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  • Review Article
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Neural control of micturition in humans: a working model

Nature Reviews Urology volume 12, pages 695–705 (2015)Cite this article

Subjects

Key Points

  • Neural control of the bladder is complex, but many aspects can be accounted for by a simple working model

  • In this model, a few forebrain circuits, acting on the midbrain, can advance or delay the triggering of the voiding reflex and generate bladder sensations, such as desire to void

  • Understanding these circuits might, in the future, offer a new route to more effective treatments of urgency incontinence or overactive bladder

  • This new knowledge might shift clinical attention toward behavioural and/or electrophysiological treatments, or even direct stimulation of the deep brain

Abstract

Results from functional brain scanning have shown that neural control of the bladder involves many different regions. Yet, many aspects of this complex system can be simplified to a working model in which a few forebrain circuits, acting mainly on the midbrain periaqueductal grey (PAG), advance or delay the triggering of the voiding reflex and generate bladder sensations according to the volume of urine in the bladder, the safety of voiding and the emotional and social propriety of doing so. Understanding these circuits seems to offer a route to treatment of conditions, such as urgency incontinence or overactive bladder, in patients without overt neurological disease. Two of these circuits include, respectively, the medial prefrontal cortex and the parahippocampal complex, as well as the PAG. These circuits belong to a well-known network that is active at rest and deactivated when attention is required. Another circuit, comprising the insula and the midcingulate or dorsal anterior cingulate cortex, is activated by bladder filling and belongs to a salience network that generates sensations such as the desire to void. Behavioural treatments of urgency incontinence lead to changes in brain function that support the working model and suggest the mechanism of this type of treatment.

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Figure 1: Simple working model of LUT control.
Figure 2: Brain activity during pelvic floor muscle contractions.
Figure 3: Brain responses to bladder filling.
Figure 4: Responses to bladder filling in women with UUI.

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Acknowledgements

The author acknowledges the indispensable help of his colleagues, especially Dr Stasa Tadic, Dr Neil Resnick and Professor Clare Fowler, in developing—over many years—the ideas put forward in this Review.

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  1. Division of Geriatric Medicine and Institute on Aging, University of Pittsburgh, Kaufmann Medical Building, Suite 500, 3471 Fifth Avenue, Pittsburgh, 15213, PA, USA

    Derek Griffiths

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Correspondence to Derek Griffiths.

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D.G. declares that he has acted as a consultant for J & J and Laborie Medical.

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Griffiths, D. Neural control of micturition in humans: a working model. Nat Rev Urol 12, 695–705 (2015). https://doi.org/10.1038/nrurol.2015.266

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