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Bladder control, urgency, and urge incontinence: evidence from functional brain imaging
Derek Griffiths1, Stasa D Tadic
1Division of Geriatric Medicine and Institute on Aging, University of Pittsburgh, Pennsylvania, USA. griffithsdj@dom.pitt.edu
Neurourology and Urodynamics
|December 20, 2007
Summary
Brain imaging reveals distinct neural patterns in normal bladder control versus urge incontinence. Understanding these brain networks is key to identifying causes and developing targeted treatments for incontinence.
Area of Science:
- Neuroscience
- Urology
- Medical Imaging
Background:
- Bladder control involves complex supraspinal pathways.
- Urge incontinence is characterized by involuntary bladder contractions and a sudden, compelling need to void.
- Brain imaging offers insights into the neural mechanisms of bladder function and dysfunction.
Purpose of the Study:
- To review brain imaging studies on bladder control in healthy individuals and those with urge incontinence.
- To establish a model of supraspinal bladder control.
- To identify neural correlates of urgency and potential origins of urge incontinence.
Main Methods:
- Comprehensive review of published brain imaging studies related to urine storage.
- Secondary analysis of previously collected observational data.
Main Results:
- A model of normal urine storage involves the periaqueductal gray (PAG), insula, anterior cingulate gyrus (ACG), and prefrontal cortex.
- In urge incontinence, exaggerated cortical responses (especially ACG) occur, potentially linked to urgency.
- Detrusor overactivity (DO) in urge incontinence may be associated with prefrontal cortex deactivation.
Conclusions:
- Bladder control relies on a widespread brain network.
- Dysfunction in specific brain regions can lead to urge incontinence.
- Distinct neural patterns suggest different phenotypes of urge incontinence may require tailored treatments.
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