Skip to main content
SpringerLink
Log in

The Conus Medullaris and Sphincter Control

  • Chapter
Book cover Spinal Cord Disease

  • 159 Accesses

Abstract

The anal and urinary sphincters are responsive to filling of the anorectum and urinary bladder respectively. The normal storage and voiding functions of these organ systems reflect their pressure/volume relationships, and the ability of the detrusor mechanisms to overcome the passive and active resistance to the passage of faeces and urine offered by the anal canal and urethra. In both systems voiding may occur in response to the activity of the smooth muscle of the anorectum and colon, and of the urinary bladder, or it may be assisted by the additional contraction of the abdominal wall. In both systems, voiding depends on the orderly relationship between detrusor mechanisms and relaxation of the smooth and striated muscular sphincters that guard the exits of the bladder and anal canal. In this review, the anatomical arrangements responsible for continence and voiding will be described, and the role of the conus region of the spinal cord will be considered in relation to disorders of its function.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  • Andrews J, Nathan P (1964) Lesions of the anterior frontal lobes and disturbances of micturition anddefaecation. Brain 87:233–262

    Article  Google Scholar 

  • Brodal A (1981) Neurological anatomy in relation to clinical medicine, 3rd edn. Oxford University Press, p 779

    Google Scholar 

  • Burnstock G (1990) Innervation of bladder and bowel. In: Bock G, Whelan J (eds) Neurobiology of incontinence. CIBA Foundation symposium 151. Wiley, Chichester, pp 2–43

    Google Scholar 

  • Carlstedt A, Nordgren S, Fasth S, Appelgren L, Hulten L (1988) Sympathetic influence on the internalanal sphincter and rectum in man. Int J Colorectal Dis 3:90–95

    Article  PubMed  CAS  Google Scholar 

  • Chokroverty S, Sachdeo R, Dilullo J, Duvoisin RC (1989) Magnetic stimulation in the diagnosis oflumbosacral radiculopathy. J Neurol Neurosurg Psychiatry 52:767–772

    Article  PubMed  CAS  Google Scholar 

  • Crowe R, Burnstock G (1989) A histochemical and immunohistochemical study of the autonomic innervation of the lower urinary tract of the female pig. Is the pig a good model for the human bladder and urethra? J Urol 141:414–422

    PubMed  CAS  Google Scholar 

  • Crowe R, Burnstock G, Light JK (1989) Adrenergic innervation of the striated muscle of the intrinsic external urethral sphincter from patients with lower motor spinal cord lesion. J Urol 141:47–49

    PubMed  CAS  Google Scholar 

  • De Groat WC (1990) Central neural control of the lower urinary tract. In: Bock G, Whelan J (eds)Neurobiology of incontinence. CIBA Foundation symposium 151. Wiley, Chichester, pp 27–56

    Google Scholar 

  • De Groat WC, Kawatani M (1985) Neural control of the urinary bladder: possible relationship betweenpeptidergic inhibitory mechanisms and detrusor instability. Neurourol Urodyn 4:285–300

    Article  Google Scholar 

  • Drife JO, Hilton P, Stanton SL (eds) (1990) Micturition. Springer-Verlag, London

    Google Scholar 

  • Duthie HL, Gairns FW (1960) Sensory nerve endings and sensation in the anal region of man. Br J Surg 47:585–590

    Article  PubMed  CAS  Google Scholar 

  • Fowler CJ, Kirby RS, Harrison WJG, Milroy ELJ, Turner-Warwick R (1984) Individual motor unit analysis in the diagnosis of disorders of urethral sphincter innervation. J Neurol Neurosurg Psychiatry 47:637–641

    Article  PubMed  CAS  Google Scholar 

  • Frenckner B, Ihre T (1976) Influence of autonomic nerves on the internal anal sphincter of man. Gut 17:306–312

    Article  PubMed  CAS  Google Scholar 

  • Fukuda H, Fukai K (1986) Location of the reflex centre for straining elicited by activation of pelvicafferent fibres of decerebrate dogs. Brain Res 380:287–296

    Article  PubMed  CAS  Google Scholar 

  • Furness JB, Costa M (1987) The enteric nervous system. Churchill Livingstone, Edinburgh

    Google Scholar 

  • Gershon MD (1990) The enteric nervous system: neurotransmitters and neuromodulators. Curr OpinNeurol Neurosurg 3:517–522

    Google Scholar 

  • Glick ME, Meshkinpour H, Haldeman S, Bhatia NN, Bradley WE (1982) Colonic dysfunction in multiplesclerosis. Gastroenterology 83:1002–1007

    PubMed  CAS  Google Scholar 

  • Gould RP (1960) Sensory innervation of the anal canal. Nature 187:337–338

    Article  Google Scholar 

  • Henry MM, Swash M (1991) Coloproctology and the pelvic floor, 2nd edn. Butterworth-Heinemann, London

    Google Scholar 

  • Ito Y, Kimoto Y (1985) The neural and non-neural mechanisms involved in urethral activity in rabbits.J Physiol (Lond) 367:57–72

    CAS  Google Scholar 

  • Kiff ES, Swash M (1984) Slowed motor conduction in the pudendal nerves in idiopathic (neurogenic)anorectal incontinence. Br Surg 71:614–616

    Article  CAS  Google Scholar 

  • Kuzuhara S, Kanazawa I, Nakanishi T (1980) Topographical localization of the Onufs nuclear neurons innervating the rectal and vesical striated sphincter muscles: a retrograde fluorescent double labelling study in cat and dog. Neurosci Lett 16:125

    Article  PubMed  CAS  Google Scholar 

  • Langley JN, Anderson HK (1895) The innervation of the pelvic and adjoining viscera. IV: the internalgenerative organs. J Physiol (Lond) 19:122–130

    Google Scholar 

  • Lubowski DZ, Nicholls RJ, Swash M, Jordan MJ (1987) Neurol control of internal anal sphincter function. Br J Surg 74:668–670

    Article  PubMed  CAS  Google Scholar 

  • Mannen T, Iwata AR, Toyokura Y, et al. (1977) Preservation of a certain motoneuron group of the sacral cord in amyotrophic lateral sclerosis: its clinical significance. J Neurol Neurosurg Psychiatry 40:464–469

    Article  PubMed  CAS  Google Scholar 

  • Mathers SE, Swash M (1990) The neurology of sphincter control mechanisms. In: Kennard C (ed) Recentadvances in clinical neurology 6. Churchill Livingstone, Edinburgh, pp 157–186

    Google Scholar 

  • Mathers SE, Ingram DA, Swash M (1990) Electrophysiology of motor pathways for sphincter control inmultiple sclerosis. J Neurol Neurosurg Psychiatry 53:955–960

    Article  PubMed  CAS  Google Scholar 

  • Merton PA, Morton HB, Hill DK, et al. (1982) Scope for a technique for electrical stimulation of humanbrain, spinal cord and muscle. Lancet ii:597–600

    Google Scholar 

  • Meunier P, Mollard P (1977) Control of the internal anal sphincter (manometric study with humansubjects). Pflugers Archivs 370:233–239

    Article  CAS  Google Scholar 

  • Miller H, Simpson CA, Yeates WK (1965) Bladder dysfunction in multiple sclerosis. Br Med J i:1265

    Article  Google Scholar 

  • Moss HE, Burnstock G (1985) A comparative study of electrical field stimulation of the guinea pig, ferretand marmoset bladder. Eur J Pharmacol 114:311–316

    Article  PubMed  CAS  Google Scholar 

  • Nakagawa S (1980) Onuf s nucleus of the sacral cord in the South American monkey (Saimiri); its location and bilateral cortical input from area 4. Brain Res 191:337–344

    Article  PubMed  CAS  Google Scholar 

  • Nathan PW, Smith MC (1953) Spinal pathways subserving defaecation. J Neurol Neurosurg Psychiatry 16:245–256

    Article  PubMed  CAS  Google Scholar 

  • Neill ME, Swash M (1980) Increased motor unit fibre density in the external anal sphincter muscle inanorectal incontinence: a single fibre EMG study. J Neurol Neurosurg Psychiatry 43:343–347

    Article  PubMed  CAS  Google Scholar 

  • Onuf (Onufrowicz) B (1900) On the arrangement and function of the cell groups of the sacral region of the spinal cord in man. Arch Neurol Psychopathol 3:387–412

    Google Scholar 

  • Percy JP, Neill ME, Swash M, Parks AG (1981) Electrophysiological study of motor nerve supply of pelvic floor. Lancet i:16–17

    Article  Google Scholar 

  • Roe AM, Bartolo DCC, Mortensen NJM (1986) A new method for assessment of anal sensation in variousanorectal disorders. Br J Surg 73:310–312

    Article  PubMed  CAS  Google Scholar 

  • Rogers J, Henry MM, Misiewicz JJ (1988) Combined sensory and motor deficit in primary neuropathicfaecal incontinence. Gut 29:5–9

    Article  PubMed  CAS  Google Scholar 

  • Roppolo JR, Nadelhaft I, De Groat WC (1985) The organization of pudendal motoneurons and primary afferent projections in the spinal cord of the rhesus monkey revealed by horseradish peroxidase. J Comp Neurol 234:475–488

    Article  CAS  Google Scholar 

  • Shepherd JJ, Wright PG (1968) The response of the internal anal sphincter in man to stimulation of thepresacral nerve. Am J Digestive Dis 13:421–427

    Article  CAS  Google Scholar 

  • Snooks SJ, Swash M (1984) Perineal nerve and transcutaneous spinal stimulation: new methods for investigation of the urethral striated sphincter musculature. Br J Urol 56:407–411

    Google Scholar 

  • Snooks SJ, Swash M (1986) The innervation of the muscles of continence. Ann R Coll Surg Engl 68:406–409

    Google Scholar 

  • Speakman MJ, Walmsley D, Brading AF (1989) An in vitro pharmacological study of the human trigone -a site of non-adrenergic, non-cholinergic neurotransmission. Br J Urol 61:304–309

    Article  Google Scholar 

  • Stelzner F (1960) Uber die Anatomie des analen Sphincterorgans wie sie der Chirurg sieht. Z Anat Entwicklung 121:525–535

    Article  CAS  Google Scholar 

  • Sung JH, Mastri AR, Segal E (1979) Pathology of the Shy-Drager syndrome. J Neuropathol Exp Neurol 38:353–367

    Article  PubMed  CAS  Google Scholar 

  • Swash M (1982) Early and late components in the human anal reflex. J Neurol Neurosurg Psychiatry 45:767–769

    Article  PubMed  CAS  Google Scholar 

  • Swash M (1990) The neurogenic hypothesis of stress incontinence. In: Bock G, Whelan J (eds) Neurobiology of incontinence. CIBA Foundation symposium 151. Wiley, Chichester, pp 156–169

    Google Scholar 

  • Swash M, Mathers S (1989) Sphincter disorders and the nervous system. In: Aminoff M (ed) Neurologyand general medicine. Churchill Livingstone, New York, pp 449–470

    Google Scholar 

  • Swash M, Snooks SJ (1986) Slowed motor conduction in lumbo-sacral nerve roots in cauda equinalesions; a new diagnostic technique. J Neurol Neurosurg Psychiatry 46:808–816

    Article  Google Scholar 

  • Swash M, Gray A, Lubowski DZ, Nicholls RJ (1986) Ultrastructural changes in internal anal sphincter inneurogenic faecal incontinence. Gut 29:1692–1698

    Article  Google Scholar 

  • Swash M, Snooks SJ, Chalmers DHK (1987) Parity as a factor in incontinence in multiple sclerosis. Arch Neurol 44:504–508

    PubMed  CAS  Google Scholar 

  • Thuneberg L (1982) Interstitial cells of Cajal: intestinal pacemaker? Adv Anat Embryol Cell Biol 71:1–130

    PubMed  CAS  Google Scholar 

  • Vodusek DB, Janko M, Lokar J (1983) Direct and reflex responses in perineal muscles on electrical stimulation. J Neurol Neurosurg Psychiatry 46:67–71

    Article  PubMed  CAS  Google Scholar 

Download references

Authors
  1. M. Swash
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Neurology, Royal Preston Hospital, Sharoe Green Lane, Preston, PR2 4HT, UK

    Edmund Critchley DM, FRCP

  2. Vancouver General Hospital, 855 West 12th Avenue, Vancouver, BC, V5Z 1M9, Canada

    Andrew Eisen MD, FRCP(C)

Rights and permissions

Reprints and permissions

Copyright information

© 1997 Springer-Verlag London Limited

About this chapter

Cite this chapter

Swash, M. (1997). The Conus Medullaris and Sphincter Control. In: Critchley, E., Eisen, A. (eds) Spinal Cord Disease. Springer, London. https://doi.org/10.1007/978-1-4471-0911-2_22

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-0911-2_22

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-1233-4

  • Online ISBN: 978-1-4471-0911-2

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation