2. BLADDER CONTROL DR.B.VISHWANATH RAO PROFESSOR OF PHYSIOLOGY
MADRAS MEDICAL COLLEGE
CHENNAI

3. The Association of Physiologists
THANKS
The Association of Physiologists
TAMILNADU

4. THANKS The Department of Physiology SRI BALAJI MEDICAL COLLEGE
& RESEARCH INSTITUTE
CHENNAI

5. Micturition Process by which urinary bladder empties.
A complex act involving both autonomic
& somatic nerve pathways
& several reflexes
that can be either
inhibited or facilitated
by higher centers
in the brain.

6. Micturition FUNDAMENTALLY A SPINAL REFLEX
FACILITATED & INHIBITED BY HIGHER BRAIN
CENTRES
SUBJECT TO VOLUNTARY FACILITATION &
INHIBITION

7. URETERS Walls contain smooth muscle arranged in
Spiral , longitudinal , circular bundles.
PERIATALTIC MOVEMENTS  1-5/min
Enter bladder wall obliquely ( always closed)
Prevents reflux of urine
No sphincters.

8. BLADDER EPITHELIUM -- transitional DETRUSOR  modified smooth muscle
URINARY BLADDER
BLADDER EPITHELIUM -- transitional
DETRUSOR  modified smooth muscle
arranged in spiral, longitudinal &
circular bundles.
 contraction can increase
pressure in the bladder to 40-60mmHg.
Normal tone prevents urine backflow into ureters.

9. Forms INTERAL SPHINCTER in the proximal part of the urethra
IUS : NORMAL TONE PREVENTS EMPTYING OF BLADDER
EXTERNAL URETHRAL SPHINCTER (skeletal muscle)  Distal urethra
EUS : ALWAYS CONTRACTED .
TRIGONE : smooth area.

10. URINARY BLADDER Ureters & openings rugae peritoneum DETRUSOR trigone
ius
urethra
eus

11. Properties of
DETRUSOR
RHYTHMICITY
TONE
ACCOMODATION /
PLASTICITY

12. INNERVATION OF
BLADDER

13. ACTIONS OF
BLADDER NERVES

14. Sense of fullness / PAIN Prevents reflux Ejaculation of semen In males
SYMPATHETIC (T1O - L2)
inferior mesenteric plexus ; inferior hypogastric nerve
Sense of fullness / PAIN
Prevents reflux
Ejaculation of semen
In males
no role in mictuirition

15. PARASYMPATHETIC (S2 - S4)
supply within
bladder wall
contraction of
bladder
PELVIC NERVES
PUDENTAL NERVE (SOMATIC NERVE)
control of external sphincter (Ach)

16. HIGHER CENTRES
FOR MICTUIRITION

17. SUPERIOR FRONTAL GYRUS
- INHIBITORY
MID BRAIN- INHIBITORY
POSTERIOR
HYPOTHALAMUS
& LIMBIC SYSTEM
- FACILITATORY
PONS - FACILITATORY
T1O - L2
s2 - s4

18. BLADDER FILLING
AND EMPTYING

19. Stages : Transport of urine to bladder Filling / storage phase
Voiding / emptying phase

20. 150ml
first
URGE to
void

21. Neuro-receptors During Storage / filling phase
Parasympathetic (cholinergic) receptors are inhibited,
Sympathetic receptors (beta) are stimulated

22. Neuro-receptors during the EMPTYING phase
Sympatheic receptors are inhibited:
- Cessation of the beta assisted stretch of detrusor muscle.
- Relaxation of the alpha controlled bladder neck.
Parasympathetic (cholinergic) receptors are stimulated:
- strengthening the detrusor contraction

23. ACT OF
MICTUIRITION

24. URINATION URINATION OCCURS WHEN POWERFUL MICTUIRITION REFLEX
CORTICAL INHIBITION REMOVED
RELAXED Int./Ext. SPHINCTERS
RELAXED PELVIC FLOOR MUSCLES
INTRA-ABDOMINAL PRESSURE RISE by contracting abdominal muscles
URINATION
DETRUSOR CONTRACTION

25. FEMALES - urine emptied by gravity
MALES - urine expelled by BULBOCAVERNOUS contraction

26. INTRAVESICULAR PRESSURE
CYSTOMETROGRAM
THE PLOT OF
INTRAVESICULAR PRESSURE
AGAINST
THE FLUID VOLUME
IN THE BLADDER

27. --> SHARP RISE IN PRESSURE 1a - SLIGHT RISE IN PRESSURE
1b- plateau

28. Law of Laplace P = 2T / r the wall tension divided by the radius.
Pressure in a spherical viscus is equal to twice
the wall tension divided by the radius.
Due to its ability to stretch, T (TENSION)
INCREASE will cause R (RADIUS) INCREASE
as well, hence P (pressure) will not increase
much.
P = 2T / r

29. 700ml --> PAIN , LOSS OF CONTROL.

30. RANDOM & WEAK REGULAR & POWERFUL REGULAR & SUSTAINED
MICTUIRITION WAVES
RANDOM & WEAK
REGULAR & POWERFUL
REGULAR & SUSTAINED

31. ABNORMALITIES
OF MICTUIRITION

32. LESION IN AFFERENT NERVES FROM THE BLADDER
Sensory denervated / atonic bladder
Bladder distended ,
Thin walled ,
Hypotonic.
Eg: TABES DORSALIS.

33. LESIONS IN BOTH AFFERENT & EFFERENT PATHWAYS

34. LESIONS OF BOTH AFFERENT & EFFERENT NERVES E.g.: CAUDA EQUINA TUMOUR
Decentralized / autonomous bladder
Bladder distended & flaccid initially
Later active with contraction (DRIBBLING)
Small shrunken hypertrophic bladder
( DENERVATION HYPERSENSITIZATION ) .

35. LESIONS OF FACILITATORY & INHIBITORY PATHWAYS

36. LESIONS OF FACILITATORY & INHIBITORY PATHWAYS SPINAL CORD TRANSECTION
E.g.: SPINAL SHOCK
SPINAL CORD TRANSECTION
During spinal shock :
Bladder is flaccid & unresponsive
Becomes overfilled & dribbles
( OVERFLOW INCONTINENCE )
After spinal shock :
hyperactive voiding reflex
bladder capacity reduced (hypertrophied walls)
SPASTIC NEUROGENIC BLADDER

37. ROLE OF PREFRONTAL LOBE
ROLE OF LIMBIC CORTEX
ROLE OF PREFRONTAL LOBE

38. Submitted 17 June 2008 ; accepted in final form 15 July 2008
RELATED ARTICLES
Modulation of bladder function by prostaglandin EP3 receptors in the central nervous system
Department of Urology, 2Biological Reagents and Assay Development, and 3Department of Medicinal Chemistry, GlaxoSmithKline Pharmaceuticals, King of Prussia, Pennsylvania
Submitted 17 June 2008 ; accepted in final form 15 July 2008

39. EP3 RECEPTORS ARE INVOLVED IN
RHYTHMIC BLADDER CONTRACTION.
VISCEROMOTOR REFLEX RESPONSE TO BLADDER DISTENSION
MICTUIRITION AT SUPRASPINAL LEVEL
NOCICEPTION AT SPINAL CENTRES.

40. Expression and function of CXCL12/CXCR4 & CXCR7in rat urinary bladder with cyclophosphamide-induced cystitis
+ Author Affiliations : Departments of 1Neurology and
2Anatomy and Neurobiology, University of Vermont College of Medicine, Burlington, Vermont .
Submitted 3 November 2009.
accepted in final form 18 December 2009.

42. BRIDLEY BLADDER
STIMULATOR