Skip to main content

The Central Nervous System and its Role in Bowel and Bladder Control


Bowel and bladder issues have been noted to be coexistent in children, and treatment of bladder symptoms without concomitant targeting of bowel issues generally leads to failure. This article explores the potential roots for this persistent connection between bowel and bladder and the role that the central nervous system plays in affecting both. An ever-increasing pool of knowledge drawn from multiple medical disciplines has provided us with a wealth of functional imaging information that is allowing us to map the areas of the brain better with regards to bowel and bladder function. We explore these new findings and attempt to connect the dots between the central nervous system bladder and bowel dysfunction.

This is a preview of subscription content, access via your institution.


Recently published papers of interest have been highlighted as • Of importance •• Of major importance

  1. Roosen A, Chapple CR, Dmochowski RR, Fowler CJ, Gratzke C, Roehrborn CG, Stief CG, Andersson KE: A refocus on the bladder as the originator of storage lower urinary tract symptoms: A systematic review of the latest literature. Eur Urol 2009

  2. Koff SA, Wagner TT, Jayanthi VR: The relationship among dysfunctional elimination syndromes, primary vesicoureteral reflux and urinary tract infections in children. J Urol 1998;160:1019–1022.

    PubMed  Article  CAS  Google Scholar 

  3. Loening-Baucke V: Urinary incontinence and urinary tract infection and their resolution with treatment of chronic constipation of childhood. Pediatrics 1997;100:228–232.

    PubMed  Article  CAS  Google Scholar 

  4. Franco I: Overactive bladder in children. Part 1: Pathophysiology. J Urol 2007;178:761–768; discussion 768.

    Google Scholar 

  5. Miyazato M, Sugaya K, Nishijima S, Ashitomi K, Ohyama C, Ogawa Y: Rectal distention inhibits bladder activity via glycinergic and gabaergic mechanisms in rats. J Urol 2004;171:1353–1356.

    PubMed  Article  Google Scholar 

  6. Fishman L, Lenders C, Fortunato C, Noonan C, Nurko S: Increased prevalence of constipation and fecal soiling in a population of obese children. J Pediatr 2004;145:253–254.

    PubMed  Article  Google Scholar 

  7. Warne SA, Godley ML, Wilcox DT: Surgical reconstruction of cloacal malformation can alter bladder function: A comparative study with anorectal anomalies. J Urol 2004;172:2377–2381; discussion 2381.

    PubMed  Article  Google Scholar 

  8. Cho SY, Oh SJ: The clinical significance of rectal contractions that occur during urodynamic studies. Neurourol Urodyn;29:418–423.

  9. Jia H, Zhang K, Zhang S, Yuan Z, Bai Y, Wang W: Quantitative analysis of sacral parasympathetic nucleus innervating the rectum in rats with anorectal malformation. J Pediatr Surg 2007;42:1544–1548.

    PubMed  Article  Google Scholar 

  10. Pezzone MA, Liang R, Fraser MO: A model of neural cross-talk and irritation in the pelvis: Implications for the overlap of chronic pelvic pain disorders. Gastroenterology 2005;128:1953–1964.

    PubMed  Article  Google Scholar 

  11. Franco I, Cagliostro, S, Collett-Gardere, T, Kearins, M, Zelkovic, P, Dyer, L, Reda, E: Treatment of lower urinary tract symptoms in children with constipation using tegaserod therapy. Urotoday International journal 2010;3:5784–5792.

    Article  Google Scholar 

  12. • Blankstein U, Chen J, Diamant NE, Davis KD: Altered brain structure in irritable bowel syndrome: Potential contributions of pre-existing and disease-driven factors. Gastroenterology;138:1783–1789. This is an excellent study revealing abnormalities in patients with IBS.

  13. Fitzgerald MP, Thom DH, Wassel-Fyr C, Subak L, Brubaker L, Van Den Eeden SK, Brown JS: Childhood urinary symptoms predict adult overactive bladder symptoms. J Urol 2006;175:989–993.

    PubMed  Article  Google Scholar 

  14. Minassian VA, Lovatsis D, Pascali D, Alarab M, Drutz HP: Effect of childhood dysfunctional voiding on urinary incontinence in adult women. Obstet Gynecol 2006;107:1247 1251.

    PubMed  Article  Google Scholar 

  15. Stone JJ, Rozzelle CJ, Greenfield SP: Intractable voiding dysfunction in children with normal spinal imaging: Predictors of failed conservative management. Urology;75:161–165.

  16. Hyde TM, Deep-Soboslay A, Iglesias B, Callicott JH, Gold JM, Meyer-Lindenberg A, Honea RA, Bigelow LB, Egan MF, Emsellem EM, Weinberger DR: Enuresis as a premorbid developmental marker of schizophrenia. Brain 2008;131:2489–2498.

    PubMed  Article  Google Scholar 

  17. Jarvelin MR, Vikevainen-Tervonen L, Moilanen I, Huttunen NP: Enuresis in seven-year-old children. Acta Paediatr Scand 1988;77:148–153.

    PubMed  Article  CAS  Google Scholar 

  18. Wang QW, Wen JG, Zhang RL, Yang HY, Su J, Liu K, Zhu QH, Zhang P: Family and segregation studies: 411 chinese children with primary nocturnal enuresis. Pediatr Int 2007;49:618–622.

    PubMed  Article  Google Scholar 

  19. von Gontard A, Schaumburg H, Hollmann E, Eiberg H, Rittig S: The genetics of enuresis: A review. J Urol 2001;166:2438–2443.

    Article  Google Scholar 

  20. •• Tadic SD, Griffiths D, Schaefer W, Cheng CI, Resnick NM: Brain activity measured by functional magnetic resonance imaging is related to patient reported urgency urinary incontinence severity. J Urol;183:221–228. This study defines the areas of the brain responsible for urgency.

  21. • Wager TD, Waugh CE, Lindquist M, Noll DC, Fredrickson BL, Taylor SF: Brain mediators of cardiovascular responses to social threat: Part i: Reciprocal dorsal and ventral sub-regions of the medial prefrontal cortex and heart-rate reactivity. Neuroimage 2009;47:821-835. This study implicates the anterior cingulate gyrus as the site responsible for autonomic control.

    PubMed  Article  Google Scholar 

  22. DasGupta R: Different brain effects during chronic and acute sacral neuromodulation in urge incontinent patients with implanted neurostimulators. BJU Int 2007;99:700.

    PubMed  Article  Google Scholar 

  23. • Dasgupta R, Critchley HD, Dolan RJ, Fowler CJ: Changes in brain activity following sacral neuromodulation for urinary retention. J Urol 2005;174:2268-2272. This study indicates that sacral nerve stimulation has some effect on brain activity.

    PubMed  Article  Google Scholar 

  24. Blok BF, Groen J, Bosch JL, Veltman DJ, Lammertsma AA: Different brain effects during chronic and acute sacral neuromodulation in urge incontinent patients with implanted neurostimulators. BJU Int 2006;98:1238–1243.

    PubMed  Article  Google Scholar 

  25. Rainville P, Duncan GH, Price DD, Carrier B, Bushnell MC: Pain affect encoded in human anterior cingulate but not somatosensory cortex. Science 1997;277:968–971.

    PubMed  Article  CAS  Google Scholar 

  26. Alonso-Alonso M, Pascual-Leone A: The right brain hypothesis for obesity. JAMA 2007;297:1819–1822.

    PubMed  Article  CAS  Google Scholar 

Download references


Dr. Israel Franco serves as a consultant for Sanofi, Novartis and Allergan, and has previously served as a consultant for Astellas Pharma and LABORIE.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Israel Franco.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Franco, I. The Central Nervous System and its Role in Bowel and Bladder Control. Curr Urol Rep 12, 153–157 (2011).

Download citation

  • Published:

  • Issue Date:

  • DOI:


  • Central nervous system
  • Bowel
  • Bladder
  • Voiding dysfunction
  • Overactive bladder
  • Pediatrics
  • Urinary tract infection
  • 5-HT4
  • Schizophrenia