Restoring pelvic function
Bladder, bowel and sexual function are affected in almost all people with a spinal cord injury. We know improving or restoring these functions is a very high priority for them, whether they have a complete or incomplete injury, and regardless of injury level. From a medical point of view, bladder and bowel dysfunction can be reasonably managed but from an individual person’s perspective it remains extremely unsatisfactory.
What You're Funding
As part of our major initiative to bring together a community of academic and clinical expertise and resources to tackle unmet priority needs for people with spinal cord injury, we are currently supporting two pre-clinical projects and two recent clinical projects involving bladder, bowel and sexual function. Because the neural circuits that modulate bladder, bowel and sexual functions are integrated and interact with one another we can study these functions in parallel.
Professor Liz Bradbury (King's College London): Novel regenerative therapies for restoring sensory function, in collaboration with Cambridge University and University College London
With recent advances in experimental regenerative strategies, we believe that restoration of sensation through axonal regeneration is achievable and will be translatable. To date, these approaches have mostly been applied to upper and lower limb function. This project, however, aims to develop therapeutic strategies for achieving long distance regeneration and reinnervation of sensory pathways of the bladder, bowel and genitalia - with the goal of restoring and improving these functions.
This project will initially determine how the bladder, perineal and genital sensory pathways are disrupted after injury to assess function and map anatomical pathways. Then the project will turn to the application of therapeutics with the aim of restoring function, building on from previous studies that only focussed on restoring sensory function to the upper limb. The initial studies in rodents will later be translated to canines and integrated with the parallel study on neuromodulation devices and methodology developed by Dr Ichiyama's groups below. The aim is to develop integrated regenerative-neuromodulatory therapeutics for restoring bladder, bowel and sexual function in humans.
Dr Ronaldo Ichiyama (Leeds University): Developing epidural electrical stimulation for bladder control: animal model
The overall aim of this research is to test the effectiveness of epidural electrical stimulation on the recovery of bladder function in the post-acute and/or chronic stages after a severe spinal cord injury. First, the group will develop a new training catheter, which, through novel instrumentation, will also allow for simultaneous recording of bladder pressure and external urethral sphincter contractions. Next, the group will determine the effects epidural electric stimulation has on the recovery of micturition following severe spinal cord injury. The aim is to develop a targeted rehabilitation protocol which combines the use of the above-mentioned catheter and epidural electric stimulation to recover bladder function following a severe spinal cord injury.
The initial studies in rodents will later be translated to canines and integrated with the parallel study on novel regeneration therapies for restoring sensory function by Professory Bradbury above. The aim again is to develop integrated regenerative-neuromodulatory therapeutics for restoring bladder, bowel and sexual function in humans.
Sarah Knight (London Spinal Cord Injury Centre): Promoting restoration of function of co-ordinated bladder storage and voiding
This collaborative project will, for the first time, use a combination of bladder training programs and spinal cord stimulation to promote restoration of complete bladder function to restore continence and improve voluntary control over voiding. Previous research in spinal cord injury has shown that training programs like pelvic floor muscle exercises can be useful in improving incontinence in spinal cord injury, but this has never been used in conjunction with spinal cord stimulation.
20 patients with motor complete and incomplete spinal cord injuries who have neurogenic detrusor over-activity (NDO) proven on urodynamics and who cannot void spontaneously or efficiently will be recruited. Patients will be randomised, and while all 20 patients will receive spinal cord stimulation (SCS) through surface electrodes placed over the lower back, only some will be taught a program of bladder training exercises to suppress NDO. Bladder capacity, bladder pressure, and voiding
efficiency will be measured as the key test.
Dr Andrei Krassioukov (University of British Columbia): Non-invasive neuromodulation to treat bladder, bowel and sexual dysfunction following spinal cord injury, at the International Collaboration on Repair Discoveries (ICORD)
This project is a a comprehensive clinical study examining the effects of transcutaneous (non-invasive) spinal cord stimulation (TCSCS) in promoting recovery of bladder, bowel and sexual functions in individuals with spinal cord injury. This non-invasive therapeutic modality uses electrodes applied over the skin to deliver electrical stimulation and is based upon principles previously established from this group of researchers and others, showing that stimulation of the spinal cord can promote motor and autonomic recovery.
The aim is to establish in individuals with chronic SCI: 1) specific stimulation parameters (i.e. electrode positioning and stimulation intensity necessary for TCSCS to activate the bladder, bowel and skeletal muscles responsible for successfully passing urine and faeces and, 2) the long-term (6 weeks) beneficial effects of TCSCS on bladder, bowel, and sexual functions. Then, six weeks after completion of stimulation experiments, bladder, bowel and sexual function will be reassessed to examine the longevity of TCSCS induced effects. It is hoped that transcutaneous spinal cord stimulation could offer a simple, cost-effective solution to treat autonomic dysfunctions that would undoubtedly significantly improve overall health-related quality of life for individuals with spinal cord injury.
Dr Nicolas Granger (Cave Veterinary Specialists / College of Veterinary Medicine & Biomedical Science): Characterisation of neurogenic urinary incontinence in the canine model of spinal cord injury using a range of urodynamic measures
During this project, the physiological characteristics of urinary incontinence in dogs with severe spinal cord injury will be studied. These dogs can form a model of spinal cord injury in humans because they present similar neurological deficits as humans. The data collected will allow the researchers to produce a set of measures that can be compared between dogs and humans, something thus far lacking. The data will then be used to embark on larger projects using dogs to test efficacy of therapies for spinal cord repair. In particular, the researchers plan to test sacral neuroprosthesis for bladder control and re-training, combined with transplantation of olfactory ensheathing cells engineered to express chondroitinase ABC and used as a regenerative therapy.
Dogs tend to suffer a high rate of spinal cord injury, and this investigation will use pets with naturally occurring spinal cord injuries.