Role of Pelvic Organ Crosstalk in Dysfunction of the Bowel and Bladder

The distal large bowel and urinary bladder are contiguous pelvic organs that share a common embryological origin with potential interaction in health and disease. Literature on the subject remains disorganized and largely unrecognized by clinical guidelines. Understanding this interaction could potentially improve patient outcomes.

The bladder and bowel interact by several mechanisms that can be broadly classified as peripheral neural, spinal central, supraspinal central, and non-neuronal. In vivo studies show that experimental insults in one organ induce changes in behavior of the other. Laboratory studies have better defined the pathways that underlie these interactions. Clinical data shows an association between bowel and bladder symptoms in a wide spectrum of patient populations. Management of these bowel symptoms could potentially improve lower urinary tract symptoms in the clinical setting. Current clinical guidelines, such as the American Urological Association Guidelines for Overactive Bladder, European Society of Pediatric Urology Guidelines for Pediatric Neurogenic Bladder, European Association of Urology Neuro-Urology Guidelines, or the UK National Institute for Health and Care Excellence Guidelines on Urinary Incontinence and Pelvic Organ Prolapse, need to take better cognizance of this relationship.

Dysfunctions of the bowel and bladder commonly co-exist. While this interaction occurs at multiple levels, much work remains to be done to improve our understanding especially with regard to management of bowel dysfunction to specifically improve lower urinary tract symptoms.