Highlights
- •Central nervous control of bladder function
- •Differential processing of Aδ and C fibre input from the bladder by the central nervous system
- •Regulation of the micturition circuitry during sleep and wakefulness
- •Long term impact of psychosocial stress on bladder function – epigenetic and environmental effects
Abstract
Afferent input from Aδ and C-fibres innervating the urinary bladder are processed
differently by the brain, and have different roles in signaling bladder sensation.
Aδ fibres that signal bladder filling activate a spino-bulbo-spinal loop, which relays
in the midbrain periaqueductal grey (PAG) and pontine micturition centre (PMC). The
excitability of this circuitry is regulated by tonic GABAergic inhibitory processes.
In humans and socialised animals micturition is normally under volitional control
and influenced by a host of psychosocial factors. Higher nervous decision-making in
a social context to ‘go now’ or ‘do not go’ probably resides in frontal cortical areas,
which act as a central control switch for micturition. Exposure to psychosocial stress
can have profoundly disruptive influence on the process and lead to maladaptive changes
in the bladder. During sleeping the voiding reflex threshold appears to be reset to
a higher level to promote urinary continence.
Under physiological conditions C-fibre bladder afferents are normally silent but are
activated in inflammatory bladder states and by intense distending pressure. Following
prolonged stimulation visceral nociceptors sensitise, leading to a lowered threshold
and heightened sensitivity. In addition, sensitization may occur within the central
pain processing circuitry, which outlasts the original nociceptive insult. Visceral
nociception may also be influenced by genetic and environmental influences. A period
of chronic stress can produce increased sensitivity to visceral pain that lasts for
months. Adverse early life events can produce even longer lasting epigenetic changes,
which increase the individual's susceptibility to developing visceral pain states
in adulthood.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: February 06, 2016
Accepted:
February 1,
2016
Received in revised form:
August 17,
2015
Received:
February 16,
2015
Identification
Copyright
© 2016 Elsevier B.V. All rights reserved.
