when treating patients with urinary symptoms, bowel symptoms, or both.

Introduction

The complex physiology of urologic and gastrointestinal function is interrelated, which has implications for the management of disorders affecting both organ systems. Convergent dorsal root ganglia neurons receiving sensory input from multiple pelvic organs have been identified in the colon, bladder and reproductive organs.[1–4] Cross-sensitization, or 'crosstalk', between neural pathways in the pelvic organs is necessary for the routine mediation of bladder, bowel and sexual function.[5] This crosstalk, however, also provides a pathway for abnormal function of these organs, with the potential for dysfunction of one pelvic organ leading to functional changes in another.[1,6,7] Consequently, crosstalk between the bladder and bowel may play a role in pelvic disorders, including chronic pelvic pain syndromes and overactive bladder (OAB) symptoms.

Constipation and OAB are two conditions that illustrate the relationship between the bowel and the bladder. Both of these conditions can adversely affect health-related quality of life (HRQL),[8–10] and their coexistence may further compound adverse outcomes in affected patients. Recognition of the interrelatedness of these symptoms can help optimise a treatment program to comprehensively address the causes and manifestations of bowel and bladder disorders. In this review, we briefly describe normal bladder and bowel physiology; discuss the role of bladder-bowel interaction in clinical conditions, with an emphasis on constipation and OAB; and provide recommendations for managing concomitant constipation and OAB in clinical practice.

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