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Patient Priorities

Restoring pelvic function

Bladder, bowel and sexual 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.

Needing help in the bathroom is emotionally and physically draining, and something I have never got used to. Not having to use a catheter would have a huge impact on my quality of life.

Lorraine, injured at C4/5

Our research plan

For some time, Spinal Research has been funding research into bladder, bowel and sexual function. This experience clearly shows that a multiangle approach to developing treatments is necessary.

A network initiative tackling patient priorities

The neural circuits that modulate bladder, bowel and sexual functions are integrated, and interact with one another. To study these functions in parallel, we are bringing together a world-leading, multi-disciplinary network of researchers. The networked laboratories, in the first instance, include centres in London, Cambridge, Leeds and Portugal. Combined, they bring expertise in clinical research; neuroprosthesis; neuromodulation; regeneration; and experimental neurobiology. They will work together to improve quality of life for people with a spinal cord injury. As funding becomes available, our intention is to bring further centres from around the world to create a truly multinational effort.

The science and aims

Advanced regenerative treatments using gene therapy will be used to reconnect the sensory nerve pathways of the bladder, bowel and genitalia. Achieving long distance regeneration of these pathways will allow multiple important problems to be addressed.

• Restoring bladder pathways – could relieve neurogenic bladder dysfunction and incontinence.
• Perineal sensation – restoring perineal sensation could lead to reduced pressure sores and improved continence of bladder and bowel.
• Genital sensation – restoring genital sensation could lead to improved sexual function.
• Female sensation – a fifth of people with spinal cord injury are female and it is important to understand the nerve pathways to improve sensation and sexual function
• Sensing pain – restoring sensory innervation could protect by warning of burns and cuts and lead to the resolution of chronic pain.
• Bowel sensation – after initial focus on bladder and perineal sensation, we aim to work on improving anal sensation and bowel function.

The network will also develop novel spinal and nerve stimulation devices, designed and optimised through the collaborative input of engineers, experimental neurobiologists and clinical experts. Electrical stimulation has already been shown to effect bladder control in patients and while exciting, this potential treatment is far from optimised. The combined input from the network will help to refine and determine the precise location and strength of spinal stimulation needed to target pelvic organ function most effectively.