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Physiology of Micturition Reflex
Physiology of Micturition Reflex
Micturition
Anatomy
The urinary bladder is a smooth muscle chamber
composed of two main parts:
(1) the body, the major part, collects urine
(2) the neck, a funnel-shaped extension of the body,
passing inferiorly and anteriorly into the urogenital
triangle and connecting with the urethra
Smooth muscle of
the bladder
(detrusor muscle)
is arranged in
spiral, longitudinal
and circular
bundles. The
muscle bundles
pass on either side
of the urethra are
called the
internal
urethral
spincter.
Body
Trigone (on the
posterior wall)
Neck
External urethral spincter
The walls of
ureters
contain
smooth
muscle
arranged in
spiral,
longitudinal
and circular
bundles.
1-5 times/minute
Ureterorenal reflex
The ureters are well supplied with pain nerve
fibers. When a ureter is blocked eg. by a ureteral
stone, there will be intense reflex constriction which
is associated with very severe pain.
These pain impulses cause a sympathetic reflex
back to the kidney to constrict the renal arterioles,
thereby decreasing urinary output from that kidney.
This effect is known as Ureterorenal reflex.
Sympathetic nerve
supply
L1
Parasympathetic nerve
supply
S
2
S3
L2
Pelvic nerve
L3
S4
Sympathetic
chain
Somatic
nerve
supply S2
Hypogastric
ganglion
Hypogastric
nerve
Urethra
External sphincter
S3
S4
Pudendal nerve
Innervation
Parasympathetic
Pre-glanglionic S2, S3, S4 unite to form Pelvic nerves
Post-ganglionic onto detrusor muscle & internal sphincter
Sympathetic
Pre-ganglionic L1, L2, L3
Post-ganglionic onto trigone, neck, & internal sphincter
Little to do with bladder contraction
o--------- o------------------------------------------
Ach
NE
Innervation cont
Afferents (sensory nerves)
Pelvic nerve: impulses due to bladder fullness; micturition reflex;
pain impulses
Hypogastric nerve: pain impulses
Pudendal nerve: sensory impulses from urethra
Somatic Efferent (Pudendal nerve)
Impulses originate in S1 and S2; innervate external sphincter
Mediate voluntary control of micturition
Anatomy of Micturition
Internal sphincter
- detrusor muscle in the bladder neck whose
tone normally keeps the bladder neck and
posterior urethra empty of urine and
therefore prevents
emptying of the bladder until the pressure in
the main part of the bladder exceeds a
critical level
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.
Parasympathetic stimulation of the bladder
smooth muscle via the same pelvic nerves
occurs.
It is self-regenerative, subsides, then regenerates again until the external
sphincter is relaxed and urination can
occur.
What is micturition?
Spinal cord reflex activity.
* facilitated or inhibited by higher centers
Cystometrogram
80
Intravesica
l pressure 60
(cm of
40
Water)
20
0
0
Ib
Ia
100
200
300
400
Micturition Cont
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
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
Detrusor muscle
PELVIC NERVE
(Parasympathetic
Motor Fibers)
SPINAL CORD
(sacral segments)
Intravesical pressure
(centimeters of water)
Micturition
contractions
lb
la
Basal cystometrogram
Volume (milliliters)
Nerve endings
sensitive to
stretch
Stimulates
contraction of
detrusor muscle
Spinal cord
Simple reflex control of micturition seen in infants.
The ability of voluntary control (inhibition) develops
at the age of 2 3 years.
Facilitation or Inhibition of
Micturition by the Brain
The micturition reflex is a completely autonomic spinal cord reflex,
but it can be inhibited or facilitated by centers in the brain.
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.
Automatic Bladder - spinal cord
injury above sacral region
Micturition reflex is intact but
uncontrolled
Abnormalities of micturition
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).