Spinal cord neural organization controlling the urinary bladder and striated sphincter

The storage and elimination of urine requires the coordination of activity between the autonomic nervous system (thoracolumbar sympathetic and sacral parasympathetic divisions) controlling the urinary bladder and urethra and the lumbosacral somatic motoneurons innervating the striated sphincter and pelvic floor muscles. These three efferent systems involved in the control of lower urinary tract function receive segmental sensory information from various visceral organs and the perineum, as well as inputs from supraspinal regions. Ascending and descending connections between the various spinal segments levels and supraspinal regions provide the reflex substrates participating in normal bladder continence and micturition reflexes. Many of the actions of descending and segmental reflexes are mediated by excitatory and inhibitory sacral spinal interneurons located within the region of the parasympathetic preganglionic autonomic neurons and the sphincter ventral horn motoneurons. This review will: (1) discuss the basic organization and spinal elements of the reflex pathways subserving continence and micturition; (2) describe features of the identified sacral interneuronal circuitry contributing to the control of the bladder and sphincter function; and (3) discuss how changes in the control of these reflex pathways and neurons may contribute to abnormal patterns of bladder and sphincter function commonly observed following spinal cord injury.