Cross-organ sensitization between the colon and bladder: to pee or not to pee?

Chronic abdominal and pelvic pain are common debilitating clinical conditions experienced by millions of patients around the globe. The origin of such pain commonly arises from the intestine and bladder, which share common primary roles (the collection, storage, and expulsion of waste). These visceral organs are located in close proximity to one another and also share common innervation from spinal afferent pathways. Chronic abdominal pain, constipation, or diarrhea are primary symptoms for patients with irritable bowel syndrome or inflammatory bowel disease. Chronic pelvic pain and urinary urgency and frequency are primary symptoms experienced by patients with lower urinary tract disorders such as interstitial cystitis/painful bladder syndrome. It is becoming clear that these symptoms and clinical entities do not occur in isolation, with considerable overlap in symptom profiles across patient cohorts. Here we review recent clinical and experimental evidence documenting the existence of “cross-organ sensitization” between the colon and bladder. In such circumstances, colonic inflammation may result in profound changes to the sensory pathways innervating the bladder, resulting in severe bladder dysfunction.

Download Full-text

Pelvic Pain and Floor Dysfunction

10.1093/med/9780199350940.003.0024 ◽

2018 ◽

Author(s):

Danielle Sarno ◽

Farah Hameed

Keyword(s):

Physical Therapy ◽

Pelvic Floor ◽

Pelvic Pain ◽

Multidisciplinary Approach ◽

Rehabilitation Program ◽

Painful Bladder ◽

Integral Role ◽

Comprehensive Rehabilitation ◽

Irritable Bowel ◽

Tract Infections

Chronic pelvic pain is defined as persistent pain perceived in structures related to the anatomic pelvis (lower abdomen below the umbilicus) of either women or men for greater than 6 months. The etiology may be related to gynecologic, urologic, gastrointestinal, musculoskeletal, and neurologic causes. Pelvic pain and floor dysfunction often are associated with a musculoskeletal disorder related to the pelvic girdle, spine, or hip. Myofascial pelvic pain may be related to other diagnoses, such as depression, irritable bowel syndrome, endometriosis, constipation, painful bladder syndrome, and chronic urinary tract infections. A thorough history and clinical examination, including an internal pelvic floor musculoskeletal examination, can help identify the underlying etiology. A multidisciplinary approach to management is essential. Pelvic floor physical therapy plays an integral role. Other treatments, such as medications, complementary therapies, and injections, may be used in conjunction with physical therapy to facilitate a comprehensive rehabilitation program and manage symptoms.

Download Full-text

An Interdisciplinary Approach to Endometriosis-associated Persistent Pelvic Pain

Journal of Endometriosis and Pelvic Pain Disorders ◽

10.5301/jeppd.5000284 ◽

2017 ◽

Vol 9 (2) ◽

pp. 77-86 ◽

Cited By ~ 4

Author(s):

Catherine Allaire ◽

Tuba Aksoy ◽

Mohamed Bedaiwy ◽

Susannah Britnell ◽

Heather L. Noga ◽

...

Keyword(s):

Pelvic Pain ◽

Chronic Pelvic Pain ◽

Myofascial Pain ◽

Interdisciplinary Approach ◽

Challenging Problem ◽

Central Sensitisation ◽

Peripheral Pain ◽

Painful Bladder ◽

Irritable Bowel

Endometriosis-associated pelvic pain is a common and often challenging problem. For certain patients, pain persists or recurs despite adequate medical or surgical therapy targeted to endometriosis. In this patient population, there is often the presence of coexisting pain conditions such as irritable bowel syndrome, painful bladder syndrome and myofascial pain as well central sensitisation. An interdisciplinary approach where both peripheral pain triggers and central sensitization are addressed is likely to lead to improved pain and quality of life. The approach to the evaluation and treatment of the patients with persistent/chronic pelvic pain and endometriosis is outlined in this article.

Download Full-text

Acute abdominal and pelvic pain in pregnancy: ESUR recommendations

European Radiology ◽

10.1007/s00330-013-2987-7 ◽

2013 ◽

Vol 23 (12) ◽

pp. 3485-3500 ◽

Cited By ~ 50

Author(s):

Gabriele Masselli ◽

◽

Lorenzo Derchi ◽

Josephine McHugo ◽

Andrea Rockall ◽

...

Keyword(s):

Pelvic Pain ◽

Abdominal And Pelvic Pain ◽

In Pregnancy

Download Full-text

Diagnostic Laparoscopy and Adhesiolysis: Does It Help with Complex Abdominal and Pelvic Pain Syndrome (CAPPS) in General Surgery?

JSLS Journal of the Society of Laparoendoscopic Surgeons ◽

10.4293/108680810x12924466008925 ◽

2011 ◽

Vol 15 (1) ◽

pp. 1-5 ◽

Cited By ~ 9

Author(s):

Gregory D. McClain ◽

Jay A. Redan ◽

Steven D. McCarus ◽

Aileen Caceres ◽

John Kim

Keyword(s):

Pelvic Pain ◽

General Surgery ◽

Diagnostic Laparoscopy ◽

Pain Syndrome ◽

Pelvic Pain Syndrome ◽

Abdominal And Pelvic Pain

Download Full-text

Irritable Bowel Syndrome: Methods, Mechanisms, and Pathophysiology. Neural and neuro-immune mechanisms of visceral hypersensitivity in irritable bowel syndrome

AJP Gastrointestinal and Liver Physiology ◽

10.1152/ajpgi.00542.2011 ◽

2012 ◽

Vol 302 (10) ◽

pp. G1085-G1098 ◽

Cited By ~ 79

Author(s):

Bin Feng ◽

Jun Ho La ◽

Erica S. Schwartz ◽

G. F. Gebhart

Keyword(s):

Irritable Bowel Syndrome ◽

Chronic Conditions ◽

Mononuclear Phagocytes ◽

Mechanical Stimuli ◽

Considerable Evidence ◽

Long Term Changes ◽

Painful Bladder ◽

Irritable Bowel ◽

Afferent Innervation

Irritable bowel syndrome (IBS) is characterized as functional because a pathobiological cause is not readily apparent. Considerable evidence, however, documents that sensitizing proinflammatory and lipotoxic lipids, mast cells and their products, tryptases, enteroendocrine cells, and mononuclear phagocytes and their receptors are increased in tissues of IBS patients with colorectal hypersensitivity. It is also clear from recordings in animals of the colorectal afferent innervation that afferents exhibit long-term changes in models of persistent colorectal hypersensitivity. Such changes in afferent excitability and responses to mechanical stimuli are consistent with relief of discomfort and pain in IBS patients, including relief of referred abdominal hypersensitivity, upon intra-rectal instillation of local anesthetic. In the aggregate, these experimental outcomes establish the importance of afferent drive in IBS, consistent with a larger literature with respect to other chronic conditions in which pain is a principal complaint (e.g., neuropathic pain, painful bladder syndrome, fibromyalgia). Accordingly, colorectal afferents and the environment in which these receptive endings reside constitute the focus of this review. That environment includes understudied and incompletely understood contributions from immune-competent cells resident in and recruited into the colorectum. We close this review by highlighting deficiencies in existing knowledge and identifying several areas for further investigation, resolution of which we anticipate would significantly advance our understanding of neural and neuro-immune contributions to IBS pain and hypersensitivity.

Download Full-text

The prevalence of chronic pelvic pain and irritable bowel syndrome in two university clinics

Journal of Psychosomatic Obstetrics & Gynecology ◽

10.1080/0167482x.1991.11742721 ◽

1991 ◽

Vol 12 (sup1) ◽

pp. 65-75 ◽

Cited By ~ 38

Author(s):

E. A. Walker ◽

W. J. Katon ◽

J. Jemelka ◽

H. Alfrey ◽

M. Bowers ◽

...

Keyword(s):

Irritable Bowel Syndrome ◽

Pelvic Pain ◽

Chronic Pelvic Pain ◽

Irritable Bowel

Download Full-text

Octreotide reduces perception of rectal electrical stimulation by spinal afferent pathway inhibition

AJP Gastrointestinal and Liver Physiology ◽

10.1152/ajpgi.1995.269.6.g821 ◽

1995 ◽

Vol 269 (6) ◽

pp. G821-G826 ◽

Cited By ~ 4

Author(s):

W. D. Chey ◽

A. Beydoun ◽

D. J. Roberts ◽

W. L. Hasler ◽

C. Owyang

Keyword(s):

Electrical Stimulation ◽

Evoked Potentials ◽

Evoked Potential ◽

Double Blind ◽

Afferent Pathways ◽

Normal Volunteers ◽

Site Of Action ◽

Cerebral Evoked Potentials ◽

Pathway Inhibition ◽

Irritable Bowel

Octreotide reduces perception of rectal distension in normal volunteers and irritable bowel patients. To localize octreotide's site of action, perceptual and evoked potential responses to rectal electrical stimulation were tested in seven normal volunteers after double-blind octreotide (100 micrograms 2) or placebo. After octreotide, the currents needed to elicit threshold perception of square-wave impulses delivered to the rectum were 29% higher than after placebo. When electrical stimulation was delivered at constant currents 50% above threshold, rectal perception scores were significantly reduced after octreotide compared with placebo. Rectal electrical stimulation led to characteristic and reproducible cerebral evoked potentials. Octreotide had no effect on latencies, but reduced peak-to-peak amplitudes by 35% compared with placebo. Rectal electrical stimulation also led to characteristic and reproducible spinal evoked potentials. Octreotide had no effect on spinal latencies, but reduced peak-to-peak amplitudes by 51%. In conclusion, octreotide reduces perception of rectal electrical stimulation, which is associated with inhibition of cerebral and spinal evoked potential amplitude, indicating effects on spinal afferent pathways.

Download Full-text

Interstitial Cystitis/Bladder Pain Syndrome

Seminars in Reproductive Medicine ◽

10.1055/s-0038-1676089 ◽

2018 ◽

Vol 36 (02) ◽

pp. 123-135 ◽

Cited By ~ 2

Author(s):

Ioana Marcu ◽

E. Campian ◽

Frank Tu

Keyword(s):

Interstitial Cystitis ◽

Pelvic Pain ◽

Pain Syndrome ◽

Bladder Pain Syndrome ◽

Bladder Pain ◽

Painful Bladder ◽

Bladder Symptoms ◽

The Many ◽

American Urological Association ◽

Underlying Pathophysiology

AbstractInterstitial cystitis/bladder pain syndrome is an uncommon but potentially devastating pelvic pain disorder affecting both women and men. This condition is often confusable and comorbid with other pelvic pain disorders. Although our understanding of the underlying pathophysiology is growing, the exact longitudinal course by which peripheral and central aberrations involving the bladder mucosa, peripheral inflammation, and central dysregulation of bladder sensitivity create painful bladder symptoms remains an area in need of further study. Only a limited number of drugs have been approved for treatment by the Food and Drug Administration, and overall durable efficacy of the many treatments reviewed in recent American Urological Association guidelines remains suboptimal, making awareness, early diagnosis, and use of effective treatments early in the disease course, where neural changes may still be reversible, imperative.

Download Full-text