Central control of micturition in women: Brain‐bladder pathways in continence and urgency urinary incontinence

Abstract

Urinary incontinence disproportionately affects women. Anatomical textbooks typically describe continence mechanisms in women in the context of the pelvic floor support of the urinary bladder and the urethral sphincters. However, the urinary bladder and urethral sphincters are under the central control of the brain through a complex network of neurons that allow storage of urine followed by voiding when socially appropriate. Recent studies suggest that the most common type of urinary incontinence in women, urgency urinary incontinence, involves significant dysfunction of the central control of micturition. In this paper, we review the anatomy and functional connectivity of the nervous system structures involved in the control of micturition. Clinical application of this anatomy in the context of urgency urinary incontinence is also discussed. Understanding the anatomy of the neural structures that control continence will allow clinicians to better understand the underlying pathology of urge incontinence and consider new ways of treating this distressing condition. Clin. Anat. 30:373-384, 2017. © 2017 Wiley Periodicals, Inc.

Brain activation during the voiding phase of micturition in healthy adults: A meta‐analysis of neuroimaging studies

“…The thalamus is a complex of nuclei surrounded by the cerebral hemispheres and has an important role in both sensory and motor pathways for integrating somatosensory information (Herrero et al, ). As a part of the attention and awareness networks, thalamic activation during storage determines which afferent signals from the bladder should reach the cerebral cortex (Arya and Weissbart, ). During voiding, thalamic activation may represent the central role of the thalamus in co‐ordinating the integration of the decision to void generated in the PFC with the relaxation of the pelvic floor including the external urethral sphincter muscles.…”

How Can Cattle Be Toilet Trained? Incorporating Reflexive Behaviours into a Behavioural Chain

“…Reliable latrine use would require that cattle, like other species, learn to control a range of voluntary and reflex responses associated with toileting [ 9 , 10 , 11 ]. These include the ability to suppress impending voiding, a reflexive-like behaviour [ 9 , 11 ], then move to the latrine, a voluntary behaviour [ 12 , 13 ], and finally reinitiate voiding at the latrine.…”

“…Reliable latrine use would require that cattle, like other species, learn to control a range of voluntary and reflex responses associated with toileting [ 9 , 10 , 11 ]. These include the ability to suppress impending voiding, a reflexive-like behaviour [ 9 , 11 ], then move to the latrine, a voluntary behaviour [ 12 , 13 ], and finally reinitiate voiding at the latrine. Dirksen et al [ 14 ] reviewed the literature on the toilet training of humans and other animals and reported that cattle have the neurophysiological and cognitive capabilities for toilet training, concluding that toilet training of cattle should be possible by using operant training methods [ 14 ].…”

The early history of our understanding of the functions of the spinal cord

“…Through clinical correlations between both symptoms and lesions of the spine, along with early manipulative investigations, historical researchers were able to identify the spinal cord as an important conduit for signals to and from the brain. Contemporary researchers [2,[11][12][13][14][15][16][17] have used investigative techniques that have gone beyond surgical manipulation and stimulation to visualize the various components of the central Fig. 1 and cover figure Collage demonstrating physicians who have studied the spinal cord over human history.…”