URINARY BLADDER ANATOMICAL
Urinary bladder is the temporary store
house of urine which gets emptied
through the urethra.
The male urethra subserving the
functions of urination and ejaculation.
Female urethra is for urination only.
CAPACITY OF THE BLADDER
Capacity in an adult male 120 to 320 ml.
Filling beyond 220 ml causes micturition,
emptied when filled to about 250 to 300
Filling up to 500 ml may be tolerated, but
beyond this it becomes painful.
Referred pain: lower part of the anterior
abdominal wall, perineum and penis(T11-
Its contains both sympathetic and
Parasympathetic efferent fibers
S2,S3, S4 are motor to the detrusor muscle
and inhibitory to the sphincter vesicae.
If these are destroyed, normal
micturition is not possible.
NERVE SUPPLY CONTI….
Sympathetic efferent fibers (T11 to L2):
- inhibitory to the detrusor
-motor to the sphincter vesicae
The pudendal nerve (S2, S3, S4)
-supplies the sphincter urethrae which
• pain sensations,
- spasm of bladder wall
- carried by parasympathetic nerves and
partly by sympathetic nerves
FUNCTIONS OF NERVES
Nerve On On On Function
detrusor internal external
muscle sphincter sphincter
Sympathetic Relaxation Constriction Not supplied Filling of urinary
Parasympathetic Constriction Relaxation Not supplied Emptying of
nerve urinary bladder
Somatic nerve Not supplied Not supplied Constriction Voluntary control
Filling of urinary bladder
Stimulation of stretch receptor
Afferent impulses pass via pelvic nerve
Sacral segments of spinal cord
Efferent impulses via pelvic nerve
Contraction of detrusor muscle & relaxation of internal sphincter
MICTURITION REFLEX CONTI…
Flow of urine into urethra and stimulation of stretch receptors
Afferent impulses via pelvic nerve
Inhibition of pudendal nerve
Relaxation of external sphincter
Voiding of urine
There are five types of neurogenic bladder:
1. Uninhibited bladder ..cortico regulatory tract
2. Reflex bladder ..spinal cord above S2
3. Autonomous bladder ..at S2, S3 and S4 level
4. Motor atonic bladder ..motor efferents
5. Sensory atonic bladder ..sensory afferents
1. UNINHIBITED BLADDER
-brain tumors, etc.
Voluntary control of micturition is lost.
Hesitancy and precipitancy of
evacuation is present.
- the midbrain
- superior frontal gyrus
REFLEX BLADDER CONTI…
Acute transaction of the cord causes
retention of urine during the stage of spinal
Leads to retention of residual urine.
During recovery stage, reflex activity begins
and automatic evacuation of bladder results.
3. AUTONOMOUS BLADDER
Congenital : spina
Trauma: gunshot, auto accidents
Infective: arachnoiditis, radiculitis
Neoplasms of the cord
Surgery: combined perineal and abdominal
sacral segment of spinal nerve.
AUTONOMOUS BLADDER CONTI…
Loss of bladder sensation
Inability to initiate micturition
paralysis of pariurethral striated
associated with anesthesia and
absent bulbocavernous reflex.
SENSORY PARALYTIC BLADDER
Loss of bladder sensation, which leads
to overdistension of bladder.
Initially there is normal capacity
increases and residual urine appears.
Initially these patients are
Gradually there is terminal dribbling
and later overflow incontinence.
5. MOTOR PARALYTIC BLADDER
Efferent fibers of the bladder
MOTOR PARALYTIC BLADDER CONTI..
Since the sensory nerves are intact,
bladder if left alone, distends and
Painful distention of the bladder and
inability to initiate micturition.
Decrease in size and force of steam
and interrupted stream.
Recurrent episodes of urinary
INCONTINENCE OF URINE
The term ‘continence’ is used to
describe the normal ability of a person
to store urine and faeces temporarily,
with conscious control over the time
and place of micturition and
‘Incontinence’ has been defined as
the involuntary or inappropriate passing
of urine or faeces, or both, that has an
impact on social functioning or
INCONTINENCE OF URINE
1. Extra urethral incontinence
2.Detrusor overactivity incontinence
3.Urodynemic stress incontinence
6.Incontinence associaed with sexual activities
Loss of urine through channels
other than the urethra
trauma at pelvic surgery such as
infection or carcinoma.
Child birth(Wall 1999)
2. Detrusor overactivity
-present as a symptom, a sign and as
complains of urge incontinence,
immediately preceded by urgency,
that is a strong desire to void.
conformed as a sign observed
at urodynamic assessment
May be further qualified as
neurogenic, in neurological condition
3.URODYNAMIC STRESS INCONTINENCE
during increased intra-abdominal
pressure, such as during coughing,
laughing, sneezing and lifting
An involuntary spurt dribble or
droplet of urine is observed to leave
urethra immediately on an increase
in intra-abdominal pressure
in absence of detrusor
During sleep, or “bed wetting”
15-20% of 5 year old children and
up to 2% of young adults(Glazener
In girls around puberty
Caused by detrusor overactivity
induced by laughter(chandra et al
6.INCONTINENCE ASSOCIATED WITH
After following intercourse in young
women postcoital dysuria
postmenopausal women dysuria,
urgency and urinary tract infection
Hilton(1988) found 24% of 324
sexually active women referred to
gynaecological clinic experience
incontinence – two third on
penetration and one third on orgasm.
involuntary loss of urine
in ability to perform toileting
functions secondary to physical or
P.J. mehta’s Practical Medicine
Physiotherapy in obstetrics and
gynaecology, 2nd edition, jill mantle
Essentials of medical physiology, 5th
edition, K Sembulingam
B.D.Chaurasia’s human anatomy, 4th
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