The effect of rectal distension on bladder function in patients with overactive bladder

Akl, Mohamed N.; Jacob, Kristina A.; Klauschie, Jennifer; Crowell, Michael D.; Kho, Rosanne M.; Cornella, Jeffrey L.

doi:10.1002/nau.21241

Cited by 11 publications

(7 citation statements)

References 20 publications

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“…24 Conversely, adult studies have demonstrated a decrease in bladder volume at which patients reported first sensation, first desire to void, and strong desire to void with RD. 23,25,26 We demonstrated, for the first time, characteristic changes in intra-anal pressure profiles during the micturition cycle. During bladder filling without RD, there was a significant decrease in intra-anal pressures during voiding and at first quartile of total bladder filling volume.…”

Section: Discussionmentioning

confidence: 72%

“…in their pediatric cohort . Conversely, adult studies have demonstrated a decrease in bladder volume at which patients reported first sensation, first desire to void, and strong desire to void with RD …”

Section: Discussionmentioning

confidence: 97%

“…The pathophysiology of the interaction between the LUT and the anorectum is not precisely known. It has been suggested in limited adult studies that rectal distention (RD) may have an effect on bladder function, producing variable changes in volume of sensation, bladder capacity, and bladder overactivity . Conversely, alterations in bladder filling dynamics may impact anorectal pressure and sensation, but no study has simultaneously studied changes in both systems.…”

Section: Introductionmentioning

confidence: 99%

“…It has been suggested in limited adult studies that rectal distention (RD) may have an effect on bladder function, producing variable changes in volume of sensation, bladder capacity, and bladder overactivity. [23][24][25][26][27] Conversely, alterations in bladder filling dynamics may impact anorectal pressure and sensation, [28][29][30] but no study has simultaneously studied changes in both systems. There is limited data regarding the physiological interaction between the LUT and the anorectum in children with BBD.…”

Section: Introductionmentioning

confidence: 99%

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Simultaneous urodynamic and anorectal manometry studies in children: insights into the relationship between the lower gastrointestinal and lower urinary tracts

Ambartsumyan

Siddiqui

Bauer

et al. 2016

Neurogastroenterology Motil

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Background Children with urinary incontinence (UI) have associated functional constipation (FC) and fecal incontinence (FI). The physiology between lower urinary tract (LUT) and anorectum in children has not been elucidated. Aims Observe the effect of rectal distention (RD) on LUT function, and bladder filling and voiding on anorectal function. Methods Children with voiding dysfunction referred to Boston Children’s Hospital were prospectively enrolled for combined urodynamic (UDS) and anorectal manometry (ARM). Anorectal and urodynamic parameters were simultaneously measured. Patients underwent 2 micturition cycles, 1st with rectal balloon deflated and 2nd with it inflated (RD). LUT and anorectal parameters were compared between cycles. Key Results 10 children (7 UI, 4 recurrent UTIs, 9 FC ± FI) were enrolled. Post void residual (PVR) increased (p=0.02) with RD. No differences were observed in percent of bladder filling to expected bladder capacity, sensation, and bladder compliance with and without RD. Bladder and abdominal pressures increased at voiding with RD (p<0.05). Intra-anal pressures decreased at voiding (p<0.05), at 25% (p=0.03) and 50% (p=0.06) of total volume of bladder filling. Conclusions & Inferences The PVR volume increased with RD. Stool in the rectum does not alter filling cystometric capacity but decreases the bladder’s ability to empty predisposing patients with fecal retention to UI and UTIs. Bladder and abdominal pressures increased during voiding demonstrating a physiological correlate of dysfunctional voiding. Intra-anal pressures decreased during bladder filling and voiding. This is the first time intra-anal relaxation during bladder filling and voiding has been described.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Simultaneous urodynamic and anorectal manometry studies in children: insights into the relationship between the lower gastrointestinal and lower urinary tracts

Ambartsumyan

Siddiqui

Bauer

et al. 2016

Neurogastroenterology Motil

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“…If stretch receptors are stimulated by fecal accumulation, diverse patterns of bladder contraction occur and induce bladder instability . Therefore, the mechanism of OAB mainly involves bowel distention, especially distension of the rectum from fecal retention, rather than constipation itself . As such, the investigation of fecal retention using objective and patient‐friendly tools, rather than the diagnosis of constipation, might be important in the management of OAB in children.…”

Section: Introductionmentioning

confidence: 99%

Treatment of fecal retention is important in the management of overactive bladder in children

Choi

Seo

Lee

et al. 2016

Neurourology and Urodynamics

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Bladder‐bowel interactions: Do we understand pelvic organ cross‐sensitization? International Consultation on Incontinence Research Society (ICI‐RS) 2018

Panicker

Marcelissen

Gontard

et al. 2019

Neurourology and Urodynamics

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Aims: Mounting evidence from experimental animal and human studies suggests that cross-sensitization exists between different organs. Lower urinary tract (LUT) and bowel dysfunction commonly overlap, and the role of crosssensitization between pelvic visceral organs is uncertain. Methods: At the International Consultation on Incontinence Research Society (ICI-RS) meeting in 2018, a panel of clinicians participated in a discussion on bladder and bowel interactions in the context of pelvic organ cross-sensitization.Results: Bladder and bowel problems commonly co-occur in adults and children across different disorders, and the mechanism responsible for overlapping dysfunction is uncertain in most instances. At a neuronal level, cross-sensitization occurs as a result of afferent signaling from the LUT and lower bowel through different central and peripheral mechanisms. Studies in animals and humans have demonstrated evidence for cross-organ sensitization following experimental inflammation or distension of the lower bowel, affecting the LUT. Nerve stimulation is an effective treatment for different functional LUT and bowel disorders, and whether this treatment may influence crossorgan sensitization remains uncertain. The role of physiologically dormant C-fibers, the bladder-gut-brain axis, and gut microbiome in cross-sensitization are speculative. Conclusion: Recommendations for research were made to explore the role of cross-organ sensitization in the pathogenesis of co-occurring LUT and bowel dysfunction in humans. K E Y W O R D Sbladder pain syndrome, constipation, cross-organ, cross-talk, irritable bowel syndrome, microbiome, psychology, sensitization F I G U R E 1 Inter-relationship between disorders of the lower urinary tract and bowel. LUTS, lower urinary tract symptoms S26 |

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The effect of rectal distension on bladder function in patients with overactive bladder

Abstract: Rectal distention in patients with OAB symptoms significantly lowered bladder sensation volumes (normal desire, strong desire, and maximal capacity).

Cited by 11 publications

References 20 publications

Simultaneous urodynamic and anorectal manometry studies in children: insights into the relationship between the lower gastrointestinal and lower urinary tracts

Simultaneous urodynamic and anorectal manometry studies in children: insights into the relationship between the lower gastrointestinal and lower urinary tracts

Treatment of fecal retention is important in the management of overactive bladder in children

Bladder‐bowel interactions: Do we understand pelvic organ cross‐sensitization? International Consultation on Incontinence Research Society (ICI‐RS) 2018

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