Disclosures Steven A. Kaplan is a consultant and a member of the speakers bureau for Pfizer. Roger Dmochowski is a consultant to Pfizer. Brooks Cash is a consultant to Pfizer. Zoe S. Kopp was an employee of Pfizer Inc during the writing of this article. Sandra J. Berriman was an employee of Pfizer Inc during the writing of this article. Vik Khullar is a consultant/investigator/speaker for Allergan, Astellas, Bioxell, Novartis and Pfizer.
Systematic review of the relationship between bladder and bowel function: implications for patient management
Article first published online: 15 FEB 2013
© 2013 Blackwell Publishing Ltd
International Journal of Clinical Practice
Volume 67, Issue 3, pages 205–216, March 2013
How to Cite
Kaplan, S. A., Dmochowski, R., Cash, B. D., Kopp, Z. S., Berriman, S. J. and Khullar, V. (2013), Systematic review of the relationship between bladder and bowel function: implications for patient management. International Journal of Clinical Practice, 67: 205–216. doi: 10.1111/ijcp.12028
- Issue published online: 15 FEB 2013
- Article first published online: 15 FEB 2013
- Paper received May 2012, accepted August 2012
Background: The complex relationship between bladder and bowel function has implications for treating pelvic disorders. In this systematic review, we discuss the relationship between bladder and bowel function and its implications for managing coexisting constipation and overactive bladder (OAB) symptoms.
Methods: Multiple PubMed searches of articles published in English from January 1990 through March 2011 were conducted using combinations of terms including bladder, bowel, crosstalk, lower urinary tract symptoms, OAB, incontinence, constipation, hypermotility, pathophysiology, prevalence, management and quality of life. Articles were selected for inclusion in the review based on their relevance to the topic.
Results: Animal studies and clinical data support bladder-bowel cross-sensitization, or crosstalk. In the rat, convergent neurons in the bladder and bowel as well as some superficial and deeper lumbosacral spinal neurons receive afferent signals from both bladder and bowel. On a functional level, in animals and humans, bowel distention affects bladder activity and vice versa. Clinically, the bladder-bowel relationship is evident through the presence of urinary symptoms in patients with irritable bowel syndrome and bowel symptoms in patients with acute cystitis. Functional gastrointestinal disorders, such as constipation, can contribute to the development of lower urinary tract symptoms, including OAB symptoms, and treatment of OAB with antimuscarinics can worsen constipation, a common antimuscarinic adverse effect. The initial approach to treating coexisting constipation and OAB should be to relieve constipation, which may resolve urinary symptoms.
Conclusions: The relationship between bladder and bowel function should be considered when treating patients with urinary symptoms, bowel symptoms, or both.