Chapter 19 - Mechanisms of Action of Sacral Nerve and Peripheral Nerve Stimulation for Disorders of the Bladder and Bowel

Abstract

Neuromodulation elicited by electrical stimulation of peripheral or spinal nerves is a US Food and Drug Administration–approved therapy for treating several disorders of the pelvic viscera. Although the detailed mechanisms underlying the effects of neuromodulation are still to be elucidated, it is generally believed that its beneficial effects are due to activation of somatic afferent nerves, which induces the release of neurotransmitters in the central nervous system, leading to modulation of abnormal visceral sensory and motor mechanisms. Studies in animals have revealed that different types of neuromodulation act by releasing different inhibitory and excitatory neurotransmitters. This chapter will provide a summary of neural control of the lower urinary tract and distal bowel, the clinical use of neuromodulation for the treatment of bladder and bowel dysfunctions, putative mechanisms of action of neuromodulation based on animal studies and new experimental approaches using combination therapies to improve the efficacy of neuromodulation.