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Am J Physiol Regul Integr Comp Physiol. 2010 Aug;299(2):R416-38. doi: 10.1152/ajpregu.00111.2010. Epub 2010 May 19.

Neural control of the female urethral and anal rhabdosphincters and pelvic floor muscles.

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1
Urogenix, Inc., Durham, North Carolina, USA. karl.thor@urogenix.com

Abstract

The urethral rhabdosphincter and pelvic floor muscles are important in maintenance of urinary continence and in preventing descent of pelvic organs [i.e., pelvic organ prolapse (POP)]. Despite its clinical importance and complexity, a comprehensive review of neural control of the rhabdosphincter and pelvic floor muscles is lacking. The present review places historical and recent basic science findings on neural control into the context of functional anatomy of the pelvic muscles and their coordination with visceral function and correlates basic science findings with clinical findings when possible. This review briefly describes the striated muscles of the pelvis and then provides details on the peripheral innervation and, in particular, the contributions of the pudendal and levator ani nerves to the function of the various pelvic muscles. The locations and unique phenotypic characteristics of rhabdosphincter motor neurons located in Onuf's nucleus, and levator ani motor neurons located diffusely in the sacral ventral horn, are provided along with the locations and phenotypes of primary afferent neurons that convey sensory information from these muscles. Spinal and supraspinal pathways mediating excitatory and inhibitory inputs to the motor neurons are described; the relative contributions of the nerves to urethral function and their involvement in POP and incontinence are discussed. Finally, a detailed summary of the neurochemical anatomy of Onuf's nucleus and the pharmacological control of the rhabdosphincter are provided.

PMID:
20484700
PMCID:
PMC2928615
DOI:
10.1152/ajpregu.00111.2010
[Indexed for MEDLINE]
Free PMC Article
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