MICTURITION

Dept. of
Physiology

Micturition (definition)

It is the process by which urinary bladder

empties itself of urine when it becomes
filled.
Phases: 1- Filling phase
Bladder fills progressively until the
tension in its walls rises above a threshold
level, this elicits the second step
2- Micturition reflex: that empties the
bladder.

Smooth
muscle of the
bladder
(detrusor
muscle) is
arranged in
spiral,
longitudinal
and circular
bundles. The
muscle
bundles pass

Body
Trigone (on
the posterior
wall)
Neck
External urethral

Filling of the bladder

The walls
of
ureters
contain
smooth
muscle
arranged
in spiral,
longitudi
nal and
circular

When urine
collects in the
renal pelvis, the
pressure in the
pelvis increases.
This increase in
the pressure
initiates a
peristaltic
contraction
beginning in the
pelvis and
spreading

The ureters pass obliquely through the detrusor muscle

and it passes little further underneath the bladder
mucosa. This oblique passage tends to keep the ureters
closed except during peristaltic waves, preventing
reflux of urine from the bladder.
In some people, the distance that the ureter courses
through the bladder mucosa is less than normal, so
that contraction of the bladder during micturition does
not always lead to complete occlusion of the ureter. As
a result some of the urine in the bladder is propelled
backward into the ureter. This is called
Vesicoureteral reflux.
Ureterorenal reflex
The ureters are well supplied with pain nerve fibers.
When a ureter is blocked eg. by a ureteral stone, there
will be intense reflex constriction which is associated
with very severe pain. These pain impulses cause a

Innervation of the
Sympathetic nerve
bladder
Parasympathetic nerve
supply
supply

L1

S2
S3

L2

Pelvic nerve

L3

S4

Sympathetic
chain
Hypogastric
ganglion
Hypogastric
nerve

Urethra
External

Somatic
nerve
supply S2
S3
S4
Pudendal nerve

Sympathetic nerve supply and Internal urethral

sphincter apparently play no role in micturition.
However sympathetics are nerves of filling.
Parasympathetic nerve supply
Sensory fibers in the pelvic nerve carry impulses from
stretch receptors present on the wall of the urinary
bladder to the spinal centre of micturition. Stimulation
of parasympathetic efferent fibers causes contraction
of detrusor muscle leading to emptying of urinary
bladder.
Somatic nerve supply
This maintains the tonic contractions of the skeletal
muscle fibers of the external sphincter, so that this
sphincter is contracted always. During micturition this

What is micturition?
Spinal cord reflex activity.
* facilitated or inhibited by
higher centers
* voluntary facilitation or
inhibition

The relationship between the volume of urine and

pressure in the urinary bladder (intravesical pressure)
can be studied by inserting a double lumen catheter
and emptying the bladder. Then the pressure is
recorded by connecting one lumen of the catheter to a
suitable recording instrument while introducing water
or air through the other lumen. The graphical
recording of the pressure changes in the urinary
bladder in relation to rise in the volume of urine
collected in it is called cystometrogram. Cystometry
is the technique used to demonstrate this relationship.

Cystometrogram

8
Intravesi
0
cal
pressure 6
0
(cm of
4
Water)
0
20
0

Ia

I
b

100
400

200

300

When the urinary bladder is empty, the intravesical

pressure is zero. When about 50 mL of fluid is
collected, the pressure rises sharply (Ia)to about 10
cm H2O (Ia in the cystometrogram). The pressure in
the bladder remains more or less constant with
further addition of about 350 mL of urine (Ib) in an
adult. This is in accordance with law of Laplace. In the
bladder tension increases as the urine is filled. At the
sametime, the radius also increases due to relaxation
of the detrusor muscle. Because of this, the pressure
rise is almost nil.
When bladder wall stretches during filling it will
initiate a reflex contraction which has lower threshold.
That does not trigger micturition reflex. When bladder
is filled about 300 400 mL of urine, there will be
sharp rise in the intravesical pressure as the
micturition reflex is triggered.

Intravesical pressure
(centimeters of water)

Micturition
contractions

lb
la

Basal cystometrogram

Volume (milliliters)

Filling of the bladder ..

Filling of the bladder partially filled
Reflex contractions
Acute increase in pressure
Contractions relax spontaneously
Pressure falls back to baseline
Bladder continues to fill
Reflex contractions more frequently and

Spinal centers of micturition which are present in

sacral and lumbar segments are regulated by higher
centers in the brain stem (Facilitatory area in the
pontine region and inhibitory area in the mid brain).
The threshold for the voiding reflex is adjusted by
the activity of facilitatory and inhibitory centers.
When the micturition is facilitated, perineal muscles
and external urethral sphincter are relaxed, the
detrusor muscle contracts and urine passes out
through the urethra. During micturition, the flow of
urine is facilitated by increase in the abdominal
pressure due to voluntary contractions of abdominal
muscles.

Nerve endings
sensitive to
stretch

Stimulates
contraction of
detrusor
muscle
Spinal
cord

Simple reflex control of micturition

seen in infants. The ability of
voluntary control (inhibition)

Brain stem &

Cerebral
cortex

Nervous control of
micturition

Spinal
cord

Abnormalities of micturition
1.Atonic bladder
This is due to destruction of sensory nerve fibers
from the bladder. When the dorsal sacral roots are
interrupted by diseases of the dorsal roots such as
tabes dorsalis or when there is crush injury to
sacral segments of spinal cord, person looses
bladder control (abolition of reflex contractions of
the bladder). Bladder muscle looses the tone
(hypotonic) and becomes flaccid). Bladder fills to
the capacity and overflows few drops at a time
through the urethra (overflow incontinence or
overflow dribbling).

2. Automatic bladder (Spastic

neurogenic bladder)
During spinal shock after complete transection of
spinal cord above sacral centres of micturition, the
urinary bladder looses its tone and becomes flaccid
and unresponsive. So, the bladder is completely
filled, and later urine overflows by dribbling. After
the spinal shock has passed, the voiding reflex
returns although there is no voluntary and higher
centre control.
Whenever, the bladder is filled with some amount
of urine, there is automatic evacuation of the
bladder.

3. Uninhibited neurogenic bladder

Due to a lesion in some parts of brain stem
(interrupting most
of the inhibitory signals), there is continuous
excitation of
spinal micturition centres by the higher
centres. There is
uncontrollable micturition. Even a small
quantity of urine
collected in bladder will elicit the micturition
reflex increasing
the frequency of micturition.

Nocturnal micturition (Bed

wetting)
This is normal in infants and children below 3
years. It occurs due to incomplete myelination of
motor nerve fibers of the bladder resulting loss of
voluntary control of micturition .