The bladder and bowel are neighbours in the body and share innervation. Shared innervation means that the nerves travel together. This may be one reason why we commonly see an overlap in symptom profiles in lower urinary tract and colonic disorders.
The phenomenon is called 'cross-organ sensitization' and the idea behind it is that nerves affected by a disorder in one organ (for example the bladder) share a pathway with and therefore affect the nerves for normal physiological function in another organ (for example the bowel).
This mechanism may lead to a need to treat multiple syndromes concurrently, as well as looking out for debilitating side effects. A recent study describes the theory behind this bladder and bowel interaction and summarizes the supporting evidence.
It has recently become apparent that disease of one of these organs [colon, bladder, and urethra] can result in the subsequent development of pathology in the otherwise unaffected adjacent organ. This process called “cross-organ sensitization” originates and is embedded within the physiological coordination of these organs. This pathological occurrence is believed to be responsible for the comorbidity of a number of lower urinary tract and colonic disorders…
Grundy and Brierley. Am J Physiol Gastrointest Liver Physiol. 2018;314:G301-G308
Association of bladder and bowel symptoms can also be seen. For example, when investigating more than 500 women with lower urinary tract symptoms (LUTS) it became evident that there is an association between urinary incontinence and bowel dysfunction, prolapse, and sexual dysfunction. Women with LUTS with urinary incontinence reported worse constipation, diarrhea, fecal incontinence, and sexual function compared to those without urinary incontinence.
Although bladder and bowel interaction seems to be common, they are not always assessed together during treatment. Therapy recommendations in bladder and bowel care are very specific; see for example the guidelines for neurogenic lower urinary tract dysfunction (NLUTD) from the National Institute for Health and Care Excellence (NICE), the European Association of Urology (EAU), and the International Consultation on Continence (ICI), which were recently reviewed and compared. There are also many new and useful position papers covering indications and best clinical practice for intermittent catheterization use, both in general terms and for specific populations, such as people with multiple sclerosis (MS).
More, and urgently needed, interventions have recently been introduced regarding bowel treatment. There are new treatment alternatives utilizing different irrigation systems, and a recent study presents the first experiences with an electronic device for transanal irrigation. The results showed that the degree of independence could be improved for people with neurogenic bowel dysfunction. Other research explores the use of percutaneous posterior tibial nerve stimulation with promising results for people with MS and fecal incontinence.
Summary of Publications
Cross-organ sensitization between the colon and bladder: To pee or not to pee?
https://www.physiology.org/doi/10.1152/ajpgi.00272.2017
Author and Origin
Grundy L, Brierley SM.
Australia
Summary
A mini-review of the neurogenic cross-talk between the colon and bladder, called cross-organ sensitization.
Conclusions
There is an overlap in symptom profiles in a number of lower urinary tract and colonic disorders. One possible mechanism behind this is ’cross-organ sensitization’ due to shared innervation.
Comments
Summary of evidence behind subsequent development of illnesses in adjacent organs (i.e. colon, bladder, and urethra).
Bowel function, sexual function, and symptoms of pelvic organ prolapse in women with and without urinary incontinence.
https://www.ncbi.nlm.nih.gov/pubmed/29635702
Author and Origin
Cameron AP, Smith A, Lai H, Bradley C, Liu A, Merion R, Gillespie B, Amundsen C, Cella D, Griffith J, Wiseman J, Kreder, K, Kenton K, Helmuth M, Fraser, M, Clemens Q, Kirkali Z, Kusek J and Siddiqui N. The LURN Study Group.
USA
Summary
A prospective cohort study on 510 women with lower urinary tract symptoms (LUTS), investigating bowel function, sexual function, and pelvic organ prolapse in relation to subtypes of urinary incontinence.
Conclusions
Women with urinary incontinence symptoms, mixed urinary incontinence (both stress and urge symptoms), and/or more severe urinary incontinence were more likely to report bowel dysfunction, prolapse symptoms, and worse sexual function.
Comments
A relatively large study demonstrating an association between urinary incontinence and bowel dysfunction, prolapse, and sexual dysfunction.
A comparison of the treatment recommendations for neurogenic lower urinary tract dysfunction in the national institute for health and care excellence, European Association of Urology and international consultations on incontinence guidelines.
https://www.ncbi.nlm.nih.gov/pubmed/29664124
Author and Origin
Jaggi A, Drake M, Siddiqui E, Fatoye F.
UK
Summary
Comparison of guidelines from the National Institute for Health and Care Excellence (NICE), the European Association of Urology (EAU), and the International Consultation on Continence (ICI) on neurogenic lower urinary tract dysfunction (NLUTD).
Conclusions
All guidelines generally recommend conservative management and intermittent catheterization before indwelling catheter use. Many recommendations are based on expert opinion due to lack of evidence. This results in different conclusions and recommendations.
Comments
Review and comparison between different treatment guidelines published for management of NLUTD.
[POSITION STATEMENT FOR INTERMITTENT CATHETERIZATION OF URINARY BLADDER].
https://www.ncbi.nlm.nih.gov/pubmed/29688647
Author and Origin
Vainrib M, Stav K, Gruenwald I, Gilon G, Aharony S, Gross M, Bluvshtein V, Kauffman Y.
Israel
Summary
Clinical best practice paper on intermittent catheterization from the Israeli Urological Association.
Conclusions
Intermittent catheterization is indicated for temporary or permanent bladder emptying. Single-use catheters are recommended.
Comments
Position paper covering indications and best clinical practice for intermittent catheterization.
[Article in Hebrew]
Application of clean intermittent catheterization for neurogenic bladder in infants less than 1 year old.
https://www.ncbi.nlm.nih.gov/pubmed/29660959
Author and Origin
Li Y, Wen Y, He X, Li Y, Wu J, Feng J, Wang Q, Wen J.
China
Summary
Observational retrospective study in 76 infants with neurogenic bladder, exploring the effect of intermittent catheterization on preserving bladder and upper urinary tract function.
Conclusions
Early introduction of intermittent catheterization seems to play an important role in preserving bladder function and preventing urinary tract infection and renal deterioration in infants with neurogenic bladder.
Comments
Study reaffirming the importance of early introduction of intermittent catheterization in children with neurogenic bladder.
Clean intermittent self-catheterisation and multiple sclerosis.
https://www.ncbi.nlm.nih.gov/pubmed/29708793
Author and Origin
Simpson P.
UK
Summary
Expert opinion and treatment recommendations for use of intermittent catheterization for people with bladder dysfunction due to multiple sclerosis (MS).
Conclusions
Recurrent urinary tract infections can lead to poor patient compliance. High quality education, good catheterization techniques and a wide assortment of catheters are recommended.
Comments
Expert recommendation on how to address MS-associated bladder dysfunction in British urology and continence clinics.
Factors affecting continuation of clean intermittent catheterisation in people with multiple sclerosis: Results of the COSMOS mixed-methods study.
https://www.ncbi.nlm.nih.gov/pubmed/29683042
Author and Origin
McClurg D, Bugge C, Elders A, Irshad T, Hagen S, Moore KN, Buckley B, Fader M.
UK
Summary
Observational study exploring variables that influenced the decision to continue or discontinue intermittent catheterization in 204 persons with multiple sclerosis (MS).
Conclusions
The most important factor that precipitates discontinuation of intermittent catheterization in people with MS is patient perception of a link between catheter use and the development of a urinary tract infection (UTI).
Comments
Explorative study on barriers to intermittent catheter use in people with MS, proposing UTI prevention as one important target area.
This blog post is an extract of the Science Alert from May 2018 (76040-USX-20180514)
