Abstract
Facilitation is defined as the biasing of the cord by the passage of a train of afferent impulses so that the reflex effect of a simultaneously or consecutively applied stimulus is enhanced. The tendency to facilitation is increased as a result of cord transection.
The urinary bladder is unique in that during filling, afferent impulses produced by stretching of the detrusor constantly increase in frequency. As a result, accommodation, as to a steady stimulus, does not occur. The effects are widespread in the somatic and autonomic nervous systems. Voiding may be prevented by excessive sphincter contraction and excessive autonomic phenomena may occur. Facilitation thus leads to the obliteration of reciprocal action between bladder and sphincter upon which voiding depends.
Artificial stimulation of the filled bladder further enhances facilitation and this may explain the shortcomings of such procedures.
The most logical approach to neurogenic bladder management is to suppress the tendency of the spinal cord to facilitate, by pharmacological means, if possible.
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Abramson, A., Roussan, M. The role of spinal cord facilitation in neurogenic bladder function. Spinal Cord 11, 125–131 (1973). https://doi.org/10.1038/sc.1973.15
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DOI: https://doi.org/10.1038/sc.1973.15