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    Micturition

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    The micturition reflex controls urination through a cycle of bladder filling and emptying. It involves stretch receptors in the bladder wall, afferent nerves to the sacral cord, and efferent nerves that trigger detrusor muscle contraction. Higher brain centers normally facilitate or inhibit this reflex for voluntary control. Lesions can cause different types of bladder dysfunction like an atonic bladder from loss of afferents or an uninhibited bladder from loss of brain inhibitory signals.

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    Micturition

    Uploaded by

    iron
    70 views15 pages
    The micturition reflex controls urination through a cycle of bladder filling and emptying. It involves stretch receptors in the bladder wall, afferent nerves to the sacral cord, and efferent nerves that trigger detrusor muscle contraction. Higher brain centers normally facilitate or inhibit this reflex for voluntary control. Lesions can cause different types of bladder dysfunction like an atonic bladder from loss of afferents or an uninhibited bladder from loss of brain inhibitory signals.

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    urinary system

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    The micturition reflex controls urination through a cycle of bladder filling and emptying. It involves stretch receptors in the bladder wall, afferent nerves to the sacral cord, and efferent nerves that trigger detrusor muscle contraction. Higher brain centers normally facilitate or inhibit this reflex for voluntary control. Lesions can cause different types of bladder dysfunction like an atonic bladder from loss of afferents or an uninhibited bladder from loss of brain inhibitory signals.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    70 views15 pages

    Micturition

    Uploaded by

    iron
    The micturition reflex controls urination through a cycle of bladder filling and emptying. It involves stretch receptors in the bladder wall, afferent nerves to the sacral cord, and efferent nerves that trigger detrusor muscle contraction. Higher brain centers normally facilitate or inhibit this reflex for voluntary control. Lesions can cause different types of bladder dysfunction like an atonic bladder from loss of afferents or an uninhibited bladder from loss of brain inhibitory signals.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 15

    Micturition

    The process by which the UB empties when it


    becomes filled
    2 main steps:
    Bladder fills progressively until the tension in its walls
    rises above a threshold level
    Micturition reflex a nervous reflex that empties the
    bladder
    If it fails, at least causes a conscious desire to urinate
    Autonomic spinal cord reflex; can be inhibited or facilitated by
    centers in the cerebral cortex or brain stem
    Reflex control of micturition
    Stimulus
    Vesicular pressure at about 18 cmH2O
    Urine volume of about 300-400 cc (150 cc first urge to void is
    felt; 400 cc marked sense of fullness)
    Receptors stretch and tension receptors in the bladder wall
    Excited by threshold stimulus
    Afferent impulses from receptors are responsible for the
    sensations of distention and the desire to urinate; can also cause
    the act of micturition when spinal reflexes are released from
    cerebral control
    Afferent limb fibers in pelvic nerves
    Center sacral cord
    Efferent limb pelvic nerves
    Urinary bladder and its innervation.
    Micturition reflex
    As the bladder fills, many superimposed
    micturition contractions begin to appear
    Initiated by sensory stretch receptors in the
    bladder wall
    Sensory signals sacral segments of the
    cord through the pelvic nerves back to
    bladder through the parasympathetic nerve
    fibers by way these same nerves
    Micturition reflex
    Bladder is only partially filled
    MC usually relax spontaneously after a fraction of
    a minute
    Detrusor muscle stop contracting
    Pressure falls back to the baseline
    As bladder continues to fill
    Micturition reflexes become more frequent,
    greater contractions of detrusor muscle
    Once it begins, it is self-regenerative
    MR is a single complete cycle
    of:
    1. progressive and rapid increase of
    pressure
    2. period of sustained pressure
    3. return of the pressure to the basal tone
    of the bladder
    Normal cystometrogram, showing also acute
    pressure waves (dashed spikes) caused by
    micturition reexes.
    Higher control of micturition
    It is normally a voluntary act
    Voluntary control can be exerted until the
    vesicular pressure increases to about 100
    cmH2O at which point involuntary micturition
    begins
    Afferent nerves: pelvic nerves, hypogastric
    and pudendal nerves
    Enter the SC at sacral levels III and IV
    hypothalamus and cortex where voluntary control
    resides
    Higher control
    Facilitory areas
    Pontine region
    Posterior hypothalamus
    Cerebral cortex
    Inhibitory areas
    Midbrain
    Cerebral cortex
    The micturition reflex is the basic cause of micturition,
    but the higher centers normally exert final control as
    follows:
    The higher centers keep the MR partially inhibited except
    when micturition is desired
    The higher centers can prevent micturition, even if the MR
    does occur, by continual tonic contraction of the external
    bladder sphincter until a convenient time presents itself
    When it is time to urinate, the cortical centers can facilitate
    the sacral micturition centers to help initiate a MR and at
    the same time inhibit the external urinary sphincter so that
    urination can occur
    Voluntary urination
    A person voluntarily contracts his abdominal
    muscles, which increases the pressure in the
    bladder and allows extra urine to enter the
    bladder neck and posterior urethra under
    pressure, stretching their walls
    Stimulates the stretch receptors
    Excites the MR
    Inhibits the external urethral sphincter
    5-10 ml left in the bladder
    Abnormalities of Micturition
    Three major types of bladder dysfunction due to
    neural lesions
    Types due to interruption of the afferent nerves from
    the bladder
    The atonic bladder caused by destruction of sensory nerve
    fibers
    MR contraction cannot occur
    Lose of bladder control despite intact efferent fibers from the cord
    and intact neurogenic connections from the brain
    Bladder fills to capacity and overflows a few drops at a time
    (overflow incon tinence)
    Cause: crush injury to the sacral segment; certain diseases like
    syphillis
    Types due to interruption of both afferent
    nerves and efferent nerves
    Automatic bladder caused by SC damage above
    the sacral region
    Sacral cord segments still intact, MR can still occur but
    no longer controlled by the brain
    1 st few days to several weeks after damage, MR are
    suppressed because of state of spinal shock caused by
    sudden loss of facilitory impulses
    If bladder is emptied periodically by catheterization to
    prevent bladder injury, MR gradually increases
    Types due to interruption of facilitory and
    inhibitory pathways descending from the brain
    The uninhibited bladder caused by lack of inhibitory
    signals from the brain
    Frequent and uncontrolled micturition
    Partial damage in SC or brain stem that interrupts most of
    the inhibitory signals
    Facilitory impulses passing continually down the cord keep
    the sacral centers so excitable that even a small quantity of
    urine will elicit an uncontrollable MR, and thereby promote
    frequent urination

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