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Physiology of micturition

 Micturation is the discharge of urine from the bladder via the urethra.  A autonomic spinal cord reflex.  Facilitated & inhibited by higher centers.  Afferent & efferent through pelvic nerves.  External sphincter is under voluntary control

Reflex and Voluntary Control of Micturition • Bladder filling reflexively contracts the bladder • Internal Sphincter mechanically opens • Stretch receptors in bladder send inhibitory impulses to external sphincter • Voluntary signals from cortex can override the reflex or allow it to take place 2 .

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.tabes dorsalis • the type due to interruption of both afferent and efferent nerves. • residual urine is left in the bladder.Disorders of micturition • the type due to interruption of the afferent nerves from the bladder. • the type due to interruption of facilitatory and inhibitory pathways descending from the brain.

and urine dribbles through the sphincters (overflow incontinence) .  It becomes overfilled.spastic neurogenic bladder The bladder becomes distended. the bladder is flaccid and unresponsive. thin-walled. and hypotonic. the bladder is flaccid and distended During spinal shock. tumors of the cauda equina or filum terminale.

overflow incontinence • Automatic Bladder Caused by Spinal Cord Damage Above the Sacral Region.Abnormalities of Micturition • Atonic Bladder Caused by Destruction of Sensory Nerve Fibers. . --. • Uninhibited Neurogenic Bladder Caused by Lack of Inhibitory Signals from the Brain.

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.The cystometrogram • Phase-1-progressive rise • Phase-2-sustained rise Phase-3.rapid rise.

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Micturition reflex  Full bladder – stimulate stretch receptors  sensory signals through pelvic nerve to spinal cord  efferent fibers from S2 S3 S4 sacral segment of spinal cord through parasympathetic nerve  it causes contraction of detrusor muscles of bladder  at the same time relaxation of internal sphincter  Pudendal nerve to external sphincter if causes its inhibition its relaxation causes urination 12 .

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two ureters enter the bladder at the upper angles of the trigone 15 . connecting with the urethra • Trigone – bladder neck opens into the posterior urethra.Physiologic anatomy of the bladder • Bladder is a smooth muscle chamber – detrusor muscle two parts • the body – in which urine collects • The neck – a funnel shaped extension of the body.

Micturition • Micturition is the process by which the urinary bladder empties when it becomes filled. It involves two steps – 1. Second step is a nervous reflex the micturition reflex 16 . The bladder fills progressively until the tension in its walls rises above a threshold level 2.

cystometogram • Shows the approximate changes in intra vesicular pressure as the bladder fills with urine • Pressure peaks are called micturition waves in the cystometogram • caused by the micturition reflex 17 .

Posterior urethra • Internal sphincter • External sphincter – voluntary skeletal muscle – under voluntary control 18 .

THE URINARY BLADDER STORES THE URINE • Gravity and peristaltic contractions propel the urine along the ureter • Parasympathetic stimulation contracts the bladder and micturition results if the sphincters (internal and external urethral sphincters) relax • The external sphincter is under voluntary control 19 .