Self-Study Programme

(Internal use only)

Anatomy of micturition
Overview of the urinary system

Upper urinary system:

Two kidneys and two ureters

Lower urinary system:

One bladder and one urethra

Function:
Controls the composition and
volume of blood
Removes waste products as urine
Expels urine from the body during
micturition (controlled by the
nervous system)
Formation of urine

Urine is formed in the nephrons of

the kidneys:
Blood is filtered to remove water,
nutrients and waste products
About 99% of the water and
nutrients is then reabsorbed into
the blood for use in the body
The remaining waste products are
eliminated as urine

Urine is approx. 95% water, 5%

solutes (e.g. urea, creatinine, drugs)
Passage of urine to the bladder

Urine travels from the kidneys to the

bladder via the ureters

The ureters pass through the bladder

wall at an oblique angle
The ends are compressed by
pressure from the bladder as it fills
This prevents reflux of urine back
into the ureter
The bladder

Receives and stores urine until it can

be conveniently voided

Contraction of the detrusor muscle

causes the bladder to contract

The trigone at the base of the

bladder is sensitive to pressure

The bladder usually empties when

urine volume reaches 200400 ml
How urine is retained in the bladder

Urine is retained in the bladder by the

bladder sphincters
These are normally closed when the
bladder is filling, to prevent leakage
and help maintain continence

When the bladder needs to empty, the

sphincters open

The internal sphincter is under

involuntary control

The external sphincter is under

voluntary control
Phases of the bladder

Bladder filling: both sphincters are closed, the detrusor is relaxed, urine enters the bladder

Bladder emptying: the detrusor contracts, the sphincters open, urine leaves the bladder

Disruption of the neural control of the sphincters and detrusor can cause incontinence
Elimination of urine from the body

Urine is eliminated from the body via the urethra (the final portion of the urinary system)

The male urethra is much longer than the female and passes through the prostate gland

BPH in men and atrophic urethra in women can lead to urinary problems (e.g. incontinence)
Summary of the urinary system

The urinary system removes waste products from the blood and eliminates
it as urine during micturition

Urine is formed in the nephrons, then travels from the kidneys through the
ureters into the bladder

As the bladder fills, the sphincters are closed and the detrusor is relaxed

When the bladder needs emptying, the detrusor contracts and the bladder
sphincters open

Urine is expelled from the body via the urethra

Bladix Self-Study Programme
Neural control of micturition
Overview of the nervous system

The bladder is controlled by the nervous

system

The main divisions of the nervous are the

CNS and PNS

The PNS is subdivided into the afferent

(sensory) and efferent (motor) pathways

The efferent pathway is subdivided into

the somatic (voluntary) and autonomic
(involuntary) nervous systems

The autonomic system is subdivided into

the sympathetic and parasympathetic
systems
Afferent and efferent control of the bladder

When the bladder is almost full, a full signal is sent via afferent nerves to the brain, which
then perceives the bladder to be full

When the bladder feels full, the brain sends signals via the efferent pathway to contract the
detrusor muscle and open the internal sphincter, resulting in bladder emptying
Autonomic and somatic control of the bladder

The autonomic nervous system is involuntary and signals are

relayed without conscious realisation
For example, when the bladder is full autonomic signals automatically
contract the detrusor muscle and relax the internal bladder sphincter, so
urine can leave the bladder

The somatic nervous system is voluntary and allows conscious

control of muscles
For example, when the bladder is full and it is convenient to urinate, a signal
is consciously sent to the external sphincter to open it and allow urine to be
released
Parasympathetic and sympathetic control of the bladder

Bladder filling:
Parasympathetic system is inhibited, to keep the detrusor from contracting
Sympathetic system is activated, which closes the sphincters and prevents
leakage of urine

Bladder emptying:
The parasympathetic system is activated and the signal for bladder contraction
is carried from the CNS to the detrusor muscle
The sympathetic system is inhibited, so that the internal sphincter relaxes,
allowing urine to be expelled from the bladder

Not convenient to urinate:

Voluntary activation of the sympathetic system tightens the external sphincter
and prevents urine from escaping the body
Neurotransmitters involved in micturition

The basic functional unit of the nervous system is called a neuron,

which transmits chemical signals called neurotransmitters

Agonists bind to cell receptors and elicit a biological response

The neurotransmitter involved in bladder contraction is acetylcholine (ACh)
ACh binds to cholinergic receptors on cells
Thus, ACh is an agonist to cholinergic receptors

Antagonists bind to cell receptors, but do not elicit a response

Used to block the effect of agonists
Oxybutynin is an antagonist
Oxybutynin blocks the effects of ACh by blocking its receptor, thus
preventing bladder contraction
The process of micturition bladder filling

Urine slowly flows into the bladder from the ureters

The parasympathetic system is inhibited, to keep the detrusor from
contracting
The sympathetic system is activated, which closes the sphincters

Thus, the detrusor stays relaxed to allow further filling, while the
sphincters tighten to prevent urine leakage

When the threshold volume is reached, sensory impulses are

transmitted from the bladder to the brain
These initiate a conscious desire to urinate and trigger the voiding reflex
The process of micturition not convenient to urinate

When it is not convenient to urinate, impulses are sent to the

micturition centre to inhibit the voiding reflex
Thus, the nerve signals that would normally contract the detrusor muscle and
open the sphincters do not even leave the micturition centre

As the bladder becomes fuller, signals from sensory fibres become

more intense
Eventually, the voiding reflex overcomes the inhibitory signals and the urge to
urinate gets much stronger
At this point, the brain sends voluntary signals to the pelvic floor muscles to
tighten them up, forming a pressure barrier to prevent leakage of urine
The process of micturition convenient to urinate

When it is convenient to urinate, the voiding reflex simultaneously:

Activates the parasympathetic system, which transmits ACh to the bladder wall and
contracts the detrusor muscle
Inhibits the sympathetic system so that the internal sphincter opens

Urine can then be expelled from the bladder

Synergy between the nervous systems is crucial for proper bladder emptying

At this point in continent people the external sphincter remains closed and
urination does not occur
When convenient, voluntary impulses from the brain inhibit the sympathetic system
so that the external sphincter relaxes, allowing urination to take place

Urine flow can be stopped at any time by voluntary activation of the sympathetic
system, which tightens the external sphincter and prevents urine from escaping
Summary of micturition

1. Sensory impulses are sent to the CNS

as the bladder fills, initiating a desire to
urinate and triggering the voiding reflex

2. Motor signals are sent to the bladder to

contract the detrusor muscle
(parasympathetic activation) and relax
the internal sphincter (sympathetic
inhibition)

3. Voluntary impulses are sent to the

external sphincter to relax it and allow
urine to be voided from the body
continence