Gastrointestinal dysfunction after spinal cord injury

Holmes, Gregory M.; Blanke, Emily N.

doi:10.1016/j.expneurol.2019.113009

Cited by 64 publications

(50 citation statements)

References 196 publications

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“…For example, it is possible that high intensities are producing a spread of current to the T12-L1 sympathetic outflow 53 and subsequent activation of sympathetic circuits are causing the decrease in activity. Additionally, the pelvic organs have a great deal of shared innervation, with overlapping central and peripheral substrates [53][54][55] , as pelvic organ crosstalk 56 and coordinated activity exists under normal conditions.…”

Section: Sex Differences Impacting Urinary Tract Functionmentioning

confidence: 99%

Bladder and bowel responses to lumbosacral epidural stimulation in uninjured and transected anesthetized rats

Hoey

Medina-Aguiñaga

Khalifa

et al. 2021

Sci Rep

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Spinal cord epidural stimulation (scES) mapping at L5-S1 was performed to identify parameters for bladder and bowel inhibition and/or contraction. Using spinally intact and chronic transected rats of both sexes in acute urethane-anesthetized terminal preparations, scES was systematically applied using a modified Specify 5–6–5 (Medtronic) electrode during bladder filling/emptying cycles while recording bladder and colorectal pressures and external urethral and anal sphincter electromyography activity. The results indicate frequency-dependent effects on void volume, micturition, bowel peristalsis, and sphincter activity just above visualized movement threshold intensities that differed depending upon neurological intactness, with some sex-dependent differences. Thereafter, a custom-designed miniature 15-electrode array designed for greater selectivity was tested and exhibited the same frequency-dependent urinary effects over a much smaller surface area without any concurrent movements. Thus, select activation of autonomic nervous system circuitries with scES is a promising neuromodulation approach for expedient translation to individuals with SCI and potentially other neurologic disorders.

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Section: Sex Differences Impacting Urinary Tract Functionmentioning

confidence: 99%

Bladder and bowel responses to lumbosacral epidural stimulation in uninjured and transected anesthetized rats

Hoey

Medina-Aguiñaga

Khalifa

et al. 2021

Sci Rep

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“…Here we provide a brief overview of the physiology of defecation; for a detailed review on physiology and pathophysiology after spinal cord injury the reader is referred elsewhere ( 13 , 14 ) and De Lahunta and Glass also provide an overview in companion animals in their textbook ( 6 ).…”

Section: Physiology Of Defecationmentioning

confidence: 99%

“…The normal neurophysiological control of the gastrointestinal system is dependent on local enteric circuits, autonomic input through the parasympathetic and sympathetic nervous systems, and higher cortical processes that serve to control timing of elimination. The local regulation of many gastrointestinal reflex functions is governed by enteric neurocircuitry that is capable of independent secretory and motor (propulsive) reflexes as well as regulating the homeostatic requirements of the gastrointestinal tissues such as blood flow ( 13 , 15 ). Parasympathetic innervation to the descending colon and rectum arises within the sacral spinal cord segments and travels by way of the pelvic nerve, promoting motility.…”

Section: Physiology Of Defecationmentioning

confidence: 99%

Bladder and Bowel Management in Dogs With Spinal Cord Injury

2020

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Spinal cord injury in companion dogs can lead to urinary and fecal incontinence or retention, depending on the severity, and localization of the lesion along the canine nervous system. The bladder and gastrointestinal dysfunction caused by lesions of the autonomic system can be difficult to recognize, interpret and are easily overlooked. Nevertheless, it is crucial to maintain a high degree of awareness of the impact of micturition and defecation disturbances on the animal's condition, welfare and on the owner. The management of these disabilities is all the more challenging that the autonomic nervous system physiology is a complex topic. In this review, we propose to briefly remind the reader the physiology of micturition and defecation in dogs. We then present the bladder and gastrointestinal clinical signs associated with sacral lesions (i.e., the L7-S3 spinal cord segments and nerves) and supra-sacral lesions (i.e., cranial to the L7 spinal cord segment), largely in the context of intervertebral disc herniation. We summarize what is known about the natural recovery of urinary and fecal continence in dogs after spinal cord injury. In particular we review the incidence of urinary tract infection after injury. We finally explore the past and recent literature describing management of urinary and fecal dysfunction in the acute and chronic phase of spinal cord injury. This comprises medical therapies but importantly a number of surgical options, some known for decades such as sacral nerve stimulation, that might spark some interest in the field of spinal cord injury in companion dogs.

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“…Spinal cord injury severely affects gastrointestinal function, causing delayed gastric emptying and colonic transit time [ 35 , 36 , 37 , 38 , 39 ]. Splanchnic blood flow is under autonomic control, but it remains unknown how SCI affects postprandial blood flow to the intestines.…”

Section: Introductionmentioning

confidence: 99%

Postprandial Hypotension and Spinal Cord Injury

Hansen

Krogh

Sundby

et al. 2021

JCM

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Postprandial hypotension (PPH) is defined as a fall of ≥20 mmHg in systolic blood pressure (SBP) or a SBP of <90 mmHg after having been >100 mmHg before the meal within two hours after a meal. The prevalence of PPH among persons with spinal cord injury (SCI) is unknown. Ambulatory blood pressure measurement was performed in 158 persons with SCI, 109 men, median age was 59.1 years (min.:13.2; max.: 86.2). In total, 78 persons (49.4%) had PPH after 114 out of 449 meals (25.4%). The median change in SBP during PPH was −28 mmHg (min.: −87; max.: −15 mmHg) and 96% of the PPH episodes were asymptomatic. The occurrence of PPH was correlated to older age (p = 0.001), level of injury (p = 0.023), and complete SCI (p = 0.000), but not, gender or time since injury. Further studies are needed to elucidate if PPH contributes to the increased cardiovascular mortality in the SCI population.

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Gastrointestinal dysfunction after spinal cord injury

Cited by 64 publications

References 196 publications

Bladder and bowel responses to lumbosacral epidural stimulation in uninjured and transected anesthetized rats

Bladder and bowel responses to lumbosacral epidural stimulation in uninjured and transected anesthetized rats

Bladder and Bowel Management in Dogs With Spinal Cord Injury

Postprandial Hypotension and Spinal Cord Injury

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