58

By
Dr. Abdel Aziz M. Hussein
Lecturer of Medical Physiology
Member of American Society of Physiology

Def.,
It is the periodic evacuation of the urinary bladder
through the urethra.

Site:
The urinary bladder is a hollow, muscular and
distensible or elastic organ that sits on the pelvic
floor (superior to the prostate in males).

Urinary Bladder in Male

Shape and Size:

The size and shape of the urinary bladder varies
with the amount of urine it contains and with pressure
it receives from surrounding organs.

Parts:
We can divide urinary bladder into:
1)Body: which is the major part in which the urine
collects
2)Neck (posterior urethra): funnel-shaped that
connects to urethra

A) Body of Bladder:
Inner cavity:
The posterior wall of the body, immediately above
the bladder neck , shows a triangular zone, called
trigone
The apex of trigone joins the bladder neck, and its
base marks the opening of the two ureters
Wall :
3 layers
1.Mucosa and submucosa
2.Muscle layer (detrusor muscle)
3.Adventia

 Its base is bounded by the opening of the 2 ureters,

while its apex forms the bladder neck.
The two ureters course obliquely through the detrusor
muscle for 1-2 cm underneath the mucosa before
emptying into the bladder.
When the bladder is filled by urine, it compresses the
2 ureters (intravesical portion of the ureters) preventing
reflux of urine into the ureter.
The urine flow from the kidney by peristaltic
movement of the ureter one every 6 seconds.

1) Submucosa:
The wall of UB is lined by a transitional epithelium
that is continuous with that in the ureters.
When the bladder is empty, the mucosa has
numerous folds called rugae.
As the bladder fills with urine these rugae flatten out
and distend with little change in intravesical pressure
This results in high compliance of the bladder, so the
volume of the bladder can from 10 ml to 400 ml with
a pressure change of only 10 cm H2O

2) Submucosa:
It supports the mucous membrane.
It is composed of connective tissue with elastic
fibers.

3) Muscle layer (Detrusor muscle):

It is composed of smooth muscle.
The smooth muscle fibers are interwoven in all
directions and collectively these are called the
detrusor muscle.
It consist of a mixture of spiral and longitudinal muscle
fibers
It can increase the pressure in the bladder to 40
60 mmHg.

Bladder Neck :
It is a funnel shaped extension of the body toward the
urogenital triangle, to join the anterior urethra (external
urethra).
The lower 2-3 cm of the bladder neck is called the
posterior or internal urethra.
The ms fibers in the bladder neck are arranged in 3
layers: inner longitudinal, middle circular, and outer
longitudinal.
The inherent tone of the bladder neck ms, specially the
middle layer, prevents emptying of the bladder until the
appropriate time for micturition.

Bladder Neck :
The urethra passes through the urogenital diaphragm
where it is surrounded by the external urethral
sphincter (under voluntary control) used to prevent or
interrupt urination, specially in males, it is poorly
developed in females.

Nerve
Efferents
:
Origin:
Supply:

Parasympathetic Supply

Sympathetic Supply

Pelvic nerve

Hypogastric Nerve

-LHCs of the S 2,3, and 4.

-Body and neck of the bladder.
a) Contraction of bladder wall.
b) Relaxation of the bladder
neck stimulation of the
Function detrusor ms of the body
s
causes longitudinal layers to
open the bladder neck.

- L1,2, and 3.
- Bladder neck.
a) Contraction of bladder
neck, specially the middle
layer facilitate the storage
of urine.
b) Relaxation of the bladder
wall by inhibiting the
parasympathetic ganglia.

a) Transmit pain sensation

Afferents a) Carry input from stretch
receptors in the bladder neck.. b) Detect bladder fullness
:
b) Detect bladder fullness.
c) Carry pain and temperature
sensation.

The Pudendal nerves (AHCs of S 2,3,and 4)

Its efferent fibers arise as the parasympathetic
nerves from the 2nd, 3rd and 4th sacral segments of
the spinal cord but from the AHCs.
They supply and control the activity of the external
urethral sphincter

In healthy individuals, the bladder has two discrete phases of

: activity
1. The storage phase, when urine is stored in the bladder; and
2. The voiding phase, when urine is released through the urethra.

 During storage, bladder pressure stays low,

because of the bladder's highly compliant
nature.
This property is helped by the presence of the
transitional epithelium.
This function is studied by a curve or plot
between bladder (intravesical) pressure against
the volume of fluid in the bladder (called a
cystometrogram)

Def.
It is a curve which studies the relationship between
intravesical pressure (IVP) and volume.
Method:
It is done by inserting a catheter into the bladder to fill
and empty the bladder by water, and through special
transducer, the intravesical pressure is recorded.
First, the bladder is empted from urine and the pressure
is recorded, then the bladder is filled with 50 ml water
and the pressure is recorded for every in the volume.

80

Intravesical Pressure
)cm H2O2 (
60
40
20
0

II

Ib

Ia

500

400
300
200
100
Intravesical Volume (ml)

Ia

Ib

Initial slight rise

II

Long flat
segment

Sharp rapid rise

Produced by the

Produced by

Produced by

1st increment of

further increase

further increase

volume by about
50 ml.

in volume up to in volume above

400 ml.

400 ml.

 Segment Ib is a manifestation of the law

of Laplace, which states that the
pressure in a spherical viscus is equal to
twice the wall tension divided by the
radius.
In the case of the bladder, the tension
increases as the organ fills, but so does
the radius.
Therefore, the pressure increase is slight
until the organ is relatively full.

Micturition
Def:
It is the periodic evacuation of urinary bladder
through urethra

Mechanism:
Micturition is fundamentally a spinobulbospinal
reflex facilitated and inhibited by higher brain
centers and, like defecation, subject to voluntary
facilitation and inhibition.

 Center: sacral segments 2, 3 & 4.

Receptors: stretch (receptor) in the wall of
bladder.
Afferent & efferent: pelvic nerve.
Response:
1. Contraction of detrusor muscle (body).
2. Relaxation of internal sphincter of urethra.
3. Relaxation of external urethral sphincter via the
pudendal nerve which is somatic nerve originating
from AHC of sacral segment 2, 3, & 4.

Stretch receptors
Center
S2,3,4,

IVP
Contraction of wall
Afferents
Pelvic Nerve
Relaxation of int. sphincter
Efferent
Pelvic Nerve

Relaxation of ext. sphincter

 1) Cerebral cortex: Motor cortex exerts a voluntary

control of micturition either stimulation or inhibition.
2) Hypothalamus: There is facilitatory area in the
hypothalamus.
3) Midbrain: Inhibition.
4) Pons: facilitation

1. Keeping the micturition reflex partially inhibited all

the time except when there is a desire for
micturition.
2. Prevent the micturition even when the reflex is
initiated until appropriate time allows.

Voluntary Initiation of Micturition

Voluntary initiation of micturition
Relaxation of perineal ms causing traction on the bladder
Contraction of anterior abdominal wall and diaphragm to
increase intra-abdominal pressure compressing bladder.
Relaxation of external urethral sphincter.
Flow of urine in urethra intensification of the reflex.
If the condition unfavourable, the higher center will delay
micturition until convenient time by:
1) Inhibition of sacral segment of micturition.
2) Stimulation of external urethral sphincter.
3) Contractions of perineal muscle decrease intravesical
pressure.

 If the bladder fluid content exceeds 700 ml,

urine starts to dribble in spite of the voluntary
control

1) Tabetic bladder:
Due to interruption of the afferent fibers
sensory atonic bladder over flow incontinence.
Occurs in tabes dorsalis.
2- Denervated or decentralized bladder:
There is interruption of the afferent and efferent
fibers as in cauda equine lesion shrunken and
hypertrophied bladder, it can expel dripples 25-50
ml at a time.

 3- Injury to superior frontal gyrus:

Causes reduction in the desire to micturition, but
once started it's difficult to interrupt.
4- Transection of spinal cord:
Complete transection of spinal cord affects
micturition as such:
During the spinal shock over flow incontinence.
After recovery automatic bladder the U.B fill with urine,
till certain volume and pressure capable of micturition
reflex to be carried out in the spinal sacral centers without
supraspinal influence and with conscious feeling of
micturition as infants and children below 2 years.

THANKS