Is the cough-anal reflex the expression of a pre-programmed postural action?

In the literature, the cough-anal reflex is originally described as a reflex contraction of the external anal sphincter, caused by cough. Thus, in this action a precise relationship between the cause and effect is identified. However, recent literature reports that the anal contraction precedes the rise in abdominal pressure which ends in coughing. Although these authors underline that the sphincter activity should be pre-programmed, nobody explicitly states that the pelvic floor response may be an anticipatory postural action. In recent years, an important family of pre-programmed muscle contractions has been well documented during voluntary movements: these anticipatory adjustments play a fundamental role in whole body and segmental postural control, so that they are referred to as anticipatory postural adjustments (APAs). On these basis, we searched in literature for similarities between APAs and the so called anal reflex, observing that both follow the same predictive homeostatic principle, namely that anticipatory collateral actions are needed to correctly perform the primary movement. We thus propose that the sphincter control also belongs to the family of pre-programmed actions, and in this view, the cough-anal reflex may be interpreted as an APA acting on the abdominal-thoracic compartment. Thus, Anticipatory Sphincter Adjustments are likely the visceral counterpart of APAs.