MICTURITION REFLEX

Suman Pokhrel
Dept. of Physiology
BMCTH
Learning Objectives

Introduction

Functional anatomy of urinary bladder

Mechanics of micturition

Neural mechanism of micturition

 Introduction
 Micturition is the process of emptying the urinary
bladder.
 Two processes are involved:

(1) The bladder fills progressively until the tension in its

wall rises above a threshold level, and then
(2) micturition reflex occurs that empties the bladder

 Micturition reflex is a spinal cord (sacral) reflex; it

can be inhibited or facilitated by higher centers
(brainstem), subject to voluntary facilitation &
inhibition (cerebral cortex)
 Functional anatomy of urinary bladder
Body & Neck (posterior urethra)

Smooth muscle-
involuntary
Mucosa- smooth

Skeletal-voluntary
Mechanics of micturition
 Two phases: 1-filling & 2- emptying of bladder

Filling of bladder
 Urine flow from collecting ducts
Ureter have inherent pacemaker activity

 initiates regular peristaltic contraction (1-5

times/min) spread downward along length of
ureter & urine enters in spurts synchronous with
each peristaltic wave into bladder

• Peristaltic contraction in ureter- increased by

parasympathetic & decreased by sympathetic
stimulation
Mechanics of micturition contd….
 Initially During filling phase, bladder pressure-low &
internal sphincter- high

Bladder pressure is low because

- Of manifestation of Laplace law: P= 2T/r
- Detrusor muscle has property of plasticity (when stretch,

tension initially produced is not maintain)

Internal sphincter (functional sphincter, corresponds to

bladder neck) pressure- high due to high tension
(presence of elastic fibers).

External sphincter remains tonically contracted

Mechanics of micturition contd….
Cystometrogram
Relation between intravesical pressure & volume can be
studied by Cystometry (recording pressure while bladder is
filled with 50 ml increments of H2O or air)

 a plot of intravesical pressure against

volume of fluid in bladder is called
Cystometrogram
Mechanics of micturition contd….

Ia- initial slight rise in

pressure when first
increment in volume
Ib- long, nearly flat segment
as further increments are
produced (manifestation of
Laplace law: P= 2T/r)
II- sudden sharp rise in
pressure as micturition reflex
(+)
1st urge to void: ~150ml;
marked sense of fullness:
~400ml
Cystometrogram in a normal human
Mechanics of micturition contd….
Emptying of the bladder Micturition
contraction-
result of stretch
reflex initiated by
stretch receptors
(especially in neck
region)

(N)Cystometrogram, showing acute

pressure waves (dashed spikes) caused by
micturition reflexes
 Emptying of the bladder contd…

Voluntary urination
- Contracts abdominal muscles- pressure in bladder-
allows extra urine to enter posterior urethra &
relaxation of muscles of Pelvic floor - causes
downward tug on detrusor muscle; both initiates
contraction of detrusor muscle
Neural mechanism of micturition

Parasympathetic Somatic
Pudendal nerves (S2,S3,S4)
motor & sensory fibres
Sympathetic
External urethral sphincter

Sympathetic
Hypogastric nerves (L1,L2,L3)
motor & sensory fibres
Bladder wall relaxation
Internal sphincter contraction

Parasympathetic
Pelvic nerves (S2,S3,S4)
motor & sensory fibres
Bladder wall contraction
Somatic (voluntary control)
Internal sphincter relaxation
Micturition Reflex flow chart
 Neural mechanism of micturition contd….

Micturition reflex- integrated in sacral portion of spinal

cord

Threshold for micturition reflex- is adjusted by activity

of facilitatory & inhibitory centers in brainstem
- Facilitatory area- in pontine region + posterior
hypothalamus
- Inhibitory area- in midbrain
Neural mechanism of micturition contd….
In human beings- Higher centers
- Keep micturition reflex partially inhibited except
when micturition is desired

- Keep tonic contraction of external sphincter &

prevents micturition even if micturition reflex
occurs

- voluntary component is added to micturition. If

proper place & time: facilitate sacral micturition
centers to initiate micturition reflex + relax
external sphincter- urination
For Knowledge only
Abnormalities of micturition

Effects of deafferentation
destruction of sensory nerve fibers. Eg- diseases of
dorsal roots (tabes dorsalis)
Atonic bladder
All reflex contraction- abolished
Bladder: thin-walled, distended, & hypotonic; some
contraction (+)- due to intrinsic responses of smooth
muscle to stretch
Person loses bladder control; bladder fills to capacity &
overflows a few drops at time through urethra passively
(overflow incontinence)
Abnormalities of micturition contd….

Effects of denervation
Afferent + efferent nerves= destroyed (eg, tumors of
cauda equina or filum terminale)

Decentralized bladder:
-initially, flaccid & distended.
-Gradually becomes hyperactive (due to development of
denervation hypersensitization), with many contraction
waves that expel dribbles of urine out of urethra, becomes
small & hypertrophied
 Effects of spinal cord cord transection

During spinal shock- bladder: flaccid & unresponsive,

overflow incontinence

After spinal shock passed- micturition reflex returns

(bladder fills to threshold & then empties); however, no-
voluntary control & facilitation & inhibition from higher
centers (automatic bladder)

Paraplegic patients are trained to initiate urination by

pinching or stroking thighs (provoke mild mass reflex)
Abnormalities of micturition contd….

Neurogenic bladder
Due to incomplete destruction of some neuronal
pathways of micturition

irritable bladder, empties small quantities of urine

at a time repeatedly, unable to control onset of
micturition satisfactorily
Happiness is…
END OF RENAL PHYSIOLOGY..!

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