Bowel and sexual function

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PARASYMPATHETIC

Vagus -

gastric emptying, intestinal peristalsis.

gastric emptying, intestinal peristalsis.

Sacral nerve - peristalsis roots S2J,4 from descending colon to anus.

- erection, ejaculation.

NORMAL DEFAECATION

PROCESS i. Faeces arrive at rectosigmoid junction:

- cortical awareness of urge to defaecate

- release of sympathetic tone.

2. Relaxation of pelvic floor muscles and internal anal sphincter. Lowering of anorectum.

3. Voluntary opening of external anal sphincter.

4. Parasympathetic peristalsis and Valsalva manoeuvre empty the rectum.

Paracentral lobule of frontal lobe

- voluntary initiation or inhibition of defaecation.

SYMPATHETIC

Coeliac ganglion

- gastric and intestinal relaxation.

- contraction of internal anal sphincter.

- Hypogastric plexus

- inhibits erectile function

SEXUAL FUNCTION Parasympathetic:

- penile/clitoral erection. Reflex - in response to tactile stimulation of erogenous zones. Psychogenic - sexual thoughts or visual erotic stimulation.

- orgasm, ejaculation

Sympathetic:

- mainly anti-erectile action.

COMPLETE OR PARTIAL CORD LESION

Bowel atony for up to 1 week. — Faecal retention with impaction and faecal fluid overflow (spurious diarrhoea). Impaired/absent external sphincter tone becomes spastic after days or weeks. -» Regular bowel emptying reflexly in response to digital stimulation or suppositories achieves continence.

Prolonged reflex erection (priapism) may occur for 2-3 days, then:

- Erections and ejaculation lost for weeks or months, then:

- Reflex erections (only tactile) appear but reflex ejaculation seldom returns.

Fertility is impaired or lost.

Vaginal sensation and lubrication are lost. Fertility is retained.

CONUS LESION

CAUDA EQUINA LESION

Mixed upper and lower neurone pattern

Flaccid external sphincter. Faecal retention with impaction and faecal fluid overflow. Regular clearance of constipated stool by manual evacuation or Valsalva maneouvre achieves continence.

Loss of genital sensation. Loss of reflex erections and ejaculation (psychogenic erection may be retained). Male infertile; female fertility retained.

Male erections may be achieved by cavernosal blockade using intracavernosal injection of papaverine HC1.

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