Effects of activity dependent plasticity on recovery of bladder and sexual function after human spinal cord injury

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Abstract Bladder and bowel complications have consistently been rated as of the upmost importance by the spinal cord injury (SCI) population. Importantly, both bladder and bowel distention have been identified as primary triggers of autonomic dysreflexia (AD) in individuals with cervical and upper thoracic level lesions (majority of SCI population), a systolic blood pressure rising often more than 20 mmHg and remaining at these values with intolerable symptoms (pounding headache and/or chills, for example). We have recently documented as part of our current R01 this massive unmodulated sympathetic reflex which causes widespread vasoconstriction (presenting as severe hypertension) as a limitation for bladder capacity in numerous research participants. Anecdotally, many who use clean intermittent catheterization for bladder management report using AD symptoms daily as a signal of bladder fullness and time for emptying, an unsafe practice that needs addressing. Additionally, we and others have documented in questionnaires regular occurrences of AD symptoms during bowel programs and in ongoing lab-based studies there have been numerous instances of AD upon insertion of a rectal probe either for bladder cystometry (for recording abdominal pressure) or during anorectal manometry. The goals of the current multi-disciplinary study incorporating critical cross viscero- visceral intersystem interactions are 1) to investigate in a controlled laboratory setting and then with mobile at-home monitoring the extent, severity and frequency of occurrence of AD with respect to daily bladder and bowel function, in conjunction with identifying potential underlying mechanisms by examining urinary biomarkers for several specific vasoactive hormones, and 2) to regulate cardiovascular (CV) function therapeutically as part of bladder and bowel management using spinal cord epidural stimulation, which our CV team have shown can normalize blood pressure.