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Micturition
S3
L2
Pelvic nerve S4
L3
Sympathetic
chain
Somatic
Hypogastric nerve
ganglion supply S2
S3
Hypogastric S4
nerve Urethra Pudendal nerve
External sphincter
Sympathetic nerve supply and Internal urethral sphincter
apparently play no role in micturition. They prevent reflux of
semen into the bladder during ejaculation.
Sympathetic
Pre-ganglionic L1, L2, L3
Post-ganglionic onto trigone, neck, & internal sphincter
Little to do with bladder contraction
o--------- o------------------------------------------
Ach NE
Innervation con’t…
Afferents (sensory nerves)
Pelvic nerve: impulses due to bladder fullness; micturition reflex;
pain impulses
Hypogastric nerve: pain impulses
Pudendal nerve: sensory impulses from urethra
• External sphincter
- layer of voluntary skeletal muscle which
surrounds the urethra as it passes through
the urogenital diaphragm
- under voluntary control and can conciously
prevent urination even when involuntary
controls are attempting to empty the
bladder
Micturition Reflex
• As bladder fills sensory stretch receptors
send signals via pelvic nerves to sacral
segments of spinal cord.
Start of Micturition:
1. As bladder fills, micturition (bladder)
contractions begin to appear
a. Last from a few seconds to more than
a minute
b. Pressure peaks (micturition waves)
may rise a few cm H2O to more than 100
cm H2O
c. Caused by micturition reflex
Cystometrogram
80
Intravesic
al 60
pressure
40
(cm of Ib
20
Ia
Water)
0
0 100 200 300 400
Intravesical volume (mL)
Micturition Con’t…
2. Micturition reflex (does not need the
brain)
a. Filling stimulates sensory stretch
receptors
b. Afferent impulses in Pelvic nerve
c. Signal reflexively sent back to
bladder via efferent parasympathetic
fibers in the Pelvic nerve
d. Detrusor muscle contracts, then
relaxes
2. Micturition reflex - continued
e. As bladder fills, micturition reflex occurs
more frequently, with greater
contraction of bladder wall (positive
feedback loop)
f. Micturition powerful enough then
another signal is sent through
Pudendal nerve to inhibit external
sphincter (internal relaxes passively
when pressure is 20 - 40 cm H2O)
g. Voluntary relaxation of external
sphincter allows for urination
h. Flow thru urethra stimulates
parasympathic system, sustaining
bladder contraction
Micturition Reflex
• stretch reflex initiated by filling of the bladder with
urine which results in bladder wall contraction
• mediated by sensory stretch receptors in the
bladder wall,specially by receptors in the posterior
urethra
BLADDER
SPINAL CORD
(sacral segments)
(centimeters of water)
Micturition
Intravesical pressure
contractions
lb
la
Volume (milliliters)
Filling of the bladder ………..
Filling of the bladder – partially filled
Reflex contractions
Stimulates
contraction of
detrusor muscle
Spinal cord
Problems:
Atonic Bladder
- destruction of sensory fibers
Traumatic spinal cord injury
Overflow incontinence.
Automatic Bladder
- spinal cord injury above sacral region
Micturition reflex is intact but
uncontrolled
Micturition Abnormalities
• Atonic Bladder - destruction of
sensory fibers
– Traumatic spinal cord injury
– Overflow incontinence.
1.Atonic bladder
This is due to destruction of sensory nerve fibers from
urinary from the bladder. When the dorsal sacral roots are
interrupted by diseases of the dorsal roots such as tabes
dorsalis or when there is crush injury to sacral segments of
spinal cord, person looses bladder control (abolition of
reflex contractions of the bladder). Bladder muscle looses
the tone (hypotonic) and becomes flaccid). Bladder fills to
the capacity and overflows few drops at a time through the
urethra (overflow incontinence or overflow dribbling).
2. Automatic bladder (Spastic neurogenic
bladder)
During spinal shock after complete transection of spinal
cord above sacral centres of micturition, the urinary
bladder looses its tone and becomes flaccid and
unresponsive. So, the bladder is completely filled, and later
urine overflows by dribbling. After the spinal shock has
passed, the voiding reflex returns although there is no
voluntary and higher centre control.
Whenever, the bladder is filled with some amount of urine,
there is automatic evacuation of the bladder.
3. Uninhibited neurogenic bladder
Due to a lesion in some parts of brain stem
(interrupting most of the inhibitory signals), there is
continuous excitation of
spinal micturition centres by the higher centres. There
is uncontrollable micturition. Even a small quantity of urine
collected in bladder will elicit the micturition reflex
increasing the frequency of micturition.
Nocturnal micturition (Bed wetting)