Cough-Anal Reflex May Be the Expression of a Pre-Programmed Postural Action

Abstract

When coughing, an involuntary contraction of the external anal sphincter occurs, in order to prevent unwanted leakages or sagging of the pelvis muscular wall. Literature originally described such cough-anal response as a reflex elicited by cough, therefore identifying a precise cause-effect relationship. However, recent studies report that the anal contraction actually precedes the rise in abdominal pressure during cough expiratory effort, so that the sphincter activity should be pre-programmed. In recent years, an important family of pre-programmed muscle activities has been well documented to precede voluntary movements: these anticipatory actions play a fundamental role in whole body and segmental postural control, hence they are referred to as anticipatory postural adjustments (APAs). On these basis, we searched in literature for similarities between APAs and the cough-anal response, observing that both follow the same predictive homeostatic principle, namely that anticipatory collateral actions are needed to prevent the unwanted mechanical consequences induced by the primary movement. We thus propose that the cough-anal response also belongs to the family of pre-programmed actions, as it may be interpreted as an APA acting on the abdominal-thoracic compartment; in other words, the cough-anal response may actually be an Anticipatory Sphincter Adjustment, the visceral counterpart of APAs.

Novel insights into physiological mechanisms underlying fecal continence

“…When the intra-abdominal pressure rises during coughing or sneezing, the EAS contracts via the so-called cough response of the anal sphincter (16). The anal pressure during a vigorous cough is greater than the voluntary squeeze pressure.…”

Interaction between Feet and Gaze in Postural Control

“…When performing a voluntary movement such as pulling with the hand on a bar attached to a wall, subjects activate the ankle extensor muscles (gastrocnemius) 100 ms before the arm flexors [ 43 ]. Other anticipatory neuromuscular activities have been studied, in particular during leg elevation movements, head rotation [ 46 ]), rotation of the eyes [ 47 ], and even in relation with reflex visceral movements, such as coughing [ 48 ].…”

Biotensegrity or Fascintegrity?

“…The fascia contains and is also constituted by the viscera, which tensions and movements are not considered in the biotensegretive model. The viscera condition posture and movement with their muscular contraction through involuntary neural patterns; the viscera feel the tension that surrounds them (blood, lymph, viscera, and skeletal muscles), changing their own tension [28][29][30][31][32][33][34]. Fascintegrity is the word that should be used to construct a new model to understand the adaptation behaviour of cells and tissues, as well as musculoskeletal movement.…”