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Myofascial and Visceral Pain Syndromes: Visceral-Somatic Pain Representations
Published in Robert M. Bennett, The Clinical Neurobiology of Fibromyalgia and Myofascial Pain, 2020
The urogenital [pelvic] floor is innervated by the sympathetic, parasympathetic, and somatic nervous systems. The sympathetic and parasympathetic [pelvic splanchnic nerve] nervous system input is through the inferior hypogastric plexus. Somatic innervation is through the sacral spinal cord. The pudendal nerve receives sympathetic fibers in addition to somatic nerves. It innervates the penis or clitoris, the anal canal, the urethral sphincter, and anterior perineal muscles. The posterior pelvic floor musculature is innervated by the coccygeal plexus. There is an overlap of pelvic splanchnic nerve and pudendal nerve afferent input in the spinal cord, such that stimulation of one area of the urogenital floor can influence the output to another area (32). Thus, persons with urogenital pain syndromes complain about bowel and bladder dysfunction, sexual dysfunction, and show increased pelvic floor muscle tone or develop pelvic floor TrPs, and a global dysfunction of the pelvic region is often seen clinically [IBS, IC, dyspareunia]. The urogenital pain syndromes that are commonly seen include vulvodynia [which is associated with a profound hyperalgesia as shown by the stabbing neuropathic-like pain associated with touching the vulva with a moist cotton swab], testicular pain [orchialgia], urethral syndrome [urgency, frequency, dysuria, and regional pain, similar to IC], and prost-atodynia [accounting for 30 percent of patients with prostatitis, often associated with pelvic floor muscle pain] (32).
Neurological Disorders
Published in Linda Cardozo, Staskin David, Textbook of Female Urology and Urogynecology - Two-Volume Set, 2017
Ricardo R. Gonzalez, Edward J. Sanchez, David Goldfarb, Renuka Tyagi, Alexis E. Te
to understAnd the pAthophysiology of eAch pAtient's condition [123,124]. With cervicAl or thorAcic spinAl cord lesions, the most common outcome will be Do with DsD. sAcrAl spinAl cord injuries Are commonly AssociAted with Du, Although this mAy Also be seen with higher-level lesions. Injuries of the lumbAr spine Are more difficult to predict, with lower Urinary trAct dysfunction rAnging from Do with DsD, or Do with sphincter deficiency, to Du. The finAl phAse following sCI is lAbeled the stAble phAse And by definition is the period chArActerized by the Absence of AdditionAl neurologicAl recovery or chAnge in urodynAmic pAttern [1]. Although the pAttern of voiding pAthology remAins stAble, there cAn be An increAse in the severity of the dysfunction And/or A continued loss of compliAnce. Therefore, it is criticAl to continue periodic evAluAtion of lower Urinary trAct function And surveillAnce of the upper Urinary trAct for further sequelAe. The level of spinAl lesion And its relAtionship to lower Urinary trAct dysfunction hAve been documented And evAluAted in 489 consecutive pAtients presenting with sCI [123]. In 104 pAtients with cervicAl sCI, 15% (16 pAtients) hAd Du. In the remAining 85% (88 pAtients), involuntAry detrusor
Urinary Incontinence
Published in David M. Luesley, Mark D. Kilby, Obstetrics & Gynaecology, 2016
Dudley Robinson, Linda Cardozo
A detrusor contraction is initiated in the rostral pons. Efferent pathways emerge from the sacral spinal cord as the pelvic parasympathetic nerves (S2, S3, S4) and run forwards to the bladder. Whilst preganglionic neurotransmission is predominantly mediated by acetylcholine acting on nicotinic receptors transmission may also be modulated by adrenergic, muscarinic, purinergic and peptidergic presynaptic receptors.
The influence of level of spinal cord injury on adipose tissue and its relationship to inflammatory adipokines and cardiometabolic profiles
Published in The Journal of Spinal Cord Medicine, 2018
Gary J. Farkas, Ashraf S. Gorgey, David R. Dolbow, Arthur S. Berg, David R. Gater
Spinal cord injury (SCI) can be classified according to level of injury (LOI) as tetraplegia (TSCI), which involves neurologic insult to the cervical spinal cord, or paraplegia (PSCI), involving injury to either the thoracic, lumbar, or sacral spinal cord. It is well documented that following the injury as a result of neurological dysfunction there are drastic alterations in body composition and cardiometabolic profiles.1,2 Previous research demonstrated that those with SCI are at increased risk for hypertension, carbohydrate and lipid dysfunction, and systemic inflammation.1–4 Greater reductions of lean body mass (LBM) are observed with higher LOI which leads to reductions in energy expenditure and a state of positive energy balance ultimately contributing to a state of obesity. Collectively, these are thought to contribute to the higher prevalence of type-two diabetes mellitus (T2DM) and cardiovascular disease found in the SCI population.1–4 Two studies reported controversial findings regarding the influence of LOI of obesity: a preliminary report showed that LOI does not influence the distribution of adipose tissue between TSCI and PSCI,5 while a second study by Inskip et al.6 noted that in rat model one month after the injury central adiposity increased in rats with T3, but not in T10 SCI. Previous findings have suggested that LOI influences metabolic profiles;5,7–10 however, the role of adipose tissue and its secretory products on these profiles remains poorly understood.
Genital vibration for sexual function and enhancement: a review of evidence
Published in Sexual and Relationship Therapy, 2018
Jordan E. Rullo, Tierney Lorenz, Matthew J. Ziegelmann, Laura Meihofer, Debra Herbenick, Stephanie S. Faubion
Efferent neuronal signals originating from the spinal cord result in predictable changes in sexual physiology (e.g. erection, ejaculation, orgasm) (Everaert et al., 2010; Steers, 2000). It is hypothesized that, by stimulating spinal reflexes, vibratory stimulation can be used to promote normal sexual function (Nelson, Ahmed, Valenzuela, Parker, & Mulhall, 2007). For instance, the bulbocavernosus reflux results from stimulation of the DNP or other distal pudendal branches. Afferent signals traveling to the sacral spinal cord via the PN are integrated within Onuf's nucleus, and subsequent efferent output from both autonomic and somatic neurons results in rhythmic contraction of the bulbospongiosus and ischiocavernosus muscles. This reflex contributes not only to penile rigidity and tumescence but also to ejaculatory function (Granata et al., 2013; Steers, 2000). Clinically, this reflex is utilized to ascertain the integrity of the sacral spinal cord and is elicited in males by squeezing the glans penis and observing contraction of the anal musculature. While higher level processes including signals from the cerebral cortex play an important role in normal sexual function, reflexes such as the bulbocavernosus reflex help explain why digital (hand), oral, vaginal, and vibratory stimulation have a major role in eliciting erections as well.
Disruption of the network between Onuf’s nucleus and myenteric ganglia, and developing Hirschsprung-like disease following spinal subarachnoid haemorrhage: an experimental study
Published in International Journal of Neuroscience, 2019
Ozgur Caglar, Binali Firinci, Mehmet Dumlu Aydin, Erdem Karadeniz, Ali Ahiskalioglu, Sare Altas Sipal, Murat Yigiter, Ahmet Bedii Salman
According to the classic understanding of the autonomic innervation of human in the lower abdomen, parasympathetic ganglion cells are located near the pelvic viscera and in the pelvic plexus, whereas sympathetic ganglion cells exist along the lumbar and sacralsympathetic trunks [11]. Affection of these nerves lead to sexual and sphincter dysfunction in human [11]. This dysfunction seems to be dependent to damage to the hypogastric nervous plexus. The superior and inferior hypogastric plexuses receive input from sympathetic preganglionic fibres whose cell bodies reside in the intermediolateral cell columns of the lower spinal cord. Same mechanism may be responsible in Hirschprung Disease. The superior and inferior hypogastric plexuses receive input from sympathetic preganglionic fibres whose cell bodies reside in the intermediolateral cell columns of the lower spinal cord [12] or the sacral spinal cord. This cell group was first described in 1899 by Onufrowicz and became as known as Onuf's nucleus. These efferent, preganglionic fibres first leave the spinal cord via the ventral roots of spinal nerves and exit the spinal nerves via the white rami communicantes into the lumbosacral sympathetic chain [12]. Onuf’s nucleus is localized mainly in S3–4 segments. It is composed of organized medium-sized neurons and located in the ventrolateral aspect of the ventral horn of the first sacral segment. Onuf’s nucleus has different cortical afferent connections with contralateral corticospinal tract fibres [13] and contains motorneurons that innervate the pelvic floor muscles, including the external urethral and anal sphincters, and manage micturition, vomiting, defecation, and parturition reflexes [14].