Physiology of Micturition

Dr.Niranjan Murthy HL Asst Prof of Physiology SSMC, Tumkur

Kidneys to bladder
Pacemaker in calyces Peristaltic contractions of ureters (every 10 secs) Autonomic influence of peristalsis Ureters enter bladder obliquely Vesico-ureteric reflux Ureterorenal reflex

Anatomy of bladder
Detrusor muscle Trigone Internal sphincter External sphincter Rugose mucosa Transitional epithelium Nerve supply- Nervi erigentes, Hypogastric nerve, Pudendal nerve

Cystometrogram

30-50mL: 10 cm of H20 Upto 200-300mL: minimal raise >400mL: sharp raise Laplace law

Micturition Reflex
Stretch receptors in bladder wall Afferents via nervi erigentes Sacral center Efferents via nervi erigentes Facilitation/Inhibition by higher centers

Micturition centers
Facilitatory areas: pons, posterior hypothalamus, cortical areas Inhibitory areas: midbrain, cortical areas

Voluntary micturition
Voluntary contraction of abdominal muscles Pressure on bladder increased Micturition reflex Inhibition of external sphincter

Applied aspects
1. Atonic bladder: sensory fiber destruction; tabes dorsalis; overflow incontinence 2. Automatic bladder: loss of higher control; spinal shock 3. Neurogenic bladder: partial spinal damage; loss of inhibitory fibers; meningocele

Enuresis
Treatment : (i) Urine of spaded swine (ii) Cauterization of meatus (iii) Toad tied to penis (iv) Battery and sponges Mechanisms of sphincter control: 1. Maturation & development 2. Learning 3. conditioning