title: Systematic review of the relationship between bladder and bowel function: implications for patient management.
abstract: 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.
authors: Weill Cornell Medical College, Cornell University, New York, NY 10021, USA. kaplans@med.cornell.edu
authors: S A
authors: SA
authors: Kaplan
authors: R
authors: R
authors: Dmochowski
authors: B D
authors: BD
authors: Cash
authors: Z S
authors: ZS
authors: Kopp
authors: S J
authors: SJ
authors: Berriman
authors: V
authors: V
authors: Khullar
mesh_terms: D000328:Adult; D000818:Animals; D059350:Chronic Pain / Q000150:complications / Q000628:therapy; D003248:Constipation / Q000150:complications / Q000628:therapy*; D005242:Fecal Incontinence / Q000150:complications / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D056887:Pelvic Organ Prolapse / Q000150:complications / Q000628:therapy; D017699:Pelvic Pain / Q000150:complications / Q000628:therapy; D011817:Rabbits; D051381:Rats; D017207:Rats, Sprague-Dawley; D017208:Rats, Wistar; D053201:Urinary Bladder, Overactive / Q000150:complications / Q000628:therapy*; D014549:Urinary Incontinence / Q000150:complications / Q000628:therapy; D055815:Young Adult