The urinary bladder has two main parts - the body and neck. It is lined by transitional epithelium that allows the bladder to expand greatly with little pressure change. The bladder wall has three layers - mucosa, submucosa, and detrusor muscle. During storage, the bladder remains relaxed due to parasympathetic inhibition and sympathetic stimulation of the bladder neck. Micturition is initiated by sacral reflexes that cause detrusor contraction and relaxation of the internal urethral sphincter. Voluntary control is exerted by the cerebral cortex and brainstem. Damage to the nervous system can lead to uninhibited, automatic, atonic, or other types of neurogenic bladder
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The urinary bladder has two main parts - the body and neck. It is lined by transitional epithelium that allows the bladder to expand greatly with little pressure change. The bladder wall has three layers - mucosa, submucosa, and detrusor muscle. During storage, the bladder remains relaxed due to parasympathetic inhibition and sympathetic stimulation of the bladder neck. Micturition is initiated by sacral reflexes that cause detrusor contraction and relaxation of the internal urethral sphincter. Voluntary control is exerted by the cerebral cortex and brainstem. Damage to the nervous system can lead to uninhibited, automatic, atonic, or other types of neurogenic bladder
Original Description:
Anatomy of the kidney
Micturition and its control
Mechanism of micturition
The urinary bladder has two main parts - the body and neck. It is lined by transitional epithelium that allows the bladder to expand greatly with little pressure change. The bladder wall has three layers - mucosa, submucosa, and detrusor muscle. During storage, the bladder remains relaxed due to parasympathetic inhibition and sympathetic stimulation of the bladder neck. Micturition is initiated by sacral reflexes that cause detrusor contraction and relaxation of the internal urethral sphincter. Voluntary control is exerted by the cerebral cortex and brainstem. Damage to the nervous system can lead to uninhibited, automatic, atonic, or other types of neurogenic bladder
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The urinary bladder has two main parts - the body and neck. It is lined by transitional epithelium that allows the bladder to expand greatly with little pressure change. The bladder wall has three layers - mucosa, submucosa, and detrusor muscle. During storage, the bladder remains relaxed due to parasympathetic inhibition and sympathetic stimulation of the bladder neck. Micturition is initiated by sacral reflexes that cause detrusor contraction and relaxation of the internal urethral sphincter. Voluntary control is exerted by the cerebral cortex and brainstem. Damage to the nervous system can lead to uninhibited, automatic, atonic, or other types of neurogenic bladder
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Urinary Bladder and
Micturition Prepared by ; Hifza khan MEDICAL Technologist (LNH) Lecturer at Taqwa College of DPT /Lecturer at MC College Parts: We can divide urinary bladder into: 1) Body: which is the major part in which the urine collects 2) Neck (posterior urethra): funnel-shaped that connects to urethra Physiological anatomy of urinary bladder
1) Submucosa: The wall of UB is lined by a transitional epithelium that is continuous with that in the ureters. When the bladder is empty, the mucosa has numerous folds called rugae. As the bladder fills with urine these rugae flatten out and distend with little change in intravesical pressure This results in high compliance of the bladder, so the volume of the bladder can ↑ from 10 ml to 400 ml with a pressure change of only 10 cm H2O Physiological anatomy of urinary bladder
2) Submucosa: • It supports the mucous membrane. • It is composed of connective tissue with elastic fibers. 3) Muscle layer (Detrusor muscle): • It is composed of smooth muscle. • The smooth muscle fibers are interwoven in all directions and collectively these are called the detrusor muscle. • It consist of a mixture of spiral and longitudinal muscle fibers • It can increase the pressure in the bladder to 40 – 60 mmHg. Physiological anatomy of urinary bladder Physiological anatomy of urinary bladder
Bladder Neck : • It is a funnel shaped extension of the body toward the urogenital triangle, to join the anterior urethra (external urethra). • The lower 2-3 cm of the bladder neck is called the posterior or internal urethra. • The ms fibers in the bladder neck are arranged in 3 layers: inner longitudinal, middle circular, and outer longitudinal. • The inherent tone of the bladder neck ms, specially the middle layer, prevents emptying of the bladder until the appropriate time for micturition. Innervations of Urinary Bladder Autonomic Innervations of the bladder Autonomic Innervations of the bladder Parasympathetic Supply Sympathetic Supply
Nerve Pelvic nerve Hypogastric Nerve
Efferents: Origin: -LHCs of the S 2,3, and 4. - L1,2, and 3. Supply: -Body and neck of the bladder. - Bladder neck
Functions a) Contraction of bladder wall. a) Contraction of bladder neck, b) Relaxation of the bladder specially the middle layer→ neck → stimulation of the facilitate the storage of urine. detrusor ms of the body causes b) Relaxation of the bladder longitudinal layers to open the wall by inhibiting the bladder neck. parasympathetic ganglia. Afferents: a) Carry input from stretch a) Transmit pain sensation receptors in the bladder neck.. b) Detect bladder fullness b) Detect bladder fullness. c) Carry pain and temperature sensation. (Hypogastric nerve)
(Pelvic nerve) Somatic Innervations of the bladder
The Pudendal nerves (AHCs of S 2,3,and 4)
Its efferent fibers arise as the parasympathetic nerves from the 2nd, 3rd and 4th sacral segments of the spinal cord but from the AHCs. They supply and control the activity of the external urethral sphincter Autonomic and Somatic Innervations of the bladder Functions of the Urinary Bladder
In healthy individuals, the bladder has two discrete phases of
activity: 1. The storage phase, when urine is stored in the bladder; and
2. The voiding phase, when urine is released through the
urethra. Storage Phase • During storage, bladder pressure stays low, because of the bladder's highly compliant nature. • This property is helped by the presence of the transitional epithelium. • This function is studied by a curve or plot between bladder (intravesical) pressure against the volume of fluid in the bladder (called a cystometrogram) Micturition Micturition Def: It is the periodic evacuation of urinary bladder through urethra
Mechanism: • Micturition is fundamentally a spinobulbospinal reflex facilitated and inhibited by higher brain centers and, like defecation, subject to voluntary facilitation and inhibition. Micturition Reflexes • Center: sacral segments 2, 3 & 4. • Receptors: stretch (receptor) in the wall of bladder. • Afferent & efferent: pelvic nerve. • Response: 1. Contraction of detrusor muscle (body). 2. Relaxation of internal sphincter of urethra. 3. Relaxation of external urethral sphincter via the pudendal nerve which is somatic nerve originating from AHC of sacral segment 2, 3, & 4. Stretch receptors Center S2,3,4, ↑ IVP Contraction of wall Afferents Pelvic Nerve Relaxation of int. sphincter
Efferent Pelvic Nerve Relaxation of ext. sphincter MICTURITION REFLEX Voluntary Control of Micturition Higher Centers Control Micturition
• 1) Cerebral cortex: Motor cortex exerts a voluntary
control of micturition either stimulation or inhibition. • 2) Hypothalamus: There is facilitatory area in the hypothalamus. • 3) Midbrain: Inhibition. • 4) Pons: facilitation Higher Centers Control Micturition
1. Keeping the micturition reflex partially inhibited all
the time except when there is a desire for micturition. 2. Prevent the micturition even when the reflex is initiated until appropriate time allows. Voluntary Initiation of Micturition Voluntary initiation of micturition • Relaxation of perineal ms causing traction on the bladder • Contraction of anterior abdominal wall and diaphragm to increase intra-abdominal pressure compressing bladder. • Relaxation of external urethral sphincter. • Flow of urine in urethra intensification of the reflex. • If the condition unfavourable, the higher center will delay micturition until convenient time by: • 1) Inhibition of sacral segment of micturition. • 2) Stimulation of external urethral sphincter. • 3) Contractions of perineal muscle decrease intravesical pressure. • If the bladder fluid content exceeds 700 ml, urine starts to dribble in spite of the voluntary control Uninhibited Neurogenic Bladder • Caused by Lack of Inhibitory Signals from the Brain. • This condition derives from partial damage in the spinal cord or the brain stem that interrupts most of the inhibitory signals. • Which results in frequent and relatively uncontrolled micturition. • Therefore, facilitative impulses passing continually down the cord keep the sacral centers so excitable that even a small quantity of urine elicits an uncontrollable micturition reflex, thereby promoting frequent urination. Automatic/Reflex Bladder • Caused by Spinal Cord Damage Above the Sacral Region. If the spinal cord is damaged above the sacral region but the sacral cord segments are still intact. • typical micturition reflexes can still occur. • However, they are no longer controlled by the brain. • During the first few days to several weeks after the damage to the cord has occurred, the micturition reflexes are suppressed because of the state of “spinal shock” caused by the sudden loss of facilitative impulses from the brain stem and cerebrum. • However, if the bladder is emptied periodically by catheterization to prevent bladder injury caused by overstretching of the bladder, the excitabilityof the micturition reflex gradually increases until typical micturition reflexes return; then, periodic (but unannounced) bladder emptying occurs. Atonic Bladder • Caused by Destruction of Sensory Nerve Fibers. • Micturition reflex contraction cannot occur if the sensory nerve fibers from the bladder to the spinal cordare destroyed, thereby preventing transmission of stretch signals from the bladder. • When this happens, a person loses bladder control, despite intact efferent fibers from the cord to the bladder and despite intact neurogenic connections within the brain. • Instead of emptying periodically, the bladder fills to capacity and overflows a few drops at a time through the urethra. This is called overflow incontinence. • A common cause of atonic bladder is crush injury to the sacral region of the spinal cord. Certain diseases can also cause damage to the dorsal root nerve fibers that enter the spinal cord. For example, syphilis can cause constrictive fibrosis around the dorsal root nerve fibers, destroying them. This condition is called tabes dorsalis, and the resulting bladder condition is called tabetic bladder. Reference Guyton (Text book of Medical Physiology )
